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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]

In New Zealand an advance directive can be either an oral statement or a written document. Such directives give individuals the opportunity to make choices about future medical treatment in the event they are cognitively impaired or otherwise unable to make their preferences known. All consumers of health care have the right to make an advance directive in accordance with the common law. When we consider New Zealand's rapidly ageing population, the fact that more people now live with and die of chronic rather than acute conditions, the importance given to respecting autonomous decision-making, increasing numbers of individuals who require long-term residential care, and financial pressures in the allocation of medical resources, there would seem to be a number of compelling reasons to encourage individuals to write or verbalise an advance directive. Indeed the promotion of advance directives is encouraged. However, caution should be exercised in promoting advance directives to older people, especially in light of several factors: ageist attitudes and stereotypes towards them, challenges in the primary healthcare setting, and the way in which advance directives are currently focused and formulated. This paper considers some of the specific challenges that need to be addressed if the promotion of advance directives are to improve outcomes of patient treatment and care near the end of life. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To identify the proportion of adult cigarette smokers who have experienced cigarette-caused fires and burns and to describe smoker characteristics associated with increased risk of cigarette-caused fires and burns. METHODS: Data on cigarette-caused fires and burns were collected in the baseline questionnaire of a randomised trial of a smoking cessation intervention conducted in New Zealand between March 2006 and May 2007. Participants were adult callers to a national smoking cessation counselling service. Lifetime prevalence estimates of cigarette-caused fires and burns were obtained and associations between smoker characteristics and risk of fires and burns examined using logistic regression. RESULTS: Of 1097 participants in the trial at baseline, 75 (6.8%) reported past experience of 1 fires caused by cigarettes (96 fires reported in total) and 658 (60.0%) described at least 1 cigarette-caused burn. In all, 57 participants (5.2%) reported burns that required medical attention. Male sex and Mori ethnicity (indigenous New Zealanders, who comprise 15% of the national population and among whom 42% of adults are smokers) were associated with increased risk of cigarette-caused fires. Male sex, younger age, younger age of smoking initiation, being unmarried, having a partner who smoked, having a higher education level and an annual income of $20 000 or more were associated with increased risk of cigarette burn injuries. CONCLUSIONS: The results indicate that cigarette-caused fires and burns are common among New Zealand smokers, are a source of inequality and therefore deserve greater attention from health advocates and policymakers. [ABSTRACT FROM AUTHOR]

Objective: Recent studies suggest an association between the contextual attributes of neighbourhoods and the health status of residents. However, there has been a scarcity of studies that have directly measured the material characteristics of neighbourhoods theorised to have an impact on health and health inequalities. This paper describes the development of an innovative methodology to measure geographical access to a range of community resources that have been empirically linked to health. Geographical information systems (GIS) were applied to develop precise measures of community resource accessibility for small areas at a national scale. Design: Locational access to shopping, education, recreation, and health facilities was established for all 38 350 census meshblocks across New Zealand. Using GIS, distance measures were calculated from the population weighted centroid of each meshblock to 16 specific types of facilities theorised as potentially health related. From these data, indices of community resource accessibility for all New Zealand neighbourhoods were constructed. Results: Clear regional variations in geographical accessibility to community resources exist across the country, particularly between urban and rural areas of New Zealand. For example, the average travel time to the nearest food shop ranged from less than one minute to more than 244 minutes. Noticeable differences were also apparent between neighbourhoods within urban areas. Conclusions: Recent advances in GIS and computing capacity have made it feasible to directly measure access to health related community resources at the neighbourhood level. The construction of access indices for specific community resources will enable health researchers to examine with greater precision, variations in the material characteristics of neighbourhoods and the pathways through which neighbourhoods impact on specific health outcomes. [ABSTRACT FROM AUTHOR]

Objectives: This paper examines the cost effectiveness of the compulsory bicycle helmet wearing law (HWL) introduced in New Zealand on 1 January 1994. The societal perspective of costs is used for the purchase of helmets and the value of injuries averted. This is augmented with healthcare costs averted from reduced head injuries. Methods: Three age groups were examined: cyclists aged 5-12 years, 13-18 years, and ≥ 19 years. The number of head and non-head injuries averted were obtained from epidemiological studies. Estimates of the numbers of cyclists and the costs of helmets are used to derive the total spending on new bicycle helmets. Healthcare costs were obtained from national hospitalisation database, and the value of injuries averted was obtained directly from a willingness-to-pay survey undertaken by the Land Transport Safety Authority. Cost effectiveness ratios, benefit:cost ratios, and the value of net benefits were estimated. Results: The net benefit (benefit:cost ratios) of the HWL for the 5-12, 13-18, and ≥19 year age groups was $0.3m (2.6), -$0.2m (0.8), and -$1.5m (0.7) (in NZ $, 2000 prices; NZ $1.00 = US $0.47 = UK £0.31 approx). These results were most sensitive to the cost and life of helmets, helmet wearing rates before the HWL, and the effectiveness of helmets in preventing head injuries. Conclusions: The HWL was cost saving in the youngest age group but large costs from the law were imposed on adult (≥ 19 years) cyclists. [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.

