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A wide inequality in incidence and severity of childhood oral health conditions between Pasifika and non-Pasifika in Aotearoa/New Zealand (Aotearoa/NZ) persists with some evidence that the gap is widening. To develop an evidence base for strengths-based solutions, this study seeks to investigate the association between parental education and detected oral health conditions in Pasifika children.A secondary cross-sectional analysis of linked routinely collected national databases of children (Pasifika and Non-Māori non-Pasifika [NMNP]) aged 0-9 years in 2013 who completed a Before School Check (B4SC) and had their birth parents file a 2013 New Zealand census return. Parental education is represented by their self-reported highest qualification level gained. Logistic regression models were employed to investigate childhood caries and hospitalisations related to oral health conditions after adjusting for social and economic factors.During the five-year period of 2013-2017, 21 744 (10.2%) children (Pasifika and NMNP) completed the B4SC and experienced caries. Pasifika children experienced caries three times more than NMNP children (23.6% and 7.9%, respectively) and 1.8 times more dental hospitalisations (6.0% and 3.4%, respectively). Each additional level of parental education reduced their Pasifika child's odds of experiencing caries (unadjusted odds ratio [OR] = 0.83, 95% CI: 0.82-0.85) and dental hospitalization (unadjusted OR = 0.89, 95% CI: 0.87-0.91). Less than half of the reduced odds for parental education could be attributed to other covariate factors, by 43% and 25%; respectively, for caries and hospitalisations.Our findings show good educational achievement is associated with better oral health for offspring beyond other benefits that can be attributed to non-education influences. Increased education for Pasifika parents is likely to directly confer better oral health for their children. The findings from this study may provide meaningful evidence for future developments in Pasifika education policy as an investment into the health of subsequent generations of Pasifika children.

Background Although insufficient sleep has emerged as a strong, independent risk factor for obesity in children, the mechanisms by which insufficient sleep leads to weight gain are uncertain. Observational research suggests that being tired influences what children eat more than how active they are, but only experimental research can determine causality. Few experimental studies have been undertaken to determine how reductions in sleep duration might affect indices of energy balance in children including food choice, appetite regulation, and sedentary time. The primary aim of this study is to objectively determine whether mild sleep deprivation increases energy intake in the absence of hunger. Methods The Daily, Rest, Eating, and Activity Monitoring (DREAM) study is a randomized controlled trial investigating how mild sleep deprivation influences eating behaviour and activity patterns in children using a counterbalanced, cross-over design. One hundred and ten children aged 8–12 years, with normal reported sleep duration of 8–11 h per night will undergo 2 weeks of sleep manipulation; seven nights of sleep restriction by going to bed 1 hr later than usual, and seven nights of sleep extension going to bed 1 hr earlier than usual, separated by a washout week. During each experimental week, 24-h movement behaviours (sleep, physical activity, sedentary behaviour) will be measured via actigraphy; dietary intake and context of eating by multiple 24-h recalls and wearable camera images; and eating behaviours via objective and subjective methods. At the end of each experimental week a feeding experiment will determine energy intake from eating in the absence of hunger. Differences between sleep conditions will be determined to estimate the effects of reducing sleep duration by 1–2 h per night. Discussion Determining how insufficient sleep predisposes children to weight gain should provide much-needed information for improving interventions for the effective prevention of obesity, thereby decreasing long-term morbidity and healthcare burden. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12618001671257. Registered 10 October 2018.

