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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]

Accessible Summary: What is known on the subject?: Seclusion is a harmful and traumatising intervention for people accessing mental health services.People who are subject to seclusion in inpatient mental health services often first experience this within the first 24 h following admission.There is limited research examining how recent contact with services impacts the likelihood of seclusion when people are admitted to inpatient services. What the paper adds to existing knowledge?: Males, Māori and Pasifika experience higher rates of seclusion within the first 24 h following inpatient admission.People perceived by clinicians as overactive, aggressive, disruptive or agitated are seven times more likely to be secluded within the first 24 h.People referred from police or justice services are three times more likely to be secluded within the first 24 h.People who had frequent contact with community mental health services prior to inpatient admission were less likely to be secluded. What are the implications for practice?: The first 24 h of inpatient admission is a critical focus for eliminating the use of seclusion. Initial interactions with people recently admitted should focus on nurturing relationships and reducing distress.Mental health staff should consider the person's cultural needs, referral pathway, recent service contact and baseline ratings on the Health of the Nation Outcomes Scales (HoNOS) when working proactively to prevent the use of seclusion in the first 24 h following admission.Strengthening the focus on nurturing relationships, cultural understanding and non‐coercive de‐escalation approaches requires leadership support and strategic workforce development. Introduction: People who experience seclusion in inpatient mental health services often do so within the first 24 h following admission. There is limited research examining the potential contributing factors, particularly recent contact with services. Aim/Question: To identify factors associated with seclusion within the first 24 h following admission into acute inpatient mental health services. Method: A retrospective analysis was undertaken using routinely collected data from Aotearoa New Zealand mental health services. Results: A higher likelihood of seclusion within the first 24 h following admission was associated with: males, Māori, Pasifika, referrals from police/justice services, inpatient transfers, recent contact with crisis assessment teams and clinician perceptions of aggression, problematic substance use, cognitive problems and hallucinations or delusions. Recent contact with community mental health services was associated with a lower likelihood. Discussion: People's cultural needs, referral pathway, recent service contact and HoNOS scores should be considered when working to prevent the use of seclusion in the first 24 h following admission. Implications for Practice: The first 24 h following inpatient admission is a critical period for preventing the use of seclusion. Nurturing relationships, cultural understanding and use of non‐coercive de‐escalation approaches can support better outcomes for people recently admitted. [ABSTRACT FROM AUTHOR]

Background WHO estimates that seasonal influenza epidemics result in three to five million cases of severe illness (hospitalisations) every year. We aimed to improve the understanding of influenza-associated hospitalisation estimates at a national and global level. Methods We performed a systematic literature review of English- and Chinese-language studies published between 1995 and 2020 estimating influenza-associated hospitalisation. We included a total of 127 studies (seven in Chinese) in the meta-analysis and analyzed their data using a logit-logistic regression model to understand the influence of five study factors and produce national and global estimates by age groups. The five study factors assessed were: 1) the method used to calculate the influenza-associated hospitalisation estimates (rateor time series regression-based), 2) the outcome measure (divided into three envelopes: narrow, medium, or wide), 3) whether every case was laboratory-confirmed or not, 4) whether the estimates were national or sub-national, 5) whether the rates were based on a single year or multiple years. Results The overall pooled influenza-associated hospitalisation rate was 40.5 (95% confidence interval (CI) = 24.3-67.4) per 100 000 persons, with rates varying substantially by age: 224.0 (95% CI = 118.8-420.0) in children aged 0-4 years and 96.8 (95% CI = 57.0-164.3) in the elderly aged >65 years. The overall pooled hospitalisation rates varied by calculation method; for all ages, the rates were significantly higher when they were based on rate-based methods or calculated on a single season and significantly lower when cases were laboratory-confirmed. The national hospitalisation rates (all ages) varied considerably, ranging from 11.7 (95% CI = 3.8-36.3) per 100 000 in New Zealand to 122.1 (95% CI = 41.5-358.4) per 100 000 in India (all age estimates). Conclusions Using the pooled global influenza-associated hospitalisation rate, we estimate that seasonal influenza epidemics result in 3.2 million cases of severe illness (hospitalisations) per annum. More extensive analyses are required to assess the influence of other factors on the estimates (e.g. vaccination and dominant virus (sub)types) and efforts to harmonize the methods should be encouraged. Our study highlights the high rates of influenza-associated hospitalisations in children aged 0-4 years and the elderly aged 65+ years. [ABSTRACT FROM AUTHOR]

Objectives: HealthPathways, pioneered in Canterbury, New Zealand, in 2008, is a web-based tool designed to promote health care integration and patient management in primary care and to reduce fragmentation in the delivery of health services. This cross-sectional study evaluated the utilisation and perceptions of this tool among health professionals in Australia and New Zealand. Methods: A cross-sectional survey was administered online through Research Electronic Data Capture (REDCap) to general practitioners (GPs), practice nurses and managers, nurse practitioners, specialist and community nurses, hospital clinicians, nurses, managers, and allied health professionals between April and September 2018. The frequency of HealthPathways use in the previous month was modelled as an ordered response using an ordered logistic regression model after adjusting for the possible effects of sex, age, years in clinical practice, location and time spent in practice. Results: Health professionals perceived HealthPathways to be useful in primary care management and referral, as well as in the prereferral treatment of patients. GPs in New Zealand, New South Wales and Victoria were 73%, 47% and 27% more likely to have used HealthPathways ≥10 times in the previous month respectively. Conclusion: The results suggest that HealthPathways is having a positive effect on healthcare systems in New Zealand and Australia. However, differences in uptake suggests the need for focused implementation, integration into eReferral software and expanding the tool to medical students, registrars, allied health professionals and potentially patients to encourage behavioural change. What is known about the topic?: Early evaluations suggest that HealthPathways is a useful tool for health professionals, although uptake and utilisation may be limited. However, there is no comparative evidence regarding uptake and implementation of the tool. What does the paper add?: This study is among the first to provide a comparative narrative of the literature assessing the implementation and uptake of HealthPathways across Australia and New Zealand. It is also among the first to compare the perceptions of allied health professionals in the use of HealthPathways across Australia and New Zealand. What are the implications for practitioners?: The results of this study suggest the need for focused implementation, integration into eReferral software and expanding the tool to medical students, registrars, allied health professionals and potentially patients to encourage behavioural change. [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]