Background In-work tax credit (IWTC) for families, a welfare-to-work policy intervention, may impact health status by improving income and employment. Most studies estimate that IWTCs in the USA and the UK have no effect on self-rated health (SRH) and several other health outcomes, but these estimates may be biased by confounding. The current study estimates the impact of one such IWTC intervention (called In-Work Tax Credit) on SRH in adults in New Zealand, controlling more fully for confounding. Methods We used data from seven waves (2002-2009) of the Survey of Family, Income and Employment, restricted to a balanced panel of adults in families. The exposures, eligibility for IWTC and the amount of IWTC a family was eligible for, were derived for each wave by applying government eligibility and entitlement criteria. The outcome, SRH, was collected annually. We used fixed effects regression analyses to eliminate time-invariant confounding and adjusted for measured time-varying confounders. Results Becoming eligible for IWTC was associated with no detectable change in SRH over the past year (β=0.001, 95% CI .0.022 to 0.023). A $1000 increase in the IWTC amount a family was eligible for increased SRH by 0.003 units (95% CI .0.005 to 0.011). Conclusions This study found that becoming eligible for IWTC or a substantial increase in the IWTC amount was not associated with any detectable difference in SRH over the short term. Future research should investigate the impact of IWTC on health over the longer term. [ABSTRACT FROM AUTHOR]

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]

Objective To inform endgame strategies in tobacco control, this study aimed to estimate the impact of interventions that markedly reduced availability of tobacco retail outlets. The setting was New Zealand, a developed nation where the government has a smokefree nation goal in 2025. Methods Various legally mandated reductions in outlets that were phased in over 10 years were modelled. Geographic analyses using the road network were used to estimate the distance and time travelled from centres of small areas to the reduced number of tobacco outlets, and from there to calculate increased travel costs for each intervention. Age-specific price elasticities of demand were used to estimate future smoking prevalence. Results With a law that required a 95% reduction in outlets, the cost of a pack of 20 cigarettes (including travel costs) increased by 20% in rural areas and 10% elsewhere and yielded a smoking prevalence of 9.6% by 2025 (compared with 9.9% with no intervention). The intervention that permitted tobacco sales at only 50% of liquor stores resulted in the largest cost increase (∼$60/ pack in rural areas) and the lowest prevalence (9.1%) by 2025. Elimination of outlets within 2 km of schools produced a smoking prevalence of 9.3%. Conclusions This modelling merges geographic, economic and epidemiological methodologies in a novel way, but the results should be interpreted cautiously and further research is desirable. Nevertheless, the results still suggest that tobacco outlet reduction interventions could modestly contribute to an endgame goal. [ABSTRACT FROM AUTHOR]

Background High smoking rates among Pacific people living within New Zealand (26.9%) are a significant and poorly understood problem. A proposed approach to tobacco control is to enhance restrictions on or ban duty-free sales, a pertinent notion for Pacific people given their frequent travel between New Zealand and the Pacific Islands. This study examines the purchase and distribution of duty-free tobacco by Pacific people, whether it is being used as a strategy to circumvent the tobacco excise tax increases and how duty-free cigarette sales are perceived within the Pacific community. Methods We undertook a qualitative research study using six focus groups with Pacific smokers and nonsmokers aged between 18 and 54 years. Half of the focus groups consisted of smokers and half nonsmokers. We used a thematic analysis approach to identify, explore and report key themes within the data. Results Pacific smokers and non-smokers frequently purchase duty-free tobacco when travelling, and the usage of duty-free cigarettes for gift giving is a strongly embedded cultural value for Pacific peoples. However, nearly all participants strongly supported a proposal to reduce or ban duty-free tobacco sales. Conclusions The findings suggest a ban on duty-free sales could be an important measure to help achieve the smokefree 2025 goal among Pacific communities in New Zealand. This measure would eliminate duty-free tobacco as a cheap form of supply, and efforts to denormalise the practice of gifting duty-free tobacco among Pacific people may also be helpful in reducing high prevalence rates within these communities. [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 It has been suggested that inhibition of monoamine oxidase (MAO) activity by components of cigarette smoke may impact on smoking addiction, but it is unclear to what extent the known MAO inhibitors in tobacco smoke cause this inhibition. Methods MAO inhibitory activity was measured in a series of tobacco particulate matter preparations from different brands of cigarette and loose-leaf tobacco commonly available in New Zealand. Results When tobacco extracts were diluted to contain a physiologically relevant nicotine concentration of 0.2µM, all samples tested inhibited MAO-A and MAO-B by between 4% and 12% in a standard assay. Per mg of nicotine, samples from factory-made cigarettes contained significantly less MAO inhibitory activity than did samples from loose-leaf tobacco. When inhibitory activity was calculated on a per mg of tar basis, there was no significant difference between loose-leaf tobaccos and factory-made cigarettes. Conclusions The present study shows that the ratio of nicotine to MAO inhibitory activity varies depending on the type of tobacco product used. The roll-your-own tobaccos tested delivered more tar and more MAO inhibitory activity per mg of nicotine than the factory made cigarettes. These findings suggest that smokers of roll-your-own tobacco may experience greater difficulty in stopping smoking. [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]