BACKGROUND Around 10% of young people suffer from chronic health conditions, and their health care needs are different from those of children or adults. Most research about young people's chronic illness focuses on specific conditions, on younger children's experience, and on the perspectives of parents. This study explored the experiences of young people with two very different chronic conditions (asthma and cancer) and their perception of the New Zealand health system's response to their needs. METHODS This was a collaborative research process where eight young co-researchers who had asthma or cancer were employed to work alongside the research team to develop protocols, interview peers, and assist with analysis. The challenges of this process are described in the article. Twenty-one young people between ages 15 and 27 from two urban areas of New Zealand participated in semistructured open-ended interviews about their health care experiences. Sixteen participants were female, and five male. Eleven of the participants had finished cancer treatment (with an average of 3.6 years since diagnosis), and 10 had asthma. Purposeful sampling meant that 80% of the participants with asthma were identified as Māori and the other participants identified with a range of other ethnic groups. Data were thematically coded, and coresearchers were consulted to derive the ultimate findings. RESULTS Chronic illness disrupted the trajectory of young people's lives and had significant effects on their relationships. The New Zealand health system generally did not respond well to the needs of these young people, but many encountered extraordinary individuals who supported them effectively. The experiences of some indigenous participants indicate that health professionals require effective cultural competence training. CONCLUSIONS This study provides insights into how young people with very different conditions experience the health system. Young people should be consulted and actively included in decision making about making health systems responsive to their diverse needs.

BACKGROUND: Although sleep duration is a risk factor for obesity in young children, less is known about other aspects of sleep health, including bedtime, on obesity risk. OBJECTIVE: To determine whether bedtime is associated with body mass index (BMI) z-score or obesity risk in children ages 2 to 5 years, and to determine if associations are independent of sleep duration. METHODS: Cohort analyses were undertaken using three early life obesity prevention trials (POI, INSIGHT, Healthy Beginnings) and a longitudinal cohort study (HOME). Bedtime was assessed by questionnaire and BMI through clinical measurement between 2 and 5 years in 1642 children. Adjusted regression models examined whether BMI z-score and obesity (BMI z-score ≥ 2) were associated with bedtime, nocturnal sleep time and 24-hour sleep time. A discrete mixture model categorized children into bedtime trajectory groups across time points. RESULTS: Bedtime was inconsistently associated with BMI z-score. Although each hour later of bedtime was associated with greater odds of obesity at ages 3 (OR; 95% CI: 1.05; 1.003, 1.10) and 5 (1.35; 1.08, 1.69) years, odds were attenuated after adjustment for nocturnal or 24-hour sleep time. Longer nocturnal sleep duration at 2 years was associated with lower odds of obesity (OR 0.90; 0.86, 0.94), as was longer 24-hour sleep duration at 3 years in girls (0.70; 0.62, 0.78). BMI z-score and odds of obesity were not significantly different between ‘early to bed’ and ‘late to bed’ trajectory groups. CONCLUSIONS: Timing of bedtime appears inconsistently related to obesity in young children, possibly via influencing overall sleep duration.

Issues addressed: Cutaneous melanomas and keratinocyte carcinomas (nonmelanoma skin cancer) are highly prevalent in New Zealand (NZ), making skin cancer a priority area for cancer control. Spring is an important time for encouraging sun-safety, due to ultraviolet radiation (UVR) levels becoming hazardous. The news media have a potential to play an important role in reminding people and emphasising the importance of sun-safety. This study aimed to describe how the traditional NZ media portrayed sun-safety and skin cancer in spring news stories. Methods: A media monitoring company collated stories related to cancer during spring 2016. These were reviewed for inclusion and content was coded according to the cancer type described. Stories focused on skin cancer and sun protection issues were coded according to the position on the cancer control continuum. Results: Skin cancer and sun-safety represented 3.6% (n = 110) of all cancer stories published. Stories mainly related to primary prevention (72%), early detection (37%) and survivorship (27%). The main risk factors identified included sun exposure (49%) and tanning (25%). Conclusions: Traditional media coverage of skin cancer remains relatively low during springtime. It is heartening to see that most stories included prevention information. So what? Given the impact of skin cancer in NZ, and the importance of springtime as a period for behaviour change to reduce risk, there is considerable scope for increased media coverage and advocacy. Further research could usefully analyse media trends throughout the year and within specific media platforms, both traditional and new, in order to further disseminate information to the NZ public.