Introduction. In Aotearoa New Zealand (NZ), there is inequity in rates of neural tube defects (NTDs). Among Maaori, NTD occur in 4.58/10 000 live births, and for Pacific peoples, it is 4.09/10 000 live births; this is compared to 2.81/10 000 live births for non-Maaori, non-Pacific peoples. Aim. To describe self-reported pre-pregnancy folic acid supplementation and to determine the association between pregnancy intendedness, ethnicity, parity, maternal age, care provider and pre-pregnancy folic acid supplementation. Methods. Secondary analysis of postpartum survey data collected at Te Whatu Ora Te Toka Tumai and Counties Manukau birthing facilities in 2020 was conducted. Descriptive analyses explored pregnancy intendedness and self-reported folic acid use by demographic variables. Multivariable logistic regression explored independent associations between demographic variables and folic acid use among intended pregnancies. Results. In total, 398 participants completed the survey. The response rate was (140/149) 94% at Counties Manukau and (258/315) 82% at Te Toka Tumai. Pre-pregnancy supplementation was reported by 182 of 398 participants (46%). Use was higher among those who intended their pregnancy (151/262, 58%) compared to those who were 'pregnancy ambivalent' (9/33, 27%) or did not intend to become pregnant (22/103, 21%). Factors independently associated with supplementation among intended pregnancies included: 'Other ethnicity' (European, Middle Eastern, Latin American, African) compared to Maaori (aOR 5.3 (95% CI 1.3, 21.8)), age =30 years compared to <30 years (aOR 2.1 (1.0, 4.1)), and private obstetrician compared to midwifery care (aOR 4.2 (1.6, 10.9)). Discussion. Low rates of pre-pregnancy folic acid supplementation exist in Auckland with significant ethnic disparity. Mandatory fortification of non-organic wheat is important, but supplementation is still recommended to maximally reduce risk. [ABSTRACT FROM AUTHOR]

Worldwide, populations are ageing and consequently so are the consumer profiles for most organisations. Understanding how best to ensure satisfaction in interactions with older customers, patients, members of organisations, and so on is therefore increasingly important. This paper examines two research questions: (a) How satisfied or dissatisfied are older people with their customer service experience, and what are the factors associated with dissatisfaction? and (b) What prompts older people to want to change service providers? The research questions are addressed using a mixed-methods approach – quantitative analysis of observation logs, supported by illustrative quotes from focus groups. We find that on the whole older people are generally satisfied with their interactions with organisations, although a substantial minority of interactions lead to dissatisfaction or lower-than-expected satisfaction. Dissatisfaction with interactions is mostly associated with impersonal communications, including interactions that are not conducted face to face, and those that are one-off interactions rather than repeated interactions. Media and communications firms prompted the greatest levels of dissatisfaction among older consumers. Dissatisfied older consumers from our sample are more than 12 times more likely to report an intention to switch providers than satisfied consumers. This highlights the potential costs to organisations of poor customer interactions with older people. [ABSTRACT FROM PUBLISHER]

Reported obesity rates for adolescents in different urban and rural areas are inconsistent. We examined indicators of healthy and unhealthy dietary patterns among 1863 adolescents aged 13–18 years with a healthy or excess body weight attending 23 secondary schools in four different settlement types across the Otago region, New Zealand. An online survey included demographics and dietary behaviours. Height and weight were measured, and body mass index was calculated. New Zealand defined urban and rural settlement types were used. Home addresses determined a small area-level index of deprivation. Data were analysed using Chi-square tests and ANOVA. A logistic model was fitted to estimate adjusted odds ratios of excess weight. The proportion of adolescents with a healthy weight differed (p < 0.001) between the most (64.9%) and least (76.4%) deprived neighbourhood areas. There was only indicative evidence of differences between settlement types (p = 0.087). Sugar-sweetened beverage and fast-food consumption was more frequent in the most deprived areas (p < 0.001), and in urban versus rural settlements (p < 0.001). The most important associations with excess weight were area-level deprivation and ethnicity, but not settlement type. Prioritising socioeconomic factors irrespective of settlement type is necessary when developing interventions to improve dietary patterns and body weight status among adolescents. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The ageing population means prescribing for chronic illnesses in older people is expected to rise. Comorbidities and compromised organ function may complicate prescribing and increase medication-related risks. Comorbid depression in older people is highly prevalent and complicates medication prescribing decisions. AIM: To determine the prevalence of potentially inappropriate medication use in a community-dwelling population of older adults with depressive symptoms. METHODS: The medications of 191 community-dwelling older people selected because of depressive symptoms for a randomised trial were reviewed and assessed using the modified version of the Beers' Criteria. The association between inappropriate medication use and various population characteristics was assessed using Chi-square statistics and logistic regression analyses. RESULTS: The mean age was 81 (±4.3) years and 59% were women. The median number of medications used was 6 (range 1-21 medications). The most commonly prescribed potentially inappropriate medications were amitriptyline, dextropropoxyphene, quinine and benzodiazepines. Almost half (49%) of the participants were prescribed at least one potentially inappropriate medication; 2996 were considered to suffer significant depressive symptoms (Geriatric Depression Scale >5) and no differences were found in the number of inappropriate medications used between those with and without significant depressive symptoms (Chi-square 0.005 p=0.54). DISCUSSION: Potentially inappropriate medication use, as per the modified Beers' Criteria, is very common among community-dwelling older people with depressive symptoms. However, the utility of the Beers' Criteria is lessened by lack of clinical correlation. Ongoing research to examine outcomes related to apparent inappropriate medication use is needed. [ABSTRACT FROM AUTHOR]