OBJECTIVE: To identify the impact of a smoking cessation programme on area-based social and ethnic inequalities in smoking rates through social and ethnic differences in enrolment and quitting. METHODS: Analysis of records of 11 325 patients who enrolled in an innovative smoking cessation programme in Christchurch, New Zealand between 2001 and 2006. We compare enrolment, follow-up, quitting and impact on population smoking rates in the most and least deprived neighbourhoods and the neighbourhoods with the lowest and highest proportions of Mori. RESULTS: Enrolment as a proportion of the population was higher from the most deprived areas but as a proportion of neighbourhood smokers, it was lower. Enrolees from the least deprived quintile were 40% more likely to quit than those from the most deprived quintile. Smoking rates were 2.84 (2.75 to 2.93) times higher in the most deprived neighbourhoods. If the programme had not been available we estimate that this differential would have reduced to 2.81 (2.72 to 2.90). In neighbourhoods with the highest proportion of Mori, smoking rates were 2.33 (2.26 to 2.41) times higher and we estimate that without the programme smoking rates would be 2.30 (2.23 to 2.37) times higher. CONCLUSIONS: Although enrolees were drawn from a wide variety of backgrounds, those most likely to quit tended to reside in affluent areas or areas with a low proportion of Mori. There was no evidence that this smoking cessation programme increased or decreased inequalities within the Christchurch population. For smoking cessation programmes to have an impact on health inequalities more effort is required in targeting hard-to-reach groups and in encouraging them to quit. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To examine the association between exposure to tobacco displays at the point of sale and teenage smoking and susceptibility to the uptake of smoking. DESIGN: The sample comprised a national cross-section of 14–15 year olds with two measures of exposure to tobacco displays at the point of sale and three outcome measures. The outcome measures were susceptibility to smoking initiation, experimenting with smoking or current smoking. RESULTS: Compared with visiting stores less often than weekly, a greater frequency of store visits was related to increased odds of being susceptible to smoking (daily visits, adjusted OR 1.8, 95% CI 1.6 to 2.2) and experimenting with smoking (daily visits, adjusted OR 2.7, 95% CI 2.4 to 3.1). The likelihood of being a current smoker increased with a greater frequency of store visits among students of medium and high socioeconomic status, but not among those of low socioeconomic status. CONCLUSION: Although these findings are cross-sectional in nature, they are consistent with the notion that greater exposure to tobacco displays at the point of sale increases youth smoking, and suggest display bans are needed. [ABSTRACT FROM AUTHOR]

Study objective: To determine the association of regional income inequality within New Zealand with mortality among 25-64 year olds. Design: Individual census and mortality records were linked over the 1991-94 period. Income inequality (Gini coefficients) and average household income variables were calculated for 35 regions. "Individual level" variables were sex, age, ethnicity, household income, rurality, and small area socioeconomic deprivation. Logistic regression was used for the analyses. Sensitivity analyses for the level of regional aggregation were conducted. Participants: 1.4 million New Zealand census respondents aged 25-64 years followed up for mortality for three years. Main results: Controlling for age, ethnicity, rurality, household income, and regional mean income, there was no association of income inequality with all cause mortality for either men (OR=1.007 for a 0.01 increase in the Gini, 95% confidence intervals 0.989 to 1.024) or women (OR=1.004, 0.983 to 1.026). By cause of death (cancer, cardiovascular disease, unintentional injury, and suicide) there was some suggestion of a positive association for female unintentional injury (OR=1.068, 0.952 to 1.198) and suicide (OR=1.087, 0.957 to 1.234) but the 95% confidence intervals all included 1.0. Failure to control for ethnicity at the individual level resulted in some association of increasing regional income inequality with increasing mortality risk. Using fewer (n=14) or more (n=73) regional divisions did not substantially change the findings. Conclusion: There is no convincing evidence of an association of income inequality within New Zealand with adult mortality. Previous ecological analyses within New Zealand suggesting an association of income inequality with mortality were confounded by ethnicity at the individual level. However, this study does not refute the possibility that income inequality at the national level affects health. [ABSTRACT FROM AUTHOR]

Background: Studies of the association between neighbourhood fragmentation and suicide have yielded varied results, and none has simultaneously adjusted for neighbourhood fragmentation, neighbourhood deprivation and individual-level factors. Method: A multilevel analysis of a 3-year cohort study was carried out using probabilistic linkage of census and mortality records, and two measures of neighbourhood fragmentation. A total of 2.8 million respondents to the 1996 New Zealand census were followed up for 3 years for mortality (1101 suicide deaths in the analysis), aged from 20 to 74 years at follow-up. Results: No consistent association was observed between either measure of neighbourhood social fragmentation and suicide, after controlling for individual-level confounders and neighbourhood deprivation. There was some evidence of a U-shaped relationship between neighbourhood fragmentation and suicide, especially for the Congdon(NZ) index. There was no evidence of an association for a nine-variable index that captured family-type variables as well as the usual attachment-type variables. Neighbourhood deprivation remained as an important predictor of suicide rates. Conclusion: This paper highlights the importance of understanding both the measure and the wider national context when considering neighbourhood effects on suicide. [ABSTRACT FROM AUTHOR]

Background: The Supermarket Healthy Options Project (SHOP) is a large, randomised, controlled trial designed to evaluate the effect of tailored nutrition education and price discounts on supermarket food purchases. A key objective was to recruit approximately equal numbers of Māori, Pacific and non-Māori, non-Pacific shoppers. This paper describes the recruitment strategies used and evaluates their impact on recruitment of Māori, Pacific and non-Māori, non-Pacific trial participants. Methods: Trial recruitment strategies included mailed invitations to an electronic register of supermarket customers; in-store targeted recruitment; and community-based recruitment. Results: Of the 1103 total trial randomisations for whom ethnicity was known, 247 (22%) were Māori, 101 (9%) Pacific and 755 (68%) were non-Māori, non-Pacific shoppers. Mailed invitations produced the greatest proportion of randomisations (73% vs 7% in-store, and 20% from community recruitment). However, in-store and community recruitment were essential to boost Māori and Pacific samples. The cost of mailout (NZ$40 (£14) per randomised participant) was considerably less than the cost of community and in-store recruitment (NZ$301 (£105) per randomised participant). Conclusions: The findings demonstrate considerable challenges and cost in recruiting indigenous and minority ethnic participants into intervention trials. Researchers and funding organisations should allocate more resources to recruitment of indigenous and minority populations than to recruitment of majority populations. Community recruitment and networks appear to be better ways to recruit these populations than passive strategies like mailouts. [ABSTRACT FROM AUTHOR]