Background There is limited literature on kidney disease in the Pacific Region, despite it being recognised as a leading cause of death in some Pacific Island nations. Kidney replacement therapy is only available in a handful of Pacific Islands. This paper reports the epidemiology of haemodialysis patients in Samoa. Methods Registry data from the National Kidney Foundation of Samoa was analysed to estimate the incidence and prevalence rates of kidney failure from the rates of haemodialysis in Samoa and to explore some of the demographic features related to kidney failure in Samoa Findings In total, 393 patients have received long-term haemodialysis in the National Kidney Foundation of Samoa since its inception in 2005 until August 2019. 43% of the haemodialysis population were women and the mean age of people dialysed was 54.9 years. The crude mean incidence rate of kidney failure in Samoa, based on treated kidney failure cases, is 224 patients per million population with a crude prevalence of 629 patients per million population. Diabetic nephropathy (69.4%) was the leading cause of kidney failure. Interpretation This is the first paper to report the epidemiology of haemodialysis patients in Samoa and reveals an urgent need for further studies on the extent of chronic kidney disease, and kidney failure, in Samoa to develop country specific prevention strategies to mitigate this growing burden and optimise care for kidney failure patients in Samoa. Funding : No funding was received for this study.

Background Although moving from smoking to electronic nicotine delivery systems (ENDS) could reduce the harms smokers face, many ENDS users continue to smoke tobacco. We explored the contributing factors to tobacco use among ENDS users. Methods We conducted in-depth interviews with n =20 past 30-day ENDS and tobacco users (16 used ENDS daily; the median duration of ENDS use was 4.5 months). Interviews explored motivations for using ENDS, experiences of using ENDS and tobacco, and dual use patterns. We used qualitative thematic analysis to analyse interview data. Results Most, but not all, participants used ENDS to try and quit smoking entirely. Among those who reported trying to quit, social exposure to tobacco use and alcohol consumption cued cravings and undermined a full transition to vaping. Some participants found ENDS did not sufficiently alleviate stress or replicate the nicotine hit, mouth-feel or rituals they experienced with smoking. The convenience and perceived social acceptability of using ENDS indoors also facilitated dual use. Several participants cited financial reasons as the primary motivation for using ENDS; they reported alternating between ENDS and smoking as rationing their 'real' cigarettes helped manage the cost of tobacco. Younger, social tobacco smokers reported experiencing stigma when using ENDS, which inhibited their ENDS use in some social settings where tobacco use was normative. While many participants saw dual use as a transition towards becoming smokefree, others viewed their reduced smoking levels alongside ENDS use as a successful outcome. Some perceived ENDS as healthful, not merely less harmful than tobacco; this view appeared to offset dissonance about using tobacco and positioned cigarette smoking as a reward for being "good". Conclusions Understanding factors that facilitate and support dual use of ENDS and smoked tobacco may help inform interventions that support ENDS users to make a full transition from tobacco smoking to vaping.

Issue addressed School gardens are a potentially important health promotion tool, allowing the growth and consumption of fruit and vegetables to be embedded within the students’ educational experience. This study aimed to investigate the implementation of edible gardens in New Zealand (NZ) primary and secondary schools. Methods A questionnaire mailed to principals from a randomly selected sample of 764 NZ schools included questions on whether or not the school had a garden and, if so, what produce was grown; how long the garden had been in place; how harvested crops were distributed; and curriculum integration. Results Among 491 responding schools (64.3% response rate), 52.9% currently had an edible garden – with most gardens started in the previous two years. Vegetables, herbs and tree fruit were commonly grown. Gardens were integrated into curriculum subjects, cooking lessons, recipes and messages promoting increased fruit and vegetable consumption. Conclusions Edible gardens were common within NZ schools, though often relatively new, and were used for teaching in a variety of curriculum areas. So what? Given the current popularity of school gardens, there are opportunities to deliver health promotion messages regarding consumption of fruit and vegetables, and for these to be reinforced by real life experience growing and preparing healthy food.