Background: A high proportion of unwanted or unplanned pregnancies may be alcohol-exposed due to contraception failure or non-use. Nevertheless, data on contraception and alcohol use in the context of the risk of alcohol-exposed pregnancies are sparse. Objectives: To describe contraception use and alcohol consumption in sexually active non-pregnant women and investigate the factors associated with less effective contraception methods. Study Design: A cross-sectional national survey of women aged 18–35 years. Methods: Data from non-pregnant women who were sexually active (n = 517) were analysed. Descriptive statistics were used to report demographics, consumption, and contraception measures. Logistic regression was used to investigate the factors associated with less effective contraception among drinkers. Results: The majority of participants were younger (46%), of NZ European ethnicity (78%), not in a permanent relationship (54%), with some or completed tertiary education (79%), employed (81%) and not users of the community services card (82%). Twenty-five percent of women were smokers, 94% consumed alcohol, and 72% binged at least 'monthly or less'. Most women used the pill (56%), and 20% of drinking women were using a contraception method with a 10% or more annual failure rate after 1 year of use. Women who binged 'weekly or more often' had similar odds of using less effective contraception as women who 'never' binged (p > 0.05). Younger Māori or Pacific women (odds ratio = 5.99; 95% confidence interval of odds 1.15 – 31.2; p = 0.033) and women who had no tertiary education (odds ratio = 1.75; 95% confidence interval of odds 0.00 – 3.06; p = 0.052) had higher odds of using less effective contraception. Conclusion: With 20% of women at risk of an alcohol-exposed pregnancy, public health measures to address alcohol consumption and the effective use of contraception are critical to reducing the risk for alcohol-exposed pregnancies in NZ. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Prior New Zealand studies suggest that only approximately two-thirds of patients who present with an acute coronary syndrome (ACS) are maintained on a statin/aspirin post-discharge. This could be due to sub-optimal initiation or poor longer-term adherence. AIM: To identify the pattern of statin/aspirin maintenance following ACS from initial prescription to 3 years post-discharge. METHODS: All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry data for consecutive New Zealand residents (2007-2011), who were hospitalised with ACS, were anonymously linked to national datasets to derive a medication possession ratio (MPR) to assess medication maintenance. An MPR ⩾ 0.8 is considered adequate maintenance. RESULTS: Of the 1846 patients discharged alive, 95% were prescribed a statin at discharge and 92% were dispensed a statin within 3 months, but only 75% had a MPR ⩾ 0.8 in the first year, and 67% in year 3. In the same cohort, 98% were prescribed aspirin and 88% were dispensed aspirin within the 3 months of discharge. In the first year, 72% had an aspirin MPR ⩾ 0.8 and 71% maintained this in year 3. Fifty-nine percent were maintained on both aspirin and a statin in the third year, but 20% were maintained on neither. Regression analysis identified the independent predictors of inadequate maintenance in the third year as age < 45 years, no prior statin, and Mā ori and Pacific ethnicity. CONCLUSION: Longer-term maintenance of evidenced-based secondary prevention medications after ACS is suboptimal despite high levels of initial prescribing and dispensing. Understanding the barriers to longer-term maintenance is required to improve patient outcomes. [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]

Low energy availability (LEA) describes the disruption in normal physiological function existent when insufficient energy intake is combined with exercise. To conserve energy a range of endocrine adaptations occur, impairing health and athletic performance. The prevalence of LEA has not been fully established especially among recreational exercisers. Determining recreational exercisers at risk of LEA may help to maximize prevention, early diagnosis and treatment. The design of this study was a cross-sectional online survey. One-hundred and nine female recreational exercisers, with a mean age of 23.8 (SD 6.9) years were recruited via gyms and fitness centers throughout NZ. Participants completed an online questionnaire including questions from the LEAF-Q (Low Energy Availability in Females Questionnaire). A total of 45.0% (CI, 35.4%, 54.8%) of participants were classified as "at risk" of LEA. For every extra hour of exercise per week the odds of being at risk of LEA were 1.13 times greater (CI 1.02, 1.25, p = .016). All participants reporting previous stress fracture injuries (n = 4) were classified as at risk for LEA. Significantly more subjects participating in an individual sport were classified as at risk for LEA (69.6%, CI 24.3%, 54.8%) compared with team sports (34.8%, CI 18.7%, 40.5%) {p = .006). The high prevalence of female recreational exercisers at risk of LEA is of concern, emphasizing the importance of increasing awareness of the issue, and promoting prevention and early detection strategies, so treatment can be implemented before health is severely compromised. [ABSTRACT FROM AUTHOR]

Pacific youth in New Zealand have a disproportionately high risk for gambling and gang involvement compared with New Zealand European youth. Limited evidence indicates that youth gang involvement is associated with problem gambling; no research shows if it is associated with gambling. We conducted exploratory secondary analyses of data from 1063 Pacific youth and their mothers using data from two time points (age nine and 14 years) from a longitudinal cohort study. Gang involvement at age nine years was significantly associated with gambling at age 14 years, with adjusted odds of 2.25 (95% CI [1.16, 4.37]). Of confounders, having a mother with a partner and Cook Islands ethnicity appeared protective against gambling at age 14 years. Despite some study limitations, as youth gambling can lead to subsequent adult problem gambling, our findings highlight the importance of understanding why Pacific youth join gangs, to inform public health policies to reduce the potential for future development of harmful behaviors. [ABSTRACT FROM AUTHOR]

Objectives: Aotearoa New Zealand has demonstrable maternal and perinatal health inequity. We examined the relationships between adverse outcomes in a total population sample of births and a range of social determinant variables representing barriers to equity. Methods: Using the Statistics New Zealand Integrated Data Infrastructure suite of linked administrative data sets, adverse maternal and perinatal outcomes (mortality and severe morbidity) were linked to socio-economic and health variables for 97% of births in New Zealand between 2003 and 2018 (~970,000 births). Variables included housing, economic, health, crime and family circumstances. Logistic regression examined the relationships between adverse outcomes and social determinants, adjusting for demographics (socio-economic deprivation, education, parity, age, rural/urban residence and ethnicity). Results: Māori (adjusted odds ratio=1.21, 95% confidence interval=1.18–1.23) and Asian women (adjusted odds ratio 1.39, 95% confidence interval=1.36–1.43) had poorer maternal or perinatal outcomes compared to New Zealand European/European women. High use of emergency department (adjusted odds ratio=2.68, 95% confidence interval=2.53–2.84), disability (adjusted odds ratio=1.98, 95% confidence interval=1.83–2.14) and lack of engagement with maternity care (adjusted odds ratio=1.89, 95% confidence interval=1.84–1.95) had the strongest relationship with poor outcomes. Conclusion: Maternal health inequity was strongly associated with a range of socio-economic and health determinants. While some of these factors can be targeted for interventions, the study highlights larger structural and systemic issues that affect maternal and perinatal health. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Despite more than 10 years of the diabetes annual review (DAR) programme, ensuring the annual return of diabetic patients for review remains a challenge for primary care. Regardless of future arrangements for diabetes review programmes, regular review of patients remains clinically important. AIM: To investigate the effect of patient and practice characteristics on the retention of patients continuously enrolled with the same practice in the DAR programme. METHODS: We undertook a retrospective, observational study of a cohort of enrolled diabetic patients who had a DAR in the July 2006 - June 2007 reporting year and remained enrolled with the same practice for the following three years. Controlling for death and migration, retention rates were calculated for age, gender, ethnicity, rurality, practice fundingtype and practice nurse (PN) to general practitioner (GP) ratio. RESULTS: The study included data from 78 practices and 6610 patients with Type 2 diabetes. Non-Maori and those aged 60 years and over were more likely to be retained in the programme. For practice factors, those with a higher PN to GP ratio had a significant retention advantage. Rurality and funding type was not shown to have a significant role in retention. DISCUSSION: Results support the view that both patient and practice factors influence a patient's retention within the DAR programme. The PN to GP ratio may be an important factor in the retention of patients in a DAR programme and warrants further research and consideration when planning future primary care models. [ABSTRACT FROM AUTHOR]