The article presents a study on the immediate and long-term impacts of the tobacco display ban in New Zealand. The study performed telephone survey on the support to the display ban for tobacco and attempts to quit smoking of respondents. Result shows the increase of support to the ban a year after implementation. Moreover, supporters of the ban are mainly those who attempted to quit smoking.

The article presents information on an Internet auction of cigarette butts. A cigarette butt must be one of the more bizarre items to be auctioned on an Internet website, but the sale drew widespread attention and more than 130,000 bids. It was not just any old butt, but one certified by the owners of Malt, a Popular bar in Auckland, New Zealand's largest city, to be the remains of the last cigarette legally smoked in the bar on December 9, 2004. From December 10, 2004, the country's stringent ban on smoking in workplaces came into force.

The article reports an example in which residual confounding by personal socioeconomic position remains after adjusting for neighborhood deprivation. Neither indices of neighborhood socioeconomic deprivation nor single individual socioeconomic factors fully characterize socioeconomic position. With regard to deprivation indices, the example used a New Zealand index of socioeconomic deprivation constructed for very small areas with population about 100. Where deprivation indices are constructed for larger groupings of people, the problem of residual confounding is likely to be greater than that shown in the study.

Introduction While many epidemiological studies have shown that low outdoor temperatures are associated with increased rates of hospitalisation and mortality (especially for respiratory or cardiovascular disease), very few studies have looked at the association between indoor temperatures and health. Such studies are clearly warranted, as people have greater exposure to the indoor environment than the outdoor environment. Objectives To examine the relationship between various metrics of indoor temperature and lung function in children with asthma. Our specific research questions were: (1) In which room of the home is temperature most strongly associated with lung function? (2) Which exposure metric best describes the relationship between indoor temperature and lung function? (3) Over what lag/time period does indoor air temperature affect lung function most strongly? Methods The Heating Housing and Health Study was a randomised controlled trial that investigated the effect of installing heaters in the homes of children with asthma. This study collected measurements of lung function (daily) and indoor temperature (hourly). Lung function and indoor temperature were measured for 309 children over 12 049 child-days. Statistical models were fitted to identify the best measures and metrics. Results The strongest association with lung function was found for the severity of exposure to low bedroom temperatures averaged over the preceding periods of 0-7 to 0-12 days. A 1°C increase in temperature was associated with an average increase of 0.010, 0.008, 10.06, 12.06, in our four measures of lung function (peak expiratory flow rate (PEFR) morning, PEFR evening, forced expiratory volume in 1 s (FEV1) morning and FEV1 evening). Conclusions Indoor temperatures have a small, but significant, association with short-term variations in the lung function of children with asthma. [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 Longitudinal studies specifically looking at the transition into parenthood and changes in mental health in the general population are scarce. This study aimed to investigate the impact of transition into parenthood on mental health and psychological distress using longitudinal survey data.Methods The analysis used three waves from the longitudinal Survey of Family, Income and Employment.Parenthood was classified as first time parent (first and only child <12 months at interview date), subsequent parent (child <12 months and other children in the family), existing parent (no children <12 months but other existing children in the family) and not a parent.We used fixed effects generalised linear modelling,controlling for all time-invariant and time-varying sources of confounding in a sample of 6670 adults within families.Results After adjusting for confounding from time-varying partner status, area deprivation, labour force status and household income, those who became first time parents reported an increase in mental health (β1.22, 95% CI −0.06 to 2.50; mean=83.8, SD=14.1)and a decrease in psychological distress (β −0.70 95%CI −1.10 to −0.29; mean=13.4, SD=5.0). Subsequent parents reported a decrease in psychological distress (β−0.60 95% CI −0.95 to −0.24).Conclusions Our findings suggest that a transition into parenthood for the first time leads to changes in mental health and psychological distress. Understanding the relationship between becoming a parent and mental health outcomes is important given that parental mental health is integral to effective parenting. [ABSTRACT FROM AUTHOR]