Spirituality is increasingly acknowledged as an essential element to consider within care for cancer and other chronic health conditions. As our colleagues in frontline healthcare roles integrate these concepts into their professional practice, it seems timely for the cancer research community to reflect on the place of spirituality within our work. This reflections article discusses challenges and opportunities for researchers considering spirituality in their own work roles and within broader discussions about health needs, care and research agendas.

Issue addressed This paper aims to explore the presence and role of edible gardens in Aotearoa/New Zealand Early Childhood Education Services (ECES). Methods Participant ECES providers were identified from the Ministry of Education database of Early Childhood Education Services (March 2009). These include Education and Care and Casual Education and Care, Kindergarten, Home-based Education and Care services, Playcentres, Te Kōhanga Reo. A structured, self-administered questionnaire was sent to the Principal or Head Teacher of the service Results Of the 211 ECES that responded (55% response rate), 71% had edible gardens, incorporating vegetables, berry fruit, tree fruit, edible flowers and nut trees. Garden activities were linked with teaching across all strands of the New Zealand early childhood curriculum. In addition, 34% provided guidance on using garden produce and 30% linked the garden with messages on fruit and vegetable consumption. Most gardens were established recently (past 2 years) and relied on financial and non-financial support from parents, teachers and community organisations. Barriers included a lack of funding, space, time and staff support. Conclusions/Implications Study findings suggest that gardens are already being used as a versatile teaching tool in many ECES settings. Most gardens are new, with a need to support the sustainability and workforce development among teachers and parents in order to be able to maintain these resources for future generations. So what? Given the inherent links between gardening and healthy food and exercise, there seem to be extensive opportunities for health promotion aligned with the edible garden movement.

Organisations seeking to establish themselves as leading cancer information sources for the public need to understand patterns and motivators for information seeking. This study describes cancer information seeking among New Zealanders through a national cross-sectional survey conducted in 2014/15 with a population-based sample of adults (18 years and over). Participants were asked if they had sought information about cancer during the past 12 months, the type of information they sought, what prompted them to look for information and ways of getting information they found helpful. Telephone interviews were completed by 1064 participants (588 females, 476 males, 64% response rate). Of these, 33.8% of females and 23.3% of males (total, 29.2%) had searched for information about cancer over the past year. A search was most frequently prompted by a cancer diagnosis of a family member or friend (43.3%), a desire to educate themselves (17.5%), experience of potential symptoms or a positive screening test (9.4%), family history of cancer (8.9%) or the respondent's own cancer diagnosis (7.7%). Across the cancer control spectrum, the information sought was most commonly about treatment and survival (20.2%), symptoms/early detection (17.2%) or risk factors (14.2%), although many were general or non-specific queries (50.0%). The internet was most commonly identified as a helpful source of information (71.7%), followed by health professionals (35.8%), and reading material (e.g. books, pamphlets) (14.7%).This study provides a snapshot of cancer information seeking in New Zealand, providing valuable knowledge to help shape resource delivery to better meet the diverse needs of information seekers and address potential unmet needs, where information seeking is less prevalent.

Population cancer awareness is of interest worldwide, as efforts are made to reduce cancer incidence via changes in risk and protective behaviours. To date, few studies have described changes in awareness over time, despite significant investment in raising awareness about various cancer types and risk behaviours. This paper describes the Cancer Awareness in Aotearoa New Zealand (CAANZ) survey, a cross-sectional telephone survey of adult New Zealanders conducted in 2014/2015 (CAANZ15, n = 1064) and its comparison with a similar 2001 study (CAANZ01, n = 438). Both aimed to describe current cancer awareness among a national sample of New Zealand (NZ) adults, with additional aims for CAANZ15 being to explore emerging issues in information provision and supportive care. Follow-up studies are challenged by changes in communication technologies and, in turn, potential issues in sampling. However, given the value of information about changing awareness, pragmatic steps were taken in CAANZ15 to maximise the response rate and comparability of the surveys. A response rate of 64 % was achieved for both samples. When compared to the adult NZ population, the CAANZ15 sample tended to be older, of higher socioeconomic status and under-representative of people with Pacific, Asian or, to a lesser extent, Māori (the indigenous population of NZ) ethnicity. To compensate for possible disproportionate age-by-ethnicity (Māori/non-Māori) groups in the sample, poststratification weighting was adopted. While caution will need to be exercised in drawing conclusions from comparisons made between these two cohorts, the dearth of such studies means that insights gained should be useful for guiding reflection on future cancer control directions and the generation of new hypotheses.

