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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]

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

Background: 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]

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 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: 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]

Background Ethnic disparities in cancer survival have been documented in many populations and cancer types. The causes of these inequalities are not well understood but may include disease and patient characteristics, treatment differences and health service factors. Survival was compared in a cohort of Maori (Indigenous) and non-Maori New Zealanders with colon cancer, and the contribution of demographics, disease characteristics, patient comorbidity, treatment and healthcare factors to survival disparities was assessed. Methods Maori patients diagnosed as having colon cancer between 1996 and 2003 were identified from the New Zealand Cancer Registry and compared with a randomly selected sample of non-Maori patients. Clinical and outcome data were obtained from medical records, pathology reports and the national mortality database. Cancer-specific survival was examined using Kaplan—Meier survival curves and Cox hazards modelling with multivariable adjustment. Results 301 Maori and 328 non-Maori patients with colon cancer were compared. Maori had a significantly poorer cancer survival than non-Maori (hazard ratio (HR)=1.33, 95% CI 1.03 to 1.71) that was not explained by demographic or disease characteristics. The most important factors contributing to poorer survival in Maori were patient comorbidity and markers of healthcare access, each of which accounted for around a third of the survival disparity. The final model accounted for almost all the survival disparity between Maori and non-Maori patients (HR=1.07, 95% CI 0.77 to 1.47). Conclusion Higher patient comorbidity and poorer access and quality of cancer care are both important explanations for worse survival in Maori compared with non-Maori New Zealanders with colon cancer. [ABSTRACT FROM AUTHOR]

Background: Few studies have compared ovarian cancer rates between different ethnic groups in the same country. The aim of this study was to describe ethnic patterns in the incidence and mortality of ovarian cancer in New Zealand, and to investigate ethnic and socioeconomic differences in the grade and stage of ovarian cancer. Methods: Data on all women registered with ovarian cancer on the New Zealand Cancer Registry (1993-2004) were analysed. Population data were taken from the 1996 and 2001 census. Logistic regression was used to estimate associations between ethnicity, deprivation and tumour characteristics. Results: Age-standardised incidence rates were highest in Pacific women, intermediate in Māori women, and lowest in non-Māori, non-Pacific women. Age-standardised mortality rates showed the same pattern. Ovarian cancer subtypes differed by ethnic group. There was no significant association between socioeconomic deprivation and tumour grade or stage. Age-adjusted models showed that Māori women were more likely to have well-differentiated tumours and less likely to present at a later stage compared to non-Māori, non-Pacific women. These patterns were partly explained by socioeconomic deprivation, and were not apparent for Pacific women. Conclusions: Pacific and Māori women experience higher incidence of ovarian cancer and mortality, compared to non-Māori, non-Pacific women. Māori women seemed to have better prognostic factors (local stage and well-differentiated tumours) than non-Māori, non-Pacific women. More work is needed to improve current cancer prevention strategies, particularly in Pacific women. [ABSTRACT FROM AUTHOR]