ObjectivesThe objective is to (a) refine and use methods to measure the point prevalence of smoking and of secondhand smoke exposure in moving vehicles and (b) compare these prevalences (1) between two areas of contrasting socioeconomic status and (2) over time.MethodsThe authors developed and tested a single-observer method and observed the point prevalence of smoking in vehicles in Wellington, New Zealand. The two observation sites represented high and low areas of socioeconomic deprivation (based on a small area deprivation index).ResultsA total of 149 886 vehicles were observed. The mean point prevalence of smoking in vehicles at both sites combined was 3.2% (95% CI 3.1% to 3.3%). Of those vehicles with smoking, 4.1% had children present. Smoking point prevalence in vehicles was 3.9 times higher in the area of high deprivation than in the area of low deprivation (95% CI 3.6 to 4.2). The same pattern was seen for vehicles with only the driver at 3.6 times (95% CI 3.4 to 4.0), in vehicles with other adults at 4.0 times (95% CI 3.4 to 4.7) and in vehicles with children at 10.9 times (95% CI 6.8 to 21.3), with all results adjusted for vehicle occupancy.ConclusionsObserving smoking in vehicles using a single-observer method provides a feasible and objective indicator of the different smoking behaviours, especially around children, within an area. This study further supports the evidence from this country and internationally that adults and children from high-deprivation areas are much more likely to be exposed to secondhand smoke. [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: Reducing health inequalities requires interventions that work as well, if not better, among disadvantaged populations. The aim of this study was to determine if the effects of price discounts and tailored nutrition education on supermarket food purchases (percentage energy from saturated fat and healthy foods purchased) vary by ethnicity, household income and education. Method: A 2×2 factorial trial of 1104 New Zealand shoppers randomised to receive a 12.5% discount on healthier foods and/or tailored nutrition education (or no intervention) for 6 months. Results: There was no overall association of price discounts or nutrition education with percentage energy from saturated fat, or nutrition education with healthy food purchasing. There was an association of price discounts with healthy food purchasing (0.79 kg/week increase; 95% CI 0.43 to 1.16) that varied by ethnicity (p=0.04): European/other 1.02 kg/week (n=755; 95% CI 0.60 to 1.43); Pacific 1.20 kg/week (n=101; 95% CI 0.06 to 2.34); Maori --0.15 kg/week (n=248; 95% CI --1.10 to 0.80). This association of price discounts with healthy food purchasing did not vary by household income or education. Conclusions: While a statistically significant variation by ethnicity in the effect of price discounts on food purchasing was found, the authors caution against a causal interpretation due to likely biases (eg, attrition) that differentially affected Maori and Pacific people. The study highlights the challenges in generating valid evidence by social groups for public health interventions. The null findings for tailored nutritional education across all social groups suggest that structural interventions (such as price) may be more effective. [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]

Background This study investigated the impact of the Healthy Housing Programme in reducing acute hospitalisations in South Auckland, New Zealand. The programme involved house modifications to reduce overcrowding, insulation and ventilation improvements, and health and social service assessments, referrals and linkages. Methods An intervention evaluation was used. Participants in the programme were considered cases following their house's intervention and counterfactuals/ controls prior to the intervention. Rigorous age-censoring was used to construct a case-counterfactual comparison. 9736 residents of 3410 homes were involved in the programme from September 2001 to December 2007. All lived in areas of relative deprivation (NZDep01=decile 10) and almost all self-identified as Pacific ethnic group. The main outcome measure was acute hospitalisation rates before, during and after a health and housing intervention. Hospital data were gathered from July 1999 to January 2009. Results In the post-intervention group, people aged 5-34 years had a HR of 0.77 (95% CI 0.70 to 0.85) for acute hospitalisations compared to the counterfactual (pre-intervention). For children aged 0-4 years the HR was 0.89 (95% CI 0.79 to 0.99); a non-significant increase occurred in adults aged 35 years plus. When the causes of hospitalisation were restricted to those related to housing, further falls in the HRs were seen: 0.88 (95% CI 0.74 to 1.05) for 0e4 year olds and 0.73 (95% CI 0.58 to 0.91) for 5-34 year olds. Conclusion A package of care that addresses housing conditions that impact on health and improves access to health and social services is associated with a reduced acute hospitalisation rate for 0-34 year olds. [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]

Thsi section offers tobacco industry news briefs. Increased tobacco taxes under the Framework Convention on Tobacco Control (FCTC) gives rise to worldwide arguments resisting the tobacco control policy. A media release by the New Zealand Association of Convenience Stores (NZACS) claiming an increase in tobacco smuggling was exposed as industry propaganda. Djibouti implements warnings on tobacco packaging which focuses on health and financial messages in French and Arabic languages.

Background: Housing is an important environmental influence on population health, and there is growing evidence of health effects from indoor environment characteristics such as low indoor temperatures. However, there is relatively little research, and thus little firm guidance, on the cost-effectiveness of public policies to retrospectively improve the standards of houses. The purpose of this study was to value the health, energy and environmental benefits of retrofitting insulation, through assessing a number of forms of possible benefit: a reduced number of visits to GPs, hospitalisations, days off school, days off work, energy savings and CO2 savings. Methods: All these metrics are used in a cluster randomised trial--the "Housing, Insulation and Health Study"--of retrofitting insulation in 1350 houses, in which at least one person had symptoms of respiratory disease, in predominantly low-income communities in New Zealand. Results: Valuing the health gains, and energy and CO2 emissions savings, suggests that total benefits in "present value" (discounted) terms are one and a half to two times the magnitude of the cost of retrofitting insulation. Conclusion: This study points to the need to consider as wide a range of benefits as possible, including health and environmental benefits, when assessing the value for money of an intervention to improve housing quality. From an environmental, energy and health perspective, the value for money of improving housing quality by retrofitting insulation is compelling. [ABSTRACT FROM AUTHOR]

Introduction: There have been claims in the literature that lead exposure makes a strong contribution to criminal behaviour. Objectives: To examine linkages between lead exposure in childhood and crime in late adolescence/early adulthood to (a) determine whether higher levels of lead exposure were associated with increased levels of criminal behaviour and (b( estimate the extent to which lead exposure was responsible for increases in criminal behaviour. Methods: Negative binomial regression models were fitted using data from a longitudinal birth cohort of New Zealand-born children studied from birth to age 21. Results: There were statistically significant (p