Background: Studies in southern New Zealand indicate that up to a quarter of women experienced infertility, likely due to delay in childbearing. However, these findings may not be generalisable to the whole population. Aims: To assess the lifetime prevalence of infertility and evidence for disparities for New Zealand men and women in a nationally representative sample. Materials and Methods: In 2014/15 a general health survey with a module on sexual and reproductive health was conducted among New Zealand residents aged 16–74 years; 3792 men and 5222 women provided information on infertility. Result(s): There were 8.2% (95% CI 7.1–9.4%) of men and 12.5% (11.3–13.8%) of women who had experienced infertility; among fertility‐tested women this was 15.4% (14.0–16.9%). Prevalence peaked in the 35–44 year age group (14.3% for men, 19.1% for women and 20.8% for fertility‐tested women). Estimates for European, Māori and Asian ethnicities were similar. Pacific men and women had higher relative risks: 2.37 (95% CI 1.51–3.71) and 1.76 (1.27–2.44), respectively, compared with Europeans. Medical help was sought by 69.3% (95% CI 62.4–75.5%) of infertile men and 68.2% (63.1–72.9%) of women; this was significantly lower for Māori and Pacific. Conclusions: Infertility levels for those of European ethnicity were similar to studies in southern New Zealand, and in other high‐income countries. However, infertility levels were just as high for Māori, and higher for Pacific people, despite experiencing fertility at younger ages. Focusing on reducing causes of infertility other than delayed childbearing would likely contribute to addressing this health disparity. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to identify behaviours and cues that nurses recognise as indications of unsafe practice, perceived factors that contribute to unsafe practice and actions nurses take in response. Design: Cross‐sectional survey. Methods: National cross‐sectional survey of a random sample of registered nurses (n = 231) in New Zealand, in 2017–2018. The STROBE Checklist was used to report this study. Results: Nurses reported a high rate of episodes of unsafe practices and recognised a range of behaviours and cues that alerted them to the potential for unsafe practice. Several organisational issues were perceived to contribute to unsafe practice occurring. The reporting of episodes of unsafe practice and perceived organisational support was low for nurses compared with managers. Conclusion: Failure to recognise and respond to unsafe practice may indicate a tolerance for substandard practice by individual nurses, or by the organisation. Nurses who recognise unsafe practice must be supported by the organisation. [ABSTRACT FROM AUTHOR]

Aim: Over the past decade, paradoxes have emerged in the skin cancer prevention and sunburn reduction literature. These include that individuals with higher sun protection knowledge; lower positive attitudes towards tanning; and who are users of sunscreen have higher odds of sunburn. It is also possible that sunburn paradoxes may be associated with those whose sunburn was unintended. New Zealand and Australia have, by far, the highest age standardised incidence rates of melanoma skin cancer in the world, and this study examines the extent to which sunburn and unintended sunburn is associated with the sunburn paradox variables. Method: Sun Exposure Survey data New Zealanders aged 15 + years were gathered by the New Zealand Health Promotion Agency in 2016. Results: Linkages were examined between sunburn, unintended sunburn and the paradox variables: sun protection knowledge, attitudes towards tanning and use of sunscreen. Sunburn was associated with higher respondent sun protection knowledge. No statistically significant associations were found between unintended sunburn and the paradox variables. Conclusion: This research indicates that in a well-designed study of a sample representative of the New Zealand population, the sun protection knowledge sunburn paradox still exists. Despite a high level of sun protection knowledge, many people still become sunburned. Therefore, it is important to examine this paradox further in order to find ways to reduce sunburn frequency among New Zealanders. Potential ways to reduce sunburn are discussed. [ABSTRACT FROM AUTHOR]

Objective: The aim was to investigate the prevalence of self-reported sleep complaints in New Zealand adults and determine the independent association of sleep complaints with adverse health outcomes. Design: We used 2002/03 New Zealand Health Survey data (n = 12,500 adults, ≥15 years). The prevalence of self-reported sleep complaints was estimated by ethnicity. The relationship between sleep complaints and mental health, physical health and health risk behaviors were investigated using multivariable logistic regression models. Results: The prevalence of each sleep complaint measure was highest for the indigenous Māori population (23.6% reported ‘any’ sleep complaint; 10.3% reported multiple sleep complaints). Reporting ‘any’ sleep complaint was associated with higher odds of poorer mental health, diagnosed high blood pressure, diagnosed diabetes, diagnosed heart disease, poor/fair self-rated health, obesity, current smoking, and hazardous drinking. Conclusion: The higher prevalence of sleep complaints among Māori and the consistent association with poor health suggests a potential role for suboptimal sleep in ethnic health inequities. [ABSTRACT FROM AUTHOR]

ABSTRACT: BACKGROUND: While dietary sources of calcium are important for bone health, the intake of milk and milk products decreases as children get older. A free milk in schools program may mitigate this decrease in milk consumption. We evaluated the Fonterra Milk for schools program (a free milk initiative) by determining changes in children's milk consumption and anthropometric measures over a 2‐year period. METHODS: The evaluation was conducted in children aged 7‐9 years in a representative sample of primary schools participating in the free milk program, in Auckland, New Zealand. The primary outcome was the proportion of children meeting the New Zealand guidelines for dairy and milk product consumption over 7 days (≥2 servings per day). Changes in anthropometric measures were also assessed as secondary outcomes. RESULTS: Nine schools (N = 511 children) participated in the evaluation. The proportion of children meeting the New Zealand guidelines for milk and milk product consumption over 7 days increased significantly from baseline to 2 years' follow‐up (72% vs 94%; p < .001). Body mass index z scores did not change significantly between baseline and 2 years' follow‐up. CONCLUSIONS: The Fonterra Milk for Schools initiative appears to be an effective way of increasing milk/milk product consumption behaviors in school‐aged children. [ABSTRACT FROM AUTHOR]

Objectives: Māori, the indigenous peoples of Aotearoa (New Zealand), continue to exhibit the highest rate of smoking of any ethnic group in the nation. Clarifying the present day factors which perpetuate Māori smoking has become matter of some urgency.Design: We investigate links between subjective elements of Māori identity, demographic factors and perceived discrimination with smoking status in a national probability sample of self-identified Māori (N = 667).Results: Our results suggest that core aspects of Māori identity and cultural engagement were not significantly linked with smoking. However, the extent to which participants felt they were perceived as prototypically Māori (measured as Perceived Appearance) was reliably associated with smoking. The effect of Perceived Appearance held when adjusting for perceived experiences of discrimination and other standard demographic indicators.Conclusion: Our analysis indicates that simply feeling that one is more visibly Māori is associated with an increased likelihood of smoking. This may reflect how Māori negotiate the larger systemic forces of racism present in New Zealand society. [ABSTRACT FROM AUTHOR]