Objectives: To gather information about the practices and attitudes of providers of maternity care with respect to informed consent for newborn screening (NBS). Methods: A questionnaire concerning information provision and parental consent for NBS was sent to all 1036 registered lead maternity carers (LMC) in New Zealand. Results: 93% of LMC in New Zealand report giving parents information concerning NBS, most frequently after delivery (73%) and in the third trimester (60%). The majority (85%) of LMC currently obtain some form of consent (verbal or written) for NI3S from parents and consider this to be the ideal approach (94%). Despite this a significant minority of LMC (23%) reported considering that NBS should be mandatory. Of those in our survey who believed that NBS should be mandatory, paradoxically most (89%) still believed that some form of parental consent should be obtained; of those who believed testing should not be mandatory, only a small proportion (10%) would accept parental refusal without question. Conclusions: When the results of this survey are considered in conjunction with existing evidence there appears to be a consensus that good quality information in the prenatal period should be an integral part of any NBS programme. The issue of consent is more complex and there is less agreement on the preferred degree of parental involvement in decisions to allow babies to undergo NBS. A policy that both strongly recommends NBS but also allows parental choice appears to be most consistent with the views of LMC in this survey. [ABSTRACT FROM AUTHOR]

Background: It is often suggested that neighbourhood access to food retailers affects the dietary patterns of local residents, but this hypothesis has not been adequately researched. We examine the association between neighbourhood accessibility to supermarkets and convenience stores and individuals' consumption of fruit and vegetables in New Zealand. Methods: Using geographical information systems, travel times from the population-weighted centroid of each neighbourhood to the closest supermarket and convenience store were calculated for 38 350 neighbourhoods. These neighbourhood measures of accessibility were appended to the 2002-3 New Zealand Health Survey of 12 529 adults. Results: The consumption of the recommended daily intake of fruit was not associated with living in a neighbourhood with better access to supermarkets or convenience stores. Similarly, access to supermarkets was not related to vegetable intake. However, individuals in the quartile of neighbourhoods with the best access to convenience stores had 25% (OR 0.75, 95% CI 0.60% to 0.93%) lower odds of eating the recommended vegetable intake compared to individuals in the base category (worst access). Conclusion: This study found little evidence that poor locational access to food retail provision is associated with lower fruit and vegetable consumption. However, before rejecting the commonsense notion that neighbourhood access to fruit and vegetables affects personal consumption, research that measures fruit and vegetable access more precisely and directly is required. [ABSTRACT FROM AUTHOR]

Aim: To measure exposure to second-hand smoke (SHS) in New Zealand bars before and after comprehensive smoke-free legislation enacted on 10 December 2004. Methods: Cotinine is the main specific metabolite of nicotine and a well-established biomarker for SHS exposure. We measured cotinine levels in saliva of non-smoking volunteers before and after a 3 h visit to 30 randomly selected bars in 3 cities across the country. Two measures of cotinine before the smoke-free law change during winter and spring 2004, and two follow-up measurements in the same volunteers and venues during winter and spring 2005, were included. Results: Before the smoke-free law change, in all bars and in all volunteers, exposure to SHS was evident with an average increase in saliva cotinine of 0.66 ng/ml (SE 0.03 ng/ml). Increases in cotinine correlated strongly with the volunteers' subjective observation of ventilation, air quality and counts of lit cigarettes. However, even venues that were judged to be "seemingly smoke free" with "good ventilation" produced discernable levels of SHS exposure. After the law change, there remained some exposure to SHS, but at much lower levels (mean saliva cotinine increase of 0.08 ng/ml, SE 0.01 ng/ml). Smoking indoors in bars was almost totally eliminated: in 2005 only one lit cigarette was observed in 30 visits. Conclusions: Comprehensive smoke-free legislation in New Zealand seems to have reduced exposure of bar patrons to SHS by about 90%. Residual exposures to SHS in bars do not result from illicit smoking indoors. [ABSTRACT FROM AUTHOR]

Background: Intimate partner violence (IPV) is an increasingly significant public health issue. Few studies investigate both partners' reports of such Violence. Aim: To determine the prevalence of IPV perpetration and victimisation and the concordance of both partners' reports of that violence in a representative sample of Pacific couples using a standardised measure. Methods: A cohort of Pacific infants born during 2000 in Auckland, New Zealand, was followed. At 24-months postpartum, home interviews were conducted separately for mothers and fathers, and experience of IPV within the last 12 months was measured using the Conflict Tactic Scale. Concordance and symmetry between partner's reports was assessed using the κ statistic and McNemar's test, respectively. Results: The sample included 915 partnered mothers and 698 partnered fathers of which 674 were couples. Over 85% of individuals perpetrated or were victims of verbal aggression. Perpetration and victimisation of physical IPV was reported by 37% and 28% of mothers and 11% and 8% of fathers, respectively. Fathers systematically under-reported IPV and significant differences emerged in the response distributions from couples with Tongan mothers compared with couples with Samoan or Cook Island Maori mothers. Discussion: IPV is common for many Pacific couples and consistent with that reported in other New Zealand groups. Mothers are as likely as fathers to perpetrate and be victims of this violence. However, patterns of reporting were different between mothers and fathers, and between Pacific ethnic groups, which has implications for the understanding and health promotion targeting of domestic violence. [ABSTRACT FROM AUTHOR]

Design/setting: A cohort study of 1037 people born in Dunedin, New Zealand, in 1972 or 1973. Participants: At assessment at age 32 years, 884 participants (432 women and 452 men; 87.1% of the surviving cohort) provided both sera and information on sexual behaviour. Main outcome measures: The proportion of participants with antibodies to HSV-2 infection at ages 26 and 32 years was measured, and the incidence rates from first coitus to age 26 years and from age 26 to 32 years calculated, adjusting for the number of sexual partners and same-sex contact in these age periods. Results: At age 32 years, 14.6% of men and 22.5% of women had antibodies to HSV-2. The incidence rates for men and women from first coitus to age 26 years were, respectively, 6.5 and 14.3 per 1000 person-years. The incidence rates for men and women from age 26-32 years, respectively, were 14.3 and 15.8 per 1000 person-years. When adjusted for sexual behaviour, the incidence rate ratio, comparing the older with the younger age periods, was 2.9 (95% confidence interval (CI) 1.7 to 4.9) for men and 2.0 (1.2 to 3.4) for women. The adjusted incidence rate ratio when comparing women to men from first coitus to age 26 years was 2.5 (1.6 to 4.0), and from age 26-32 years was 1.3 (0.78 to 2.2). A test for interaction indicated that men and women had different patterns of incidence over time (p =0.039). Conclusion: In the general population, the risk of acquiring HSV-2 infection seems to increase with age at least to the early 30s, and differences in risk of acquisition for women compared with men become less with age. Health promotion and treatment to control HSV-2 infection should be aimed at all ages, not just at the young. [ABSTRACT FROM AUTHOR]

Background: Relative socioeconomic disparities in cardiovascular mortality have increased in New Zealand, as in many Western countries in Northern Europe, the US and Australia during the late 20th century. However, substantial declines in cardiovascular mortality mean that its absolute contribution to overall mortality has decreased. Research questions: How did the absolute contribution of major causes of death to socioeconomic inequalities in New Zealand change during the 1980s and 90s? Methods: Linked census-mortality cohorts were used to calculate the contribution of different causes of death to inequalities in mortality, measured with the slope index of Inequality, by household income. Results: Between 1981-4 and 1996-9, the contribution of cardiovascular disease (CVD) to total inequality declined from 55% to 28% among women, whereas at the same time the contribution of cancers increased from 14% to 37%. Among men, the contribution of CVD to total inequality peaked at 47% in 1986-9, then declined to 38% in 1996-9. The contribution of cancer increased from 19% to 26% in men. Conclusion: CVD mortality has declined at all income levels and so too has the contribution of CYD to mortality inequalities. Concurrently, the contribution of cancer to inequalities in mortality by income has increased and, in women at least, is now greater than the contribution of CVD. It is hypothesised that a similar crossover is occurring in other populations where CYD mortality has declined, although socioeconomic differences in the distribution and effect of the obesity epidemic for CVD may ensure its continuing importance. Prevention efforts aimed at reducing socioeconomic inequalities in mortality will need to increasingly focus on socioeconomic inequalities in cancer mortality. [ABSTRACT FROM AUTHOR]

Study objective: To describe patterns of excess mortality among patients with diabetes in three ethnic groups. Design: A linkage study of national hospital discharge records to death records. Setting: New Zealand. Participants: The study included 74 847 patients (11 268 Mãori, 5730 Pacific, and 57 849 non-Mãori/non-Pacific) aged over 25 years with a hospital discharge diagnosis of diabetes between 1988 and 2001. By the end of 2001, 29 295 (39%) of the cohort had died. Based on the underlying cause of death, standardised mortality ratios (SMRs) (95% confidence intervals) were calculated for each ethnic group and sex. Main results: Comparing the mortality patterns of patients with diabetes to the general population of the same ethnic group, adjusting for age and calendar period, all cause SMRs were higher for Mãori women and men: 3.80 (95% Cl: 3.64 to 3.97) and 3.44 (95%Cl: 3.30 to 3.58) than for Pacific (men: 2.41 (95%CI: 2.21 to 2.61); women: 2.23 (95%Cl: 2.06 to 2.41)) and non-Mãori/non-Pacific (men: 2.98 (95%Cl: 2.93 to 3.04); women: 2.99 (95%C1: 2.93 to 3.04)) people. SMRs were significantly raised for several causes of death, including cardiovascular disease and many site specific cancers. Conclusions: The pattern of excess mortality among Moon with diabetes may relate to severity of disease. This needs further investigation, as the excess mortality may be amenable to intervention. [ABSTRACT FROM AUTHOR]