Little population-based work has been published about the mental health of adolescents with both sexual/gender (SG) and ethnic minority (i.e. double minority) status. This study aimed to provide an overview on their mental health. Analysis of data from a total of 17,607 high school students from New Zealand's 2007 and 2012 cross-sectional nationally representative Adolescent Health Surveys, including a total of 1306 (7.4%) SG minority participants, of whom 581 (3.3%) were also an ethnic minority. SG minority status, minority ethnicity, and female sex were associated with higher mental distress and poorer well-being. Generally speaking, double minority students reported poorer mental health than SG majority students of the same ethnicity, but reported better mental health than SG minority New Zealand European students. Explanations and future directions for research were suggested to further explore how double minority students negotiate mental health in the context of their communities/cultures in New Zealand. [ABSTRACT FROM AUTHOR]

Objective To examine prospectively multiple indicators of pregnancy health and associations with adverse birth outcomes within a large, diverse sample of contemporary women. Design A cohort of pregnant women who gave birth during 2009-10. Population We enrolled a sample of 6822 pregnant New Zealand ( NZ) women: 11% of all births in NZ during the recruitment period. Methods We analysed a number of maternal health indicators and behaviours during pregnancy in relation to birth outcomes using multivariable logistic regression. Associations were described using adjusted odds ratios and 95% confidence intervals. Main outcome measures Three birth outcomes, low birth weight ( LBW), pre-term birth ( PTB) and delivery type, were measured via linkage with maternity hospital perinatal databases. Small for gestational age ( SGA) was then defined as below the 10th percentile by week of gestation. Results Modelling of birth outcomes after adjusting for confounders indicated patterns of increased risk of LBW and PTB for women who smoke, have elevated pre-pregnancy body mass index ( BMI), or with insufficient pregnancy weight gain. SGA was associated with maternal smoking, alcohol use, insufficient weight gain and nausea and vomiting during pregnancy. Risk of caesarean section was associated with having a diagnosed illness before pregnancy, elevated BMI, greater pregnancy weight gain and less pregnancy exercise. Number of risk factor variables were then used to model birth outcomes. Women with multiple risk factors were at increased risk compared with those who had no risk factors. Conclusions Women with multiple health risks are at particular risk of adverse birth outcomes. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this research was to determine (1) associations between multiple lifestyle behaviours and optimal wellbeing and (2) the extent to which five lifestyle behaviours-sleep, physical activity, sedentary behaviour, sugary drink consumption, and fruit and vegetable intake-cluster in a national sample. Method: A national sample of New Zealand adults participated in a web-based wellbeing survey. Five lifestyle behaviours-sleep, physical activity, sedentary behaviour, sugary drink consumption, and fruit and vegetable intake-were dichotomised into healthy (meets recommendations) and unhealthy (does not meet recommendations) categories. Optimal wellbeing was calculated using a multi-dimensional flourishing scale, and binary logistic regression analysis was used to calculate the relationship between multiple healthy behaviours and optimal wellbeing. Clustering was examined by comparing the observed and expected prevalence rates (O/E) of healthy and unhealthy two-, three-, four-, and five-behaviour combinations. Results: Data from 9425 participants show those engaging in four to five healthy behaviours (23 %) were 4.7 (95 % confidence interval (CI) 3.8-5.7) times more likely to achieve optimal wellbeing compared to those engaging in zero to one healthy behaviour (21 %). Clustering was observed for healthy (5 %, O/E 2.0, 95 % CI 1.8-2.2) and unhealthy (5 %, O/E 2.1, 95 % CI 1.9-2.3) five-behaviour combinations and for four- and three-behaviour combinations. At the two-behaviour level, healthy fruit and vegetable intake clustered with all behaviours, except sleep which did not cluster with any behaviour. Conclusion: Multiple lifestyle behaviours were positively associated with optimal wellbeing. The results show lifestyle behaviours cluster, providing support for multiple behaviour lifestyle-based interventions for optimising wellbeing. [ABSTRACT FROM AUTHOR]

BACKGROUND: Little empirical examination of the relationship between work organisational factors and return to work following injury has been undertaken despite the growing recognition of examining broader multi-dimensional contexts for recovery following injury. OBJECTIVE: To explore relationships between pre-injury work organisational factors and work status (working/work absent) 3-month after injury among people employed prior to injury. METHODS: Cases (work absent) and controls (working), selected from a larger study of injury outcomes according to reported work status 3-month after injury, completed a postal questionnaire. Work organisational factors were compared between cases and controls using univariate and multivariable analyses. RESULTS: One hundred and twelve participants completed the questionnaire (44 cases; 68 controls). Of 11 work organisation factors examined, organisational size was the only explanatory variable significantly associated with work status in the multivariable model. Higher odds of work absence were found in small (< 50 employees) (OR 5.6) and large (> 500 employees) (OR 7.2) workplaces, compared with medium-sized (50-500 employees) organisations. CONCLUSIONS: Variations in post-injury work patterns among those working pre-injury may be partly explained by organisation size. Future research examining work status following injury should examine the influence of work organisational factors in larger studies. [ABSTRACT FROM AUTHOR]

Objective: Depression is common post-TBI, yet has not been studied longitudinally, nor at a population level. This study examined prevalence of depression in a population-based sample across the first year post-TBI. Design and methods: Prospective follow-up of 315 adults (>16 years) with assessments (Hospital Anxiety Depression Scale, DSM-IV criteria) at 1-, 6- and 12-months post-TBI. Demographic and injury-related predictors of depression at 1-year post-TBI were also explored. Results: The number of individuals identified as depressed reduced significantly between baseline and 12-months post-TBI from 21-12.4% using the HADS and 49-34% using DSM-IV criteria; with only 10 of the 28 individuals initially meeting criteria on the HADS continuing to do so at 12-month follow-up. Meeting HADS depression criteria was linked to pre-morbid depression and/or anxiety; while those meeting DSM-IV criteria were older, but not significantly so. Conclusions: The findings suggest depression is common post-TBI and that clinicians/researchers use caution in its diagnosis, as existing criteria have significant overlap with common TBI sequels. [ABSTRACT FROM AUTHOR]