Objectives: To determine the effectiveness of a mobile phone text messaging smoking cessation programme. Design: Randomised controlled trial. Setting: New Zealand. Participants: 1705 smokers from throughout New Zealand who wanted to quit, were aged over 15 years, and owned a mobile phone were randomised to an intervention group that received regular, personalised text messages providing smoking cessation advice, support, and distraction, or to a control group. All participants received a free month of text messaging; starting for the intervention group on their quit day to assist with quitting, and starting for the control group at six months to encourage follow up. Follow up data were available for 1624 (95%) at six weeks and 1265 (74%) at six months. Main outcome measures: The main trial outcome was current non-smoking (that is, not smoking in the past week) six weeks after randomisation. Secondary outcomes included current non-smoking at 12 and 26 weeks. Results: More participants had quit at six weeks in the intervention compared to the control group: 239 (28%) v 109 (13%), relative risk 2.20 (95% confidence interval 1 .79 to 2.70), P < 0.0001. This treatment effect was consistent across subgroups defined by age, sex, income level, or geographic location (p homogeneity > 0.2). The relative risk estimates were similar in sensitivity analyses adjusting for missing data and salivary cotinine verification tests. Reported quit rates remained high at six months, but there was some uncertainty about between group differences because of incomplete follow up. Conclusions: This programme offers potential for a new way to help young smokers to quit, being affordable, personalised, age appropriate, and not location dependent. Future research should test these findings in different settings, and provide further assessment of long term quit rates. [ABSTRACT FROM AUTHOR]

Success in sport can provide a source of national pride for a society, and vast financial and personal rewards for an individual athlete. It is therefore not surprising that many athletes will go to great lengths in pursuit of success. The provision of healthcare for elite sports people has the potential to create many ethical issues for sports doctors; however there has been little discussion of them to date. This study highlights these issues. Respondents to a questionnaire identified many ethical matters, common to other areas of medicine. However they also raised problems unique to sports medicine. Some of these ethical difficulties arise out of the place of the sports doctor within the hierarchy of sport. Yet others arise out of the special relationship between sports doctors and individual players/athletes. This study raises some important questions regarding the governance of healthcare in sport, and what support and guidance is available to sports doctors. As medical and scientific intervention in sport escalates, there is a risk that demands for enhanced performance may compromise the health of the athlete, and the role the sports doctor plays remains a critical question. [ABSTRACT FROM AUTHOR]

Objective: To assess the relation between demographic factors and film smoking stereotypes in adolescents and the potential influence of smoker stereotypes on smoking susceptibility. Design: A cross sectional questionnaire survey of school students (n = 3041) aged 12-13 and 16-17 years who were asked to describe the personal characteristics of female and male smokers in films. Selling: 15 primary or intermediate schools and 10 secondary schools in Auckland, New Zealand. Results: Appraisals of smokers in film were strongly influenced by age and sex with younger adolescents and males more likely to see female smokers as sexy, intelligent and healthy whereas older students and females more often appraised female smokers as stressed bored and depressed. Overall, image stereotypes (sexy, stylish) were more likely to be significantly associated with smoking susceptibility than emotional sensitivity stereotypes (stressed, depressed etc). Conclusions: Adolescents differ significantly in their appraisal of smokers in films; however, image based stereotypes, rather than emotional sensitivity stereotypes, are significantly associated with smoking susceptibility. [ABSTRACT FROM AUTHOR]

Study objective: To evaluate the New Zealand evidence for three theories of population health change: compression of morbidity, expansion of morbidity, and dynamic equilibrium. Design: Using the Sullivan method, repeated cross sectional survey information on functional limitation prevalence was combined with population mortality data and census information on the utilisation of institutional care to produce health expectancy indices for 1981 and 1996. Setting: The adult population of New Zealand in 1981 and 1996. Participants: 6891 respondents to the 1981 social indicators survey; 8262 respondents to the 1996 household disability survey. Main results: As a proportion of overall life expectancy at age 15 the expectation of non-institutionalised mobility limitations increased from 3.5% to 6% for men, and from 4.5% to 8% for women; the expectation of agility limitation increased from 3% to 7.5% for men and from 4.5% to 8.5% for women, and the expectation of self care limitations increased from 2.0% to 4.5% for men and from 3.0% to 6.0% for women. These changes were primarily attributable to increases in the expectation of moderate functional limitation. Conclusion: The dynamic equilibrium scenario provides the best fit to current New Zealand evidence on changes in population health. Although an aging population is likely to lead to an increase in demand for disability support services, the fiscal impact of this increase may be partially offset by a shift from major to moderate limitations, with a consequential reduction in the average levels of support required. [ABSTRACT FROM AUTHOR]

Background: Injuries resulting in admission to hospital provide an important basis for determining priorities, emerging issues, and trends in injury. There are, however, a number of important issues to be considered in estimating person based injury incidence using such data. Failure to consider these could result in significant overestimates of incidence and incorrect conclusions about trends. Aim: To demonstrate the degree to which estimates of the incidence of person based injury requiring hospital inpatient treatment vary depending on how one operationally defines an injury, and whether or not day patients, readmissions, and injury due to medical procedures are included. Method: The source of data for this study was New Zealand's National Minimum Dataset. The primary analyses were of a dataset of all 1989-98 discharges from public hospital who had an external cause of injury and poisoning code assigned to them. Results: The results show that estimates of the incidence of person based injury vary significantly depending on how one operationally defines an injury, and whether day patients, readmissions, and injury due to medical procedures are included. Moreover the effects vary significantly by pathology and over time. Conclusions: (1) Those using New Zealand hospital discharge data for determining the incidence of injury should: (a) select cases which meet the following criteria: principal diagnosis injury only cases, patients with day stay of one day or more, and first admissions only, (b) note in their reporting that the measure is an estimate and could be as high as a 3% overestimate. (2) Other countries with similar data should investigate the merit of adopting a similar approach. (3) That the International Collaborative Effort on Injury Statistics review all diagnoses within International Classification of Diseases 9th and 10th revisions with a view to reaching consensus on an operational definition of an injury. [ABSTRACT FROM AUTHOR]