Background: Most people prefer to receive end-of-life care in familiar surroundings rather than in hospital. This study examines variation in place of death for people dying from Parkinson's disease (PD) across 11 European and non-European countries. Methods: Using death certificate data of 2008 for Belgium, France, Italy, Hungary, Czech Republic, New Zealand, USA, Canada, Mexico, South Korea and Spain for all deaths with PD as an underlying cause (ICD-10 code: G20) cross-national differences in place of death were examined. Associations between place of death and patient socio-demographic and regional characteristics were evaluated using multivariable binary logistic regression analyses. Results: The proportion of deaths in hospital ranged from 17% in the USA to 75% in South Korea. Hospital was the most prevalent place of death in France (40%), Hungary (60%) and South Korea; nursing home in New Zealand (71%), Belgium (52%), USA (50%), Canada (48%) and Czech Republic (44%); home in Mexico (73%), Italy (51%) and Spain (46%). The chances of dying in hospital were consistently higher for men (Belgium, France, Italy, USA, Canada), those younger than 80 years (Belgium, France, Italy, USA, Mexico), and those living in areas with a higher provision of hospital beds (Italy, USA). Conclusions: In several countries a substantial proportion of deaths from PD occurs in hospitals, although this may not be the most optimal place of terminal care and death. The wide variation between countries in the proportion of deaths from PD occurring in hospital indicates a potential for many countries to reduce these proportions. [ABSTRACT FROM AUTHOR]

Main partners are a common source of new HIV infections among men who have sex with men (MSM). National behavioral surveillance data (2006-2011) for younger MSM (YMSM, aged 16-29) in New Zealand were analyzed to investigate condom use during anal intercourse with a regular partner (boyfriend/fuckbuddy) by sexual position (insertive/receptive). Backward-stepwise multivariate multinomial logistic regression was used to identify demographic, relational, behavioral, and cognitive factors associated with condom use frequency (high, medium, low). Most YMSM who reported a current regular partner ( n = 1,221) classified them as a boyfriend (59.5%) versus fuckbuddy (40.5%), though condom use was higher with the latter partner type. Condom use or nonuse was habitual across partners, although insertive sexual position was positively associated with condom use. YMSM who believed condoms reduce sensitivity reported lower condom use. Condoms remain the leading HIV/STI prevention tool for YMSM; efforts to improve condom use must consider sexual position and relationship factors. [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]

Most HIV behavioural surveillance programmes for gay, bisexual and other men who have sex with men (MSM) sample from location-based (offline) or web-based (online) populations, but few combine these two streams. MSM sampled online have been found to differ demographically and behaviourally from those sampled offline, meaning trends identified in one system may not hold for the other. The aim was to examine trends among MSM responding to supplementary repeat online behavioural surveillance surveys who had not participated in offline surveillance earlier that year in the same city, to see whether trends were parallel, converged or diverged. We recruited a total of 1613 MSM from an Internet dating site in Auckland, New Zealand in 2006, 2008 and 2011 using identical questionnaires and eligibility criteria to offline surveillance. Condom use was stable over time, HIV testing rates rose, the proportion reporting over 20 recent male partners declined, and anal intercourse rates increased, consistent with trends in offline surveillance conducted concomitantly and reported elsewhere. Variant trends included greater stability in condom use with casual partners among online-recruited MSM, and a rise in regular fuckbuddy partnering not identified among offline-recruited MSM. Among MSM recruited online, the frequency of checking Internet dating profiles increased between 2008 and 2011. In conclusion, supplementary web-based behavioural surveillance among MSM generally corroborates trends identified in offline surveillance. There are however some divergent trends, that would have been overlooked if only one form of surveillance had been conducted. As MSM populations increasingly shift their socialising patterns online and diversify, multiple forms of HIV behavioural monitoring may be required. [ABSTRACT FROM AUTHOR]

Introduction Palliative care delivery has become integral to the role of healthcare staff in residential aged care (RAC) internationally. Challenges within this work environment (e.g. workload, staffing levels, resources) may impact on healthcare staffs' willingness to undertake formal palliative care education. The study described herein explored factors (socioenvironmental and psychological) that influence staff willingness to engage in palliative care education. Methods The predictors of palliative care education uptake for healthcare staff (n = 431) from 52 New Zealand RAC facilities in one large urban District Health Board were assessed. Logistic regression was used to explore willingness to engage in education. Results Higher scores for burnout predicted a decreased likelihood of engaging in palliative care education (odds ratio (OR) 0.41, P = 0.01). The identified predictor of willingness to engage in education was previous palliative care experience (OR 1.59, P = 0.027). Discussion These results can inform the design and delivery of future palliative care education programmes within RAC. [ABSTRACT FROM AUTHOR]

Ageing in place initiatives that aim to keep older people out of hospitals and rest homes and in their own homes for longer have been at the forefront of aged care policy since the early 1990s. The success of these policies depends largely on the availability of a suitable home environment, a supportive social network and regular assessment to detect changes in the older person's health status and needs for support. The BRIGHT Trial was a randomised control trial investigating the effectiveness of introducing case finding in primary care settings to detect unmet need and risk of disability among older people. We used baseline questionnaire data collected in 2008-2009 from 3753 community-dwelling older people to estimate and describe use and need for additional personal assistance. Logistic regression was used to identify the most important predictors of reporting some need for support and unmet need. Eighty-one per cent of participants required support with at least one instrumental activity of daily living. Sixty-six per cent were meeting their needs with the support they were currently receiving. Unmet need was most frequently reported for heavy housework (65%) and light housework (53%). While spouses, family members and friends were the main providers of support for light housework, meal preparation, shopping, finances and transportation, paid staff most frequently provided personal care and heavy housework assistance. Reporting mobility difficulty ( OR = 3.5), identifying as a care provider ( OR = 1.7) and being female ( OR = 1.9) were all significant predictors of some need for assistance as well as unmet need for assistance ( OR = 2.5, 1.7 and 1.7 respectively). The findings highlight the importance of regular needs assessment for older people living in the community particularly, given the reliance on spousal support for the majority of activities. [ABSTRACT FROM AUTHOR]

Background This study reports findings from the International Alcohol Control ( IAC) study that assesses the impact of alcohol control policy on consumption and policy-related behaviors. Modeled on the International Tobacco Control study that uses longitudinal surveys with comparison between countries, the baseline survey was carried out in New Zealand. This study reports analysis of the purchasing behavior respondents report separately for on- and off-premise outlets, providing validation data for both alcohol consumption and reported prices. Methods New Zealand is a high-income country with an adult per capita alcohol consumption (as of 2011) of 9.5 l. The survey was carried out among a nationally representative sample of drinkers. Interview data on place and time of purchase, amounts purchased, price paid, and consumption (beverage and location specific) was collected. Relationships between policy relevant variables and consumption were modeled taking into account demographic variables. Validation was provided by government data on alcohol available for consumption, aggregate expenditure and prices from the Consumer Price Index. Results Drinkers paying low prices at on- or off-licensed premises had higher odds of consuming 6+ drinks on a typical occasion, as did drinkers purchasing alcohol at later times. Regarding frequency, drinkers purchasing at later times were more likely to be daily drinkers. Lower price in off licenses but not on licenses predicted daily drinking. The data collected accounted for approximately 96% of alcohol available for consumption and the prices accounted for 98% of aggregate expenditure. Conclusions Valid survey data were collected to give an accurate picture of alcohol consumption and prices paid by drinkers. Heavy drinkers were more likely to buy cheaper alcohol and purchase at later times; 2 policy issues under discussion in many settings. This analysis suggests the IAC study that has the potential to provide data to contribute to the debate on appropriate policy responses to reduce alcohol-related harm. [ABSTRACT FROM AUTHOR]

Background: Sick leave due to neck pain (NP-SL) is costly and negatively impacts the productivity of the nursing and midwifery workforce. Identification of modifiable risk indicators is necessary to inform preventive efforts. This study aimed to investigate the role of pain-related psychological features (pain catastrophizing, fear of movement, and pain coping) in NP-SL alongside other potential risk indicators. Methods: A cross-sectional analysis of a large cohort study of Australian and New Zealand nurses and midwives, established between 1st April 2006 to 30th March 2008, was undertaken. Recruitment procedures adopted within each Nursing Council jurisdiction were governed by the individual regulatory authorities and their willingness to engage with the study. Invitations directed potential participants to a purpose-built internet-based survey, where study information was provided and consent requested. Once consent was obtained, a range of standardized tools combined into one comprehensive electronic questionnaire was elicited. Exposure variables assessed included pain characteristics and a broad range of psychological, psychosocial, occupational, general health and demographic factors. Two-way interactions between age and gender and candidate exposures were also assessed. Binary logistic regression was performed using manual backward stepwise elimination of non-significant terms. Results: The cohort included 4,903 currently working nurses or midwives aged 18-65 years. Of these, 2,481 (50.6%) reported neck pain in the preceding 12 months. Our sample comprised of 1,854 working nurses and midwives with neck pain in the preceding year who supplied sick leave data. Of these, 343 (18.5%) reported taking sick leave in the preceding year due to their neck pain. The final most parsimonious multivariable model demonstrated neck pain severity (adjusted odds ratio, [aOR] = 1.59), passive pain coping (aOR = 1.08) and fear of movement (aOR = 1.06) increased the likelihood of NP-SL in the previous year. Interactions between demographic and general health factors exhibited both protective and risk relationships with NP-SL, and there was no association between pain catastrophizing and NP-SL. Conclusions: Findings demonstrate that sick leave due to neck pain was associated with pain severity, fear of movement and passive pain coping. In addition, there were complex interactions found between demographic and general health factors. These features represent potentially modifiable targets for preventive programs. [ABSTRACT FROM AUTHOR]

Study design:Longitudinal cohort study.Objectives:To estimate socioeconomic and work outcomes over 2 and a half years following spinal cord injury (SCI), and to compare those in receipt of compensation (Accident Compensation Corporation, ACC) and those not.Setting:People admitted to the two spinal units in 2007-2009 in New Zealand, where there is a unique no-fault compensation scheme for injury.Methods:Interviews were conducted at ∼6, 18 and 30 months after SCI and data collected on pre-SCI and post-SCI health and socioeconomic characteristics. Poisson regression, quantile regression and a linear mixed model regression were used to compare differences in outcomes.Results:Of the 162 eligible people, 118 (73%) participated and 91(77%) were followed to 30 months; 79% received ACC. Median personal income, self-reported standard of living and household income adequacy all fell slightly to 18 months and then stabilized at 30 months. At that time, 49% had returned to paid work. Among those not eligible for ACC, income fell to less than half the ACC group (P<0.006 after adjustment), and return to work was lower (29% versus 54%).Conclusion:The findings that most people retained their economic status and that return to work was relatively high appear to be due to the proportion entitled to the ACC no-fault compensation scheme for injury; with earnings-related compensation, a focus on rehabilitation to work and non-means-tested support services. This situation should mitigate against the downward spiral into poverty and further ill-health. [ABSTRACT FROM AUTHOR]

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Some research suggests that the risk of physical aggression by an intimate partner is related to marital status, but this relationship may vary across cultures and by gender. In the present study, we systematically examine the relationship between marital status and physical partner aggression by gender across 19 countries. Logistic and multilevel regression confirmed previous findings of lower rates of physical aggression for legally married versus cohabiting and separated/divorced women and men across most, but notably, not all countries. Single status was associated with higher risk in some countries and lower in others reflecting possible cultural differences in risk for different marital statuses. For example, single women had significantly lower rates of victimization than did married women in India where violence against wives is often accepted. The variation in the cross-cultural findings highlights the importance of examining both men and women and considering the cultural context when interpreting the relationship between partner aggression and marital status. [ABSTRACT FROM AUTHOR]

Women of child bearing age that regularly drink alcohol are at risk for drinking in early pregnancy. Evidence indicates a majority of women stop alcohol consumption on pregnancy recognition. However, there is a dearth of studies reporting on patterns and correlates of drinking in early pregnancy prior to stopping on pregnancy recognition, which the current study aims to address. In 2005, a New Zealand nationwide cross-sectional survey was conducted on a random sample of 1,256 women aged 16-40 years. Data were collected via an interviewer-administered questionnaire using a web-assisted telephone interviewing system. Of the 1,256 women who participated, 127 (10 %) were currently pregnant and 425 women (34 %) were previously pregnant. Half of currently pregnant women and 37 % of previously pregnant women reported that they ceased drinking on recognising pregnancy. Women categorised as 'risky drinkers' and those aged 16-24 years had higher odds to drink and binge drink in early pregnancy, compared with non-risky drinkers and women of other age categories respectively. A majority of women stop alcohol consumption on pregnancy recognition but prior to this, drink at levels posing a risk for the developing foetus. Women most at risk for drinking and binge drinking in early pregnancy were younger in age and exhibited risky drinking behaviour prior to pregnancy. A targeted intervention to reduce the risk for an alcohol exposed pregnancy is warranted for sexually active younger women in New Zealand and elsewhere. [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]

ABSTRACT Aim While drinking in the event is an important factor in injury occurrence, the pattern of usual drinking may also be important in risk of injury. Explored here is the relationship of an alcohol-related injury with an individual usual drinking pattern. Design Alcohol-related injury is examined using hierarchical linear models, taking into account individual usual volume of consumption over the past 12 months, as well as aggregate-level detrimental drinking pattern (DDP) and alcohol policy measures. Setting Data analyzed are from emergency departments (EDs) in 19 countries, comprising three collaborative studies on alcohol and injury, all of which used a similar methodology. Participants The sample comprised 14 132 injured drinkers across 46 emergency room (ER) studies. Measurements Alcohol-related injury was measured, separately, by any self-reported drinking prior to injury, a blood alcohol concentration (BAC) ≥ 0.08 and self-reported causal attribution of injury to drinking. Findings While individual usual volume strongly predicted an alcohol-related injury for all three measures, usual drinking pattern also predicted an alcohol-related injury (controlling for volume), with episodic heavy and frequent heavy drinking both more predictive of alcohol-related injury than other drinking patterns. When individual usual volume and drinking pattern were controlled, DDP was no longer a significant predictor of alcohol-related injury. Alcohol policy measures were predictive of both BAC and causal attribution (the stronger the policy the lower the rates of alcohol-related injury). Conclusions Volume of alcohol typically consumed and occurrence of heavy drinking episodes are associated independently with incidence of alcohol-related injury. The stronger the anti-alcohol policies in a country, the lower the rates of alcohol-related injury. [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]

Objective: Evidence indicates that medical graduates with a rural background are more likely to become rural doctors than those with an urban background (the rural background effect (RBE)). Exactly why this is so has rarely been studied. This study sought to identify the role of social, environmental and economic factors in addition to isolation characterising rural environments that either explain or modify the association between rural background and becoming a rural doctorrural practice intention. Design and setting: Secondary analysis of linked databases from the Medical Schools Outcomes Database (MSOD), Australian Bureau of Statistics and other government sources. Participants: Seven thousand four hundred twenty-two commencing medical students who took part in the MSOD survey and for whom external data could be linked. Results: No social, environmental or economic factor studied or isolation significantly contributed to explaining the RBE, although there is some evidence that areas of more attractive climate strengthen the RBE. However, even when the RBE is at its weakest, it remains a strong, positive predictor of attraction to rural practice. Conclusion: Why the RBE occurs remains unexplained. Evidence was found of a reduced RBE under certain climatic conditions and personal circumstances, but further work is required to better understand why rural background is so strongly related with rural medical intention and practice. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims To examine the associations between working hours and alcohol-related problems during early adulthood. Design and setting Longitudinal study of a birth cohort born in Christchurch, New Zealand in 1977 and studied to age 30. Participants A total of 1019 participants with data available for working hours and alcohol-related problems at either age 25 or 30. Measurements Weekly working hours in paid employment; frequent alcohol use; diagnosis of alcohol abuse/dependence; number of symptoms of alcohol abuse/dependence. Associations between working hours and alcohol-related problems were adjusted for covariates including measures of: parental and family background; personality and behaviour; IQ and educational achievement; recent negative life events; recent mental health problems; and current partner and family circumstances. Findings Longer work hours were associated significantly with more frequent alcohol use ( P < 0.0001), higher rates of alcohol abuse/dependence ( P = 0.0001) and a greater number of alcohol abuse/dependence symptoms ( P = 0.01). These associations were adjusted for a wide range of confounding factors. After adjustment there remained significant ( P < 0.05) associations between working hours and alcohol-related problems, with those working 50 or more hours per week having rates of alcohol-related problems 1.8-3.3 times higher than those who were not working. The associations between work hours and alcohol use were similar for males and females. Conclusions Longer work hours appear to be associated with higher rates of alcohol-related problems, including more frequent alcohol use, higher rates of alcohol abuse/dependence and a greater number of alcohol abuse/dependence symptoms. These associations remain even after extensive adjustment for confounding. [ABSTRACT FROM AUTHOR]

Background: The health effects of ultraviolet radiation vary according to wavelength, timing and pattern of exposure, personal characteristics and practices. Negative effects include skin cancers, eye diseases and immune suppression; positive effects primarily relate to endogenous vitamin D production which protects against bone disease. Drafting comprehensive guidelines regarding appropriate sun protective behaviours and vitamin D sufficiency is challenging. Advice given by general practitioners is potentially influential because they are widely respected. Methods: A survey instrument was developed, pre-tested and provided to practising GP's, either by on-line link or mailed, reply paid hard-copy. Odds ratios, differences in means, or ratios of geometric means from regression models are reported for potential predictor variables with 95% confidence intervals. Results: Data (demographic, training, practicing, information accessing, confidence in vitamin D knowledge) suitable for analysis were obtained from 1,089 GPs (32% participation). Many (43%) were 'not at all confident' about their vitamin D knowledge. Recent information led 29% to recommend less sun protection during winter months and 10% less all year. Confidence was positively associated with non-'Western' medical training, information sources read and practising in a metropolitan centre with a medical school. Reading the Melanoma Clinical Practice Guidelines was associated with lower estimates of the amount of summer sun exposure required to obtain adequate vitamin D. Increasing years in practice was negatively associated with provision of recommended advice about summer and winter sun protection. Greater concern about vitamin D than skin cancer was expressed by females and those in practice longer. Conclusions: Concern about the potentially negative impact of skin cancer prevention on vitamin D status may undermine appropriate sun protective recommendations. Reading some educational resources was associated with confidence about vitamin D knowledge and a perception that significantly less summer sun exposure was required for those with high sun sensitivity to achieve adequate vitamin D, suggesting a potentially positive impact of such resources. Education could be targeted towards groups least likely to promote existing recommendations. Authoritative guidelines about vitamin D and sun protection would be a valued resource among GPs. Study findings are potentially valuable to help guide public policy and target interventions [ABSTRACT FROM AUTHOR]

BackgroundVery few longitudinal studies have evaluated prospective neurodevelopmental and psychosocial risk factors for obsessive–compulsive disorder (OCD). Furthermore, despite the heterogeneous nature of OCD, no research has examined risk factors for its primary symptom dimensions, such as contamination/washing.MethodPotential risk factors for symptoms or diagnosis of OCD in adulthood and for specific adult obsessive–compulsive (OC) symptom dimensions were examined in the Dunedin Study birth cohort. The presence of obsessions and compulsions and psychological disorders was assessed using the Diagnostic Interview Schedule (DIS) at ages 26 and 32 years. Individuals with a diagnosis of OCD at either age (n=36) were compared to both a healthy control group (n=613) and an anxious control group (n=310) to determine whether associations between a risk factor and an OCD diagnosis were specific.ResultsChildhood neurodevelopmental, behavioral, personality and environmental risk factors were associated with a diagnosis of OCD and with OC symptoms at ages 26 and 32. Social isolation, retrospectively reported physical abuse and negative emotionality were specific predictors of an adult OCD diagnosis. Of note, most risk factors were associated with OC symptoms in adulthood and several risk factors predicted specific OCD dimensions. Perinatal insults were linked to increased risk for symmetry/ordering and shameful thoughts dimensions, whereas poor childhood motor skills predicted the harm/checking dimension. Difficult temperament, internalizing symptoms and conduct problems in childhood also predicted specific symptom dimensions and lower IQ non-specifically predicted increased risk for most dimensions.ConclusionsThe current findings underscore the need for a dimensional approach in evaluating childhood risk factors for obsessions and compulsions. [ABSTRACT FROM PUBLISHER]

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]