Behaviour change, specifically that which decreases cancer risk, is an essential element of cancer control. Little information is available about how awareness of risk factors may be changing over time. This study describes the awareness of cancer risk behaviours among adult New Zealanders in two cross-sectional studies conducted in 2001 and 2014/5.Telephone interviews were conducted in 2001 (n = 436) and 2014/5 (n = 1064). Participants were asked to recall things they can do to reduce their risk of cancer. They were then presented with a list of potential risk behaviours and asked if these could increase or decrease cancer risk.Most New Zealand adults could identify at least one action they could take to reduce their risk of cancer. However, when asked to provide specific examples, less than a third (in the 2014/5 sample) recalled key cancer risk reduction behaviours such as adequate sun protection, physical activity, healthy weight, limiting alcohol and a diet high in fruit. There had been some promising changes since the 2001 survey, however, with significant increases in awareness that adequate sun protection, avoiding sunbeds/solaria, healthy weight, limiting red meat and alcohol, and diets high in fruit and vegetables decrease the risk of developing cancer.

Introduction Electronic nicotine delivery systems (ENDS) arguably pose fewer health risks than smoking, yet many smokers adopt ENDS without fully relinquishing smoking. Known as ‘dual use’, this practice is widespread and compromises the health benefits that ENDS may offer. To date, few studies have explored how dual use practices arise and manifest. Methods We conducted in-depth, semi-structured interviews with 20 current ENDS users from New Zealand who reported smoking tobacco at least once a month. We explored participants’ smoking history, their recent and current smoking, trial, uptake and patterns of ENDS use, and future smoking and vaping intentions. We managed the data using NVivo V.11 and used a thematic analysis approach to interpret the transcripts. Results Dual use practices among participants evolved in four ways. First, as an attempt to manage the ‘inauthenticity’ of vaping relative to smoking and to retain meaningful rituals. Second, as complex rationalisations that framed decreased tobacco use, rather than smoking cessation, as ‘success’. Third, as a means of alleviating the financial burden smoking imposed and to circumvent smoke-free policies. Lastly, dual use reflected attempts to comply with social group norms and manage stigma. Conclusions Dual use reflects both social and physical cues. It assisted participants to navigate smoking restrictions and allowed them to manage divergent norms. Policies that discourage smoking, particularly excise tax increases on smoked tobacco and smoke-free space restrictions, appear important in prompting ENDS use. Future research could explore whether these policies also help foster complete transition from smoking to exclusive ENDS use.

Objective: To examine school participation in sponsorship, incentive and fundraising initiatives and to describe feedback about potential health implications and possible solutions from key stakeholders in the health and education sectors. Methods: All secondary/area schools and 15% of primary/intermediate schools were randomly selected from six geographical regions of New Zealand. School principals completed a self-report questionnaire. Survey findings were summarised in a discussion document and forwarded to 53 key stakeholders for comment. Results: Most schools reported participation in sponsorship, incentive and fundraising initiatives (83% of primary/ intermediate and 85% of secondary/area schools). Some partnerships delivered positive health messages to students, but others were linked with products or activities potentially deleterious to health. Examples of the latter included provision of foods high in fat and sugar to students and funding from organisations whose profits were generated from gambling and alcohol sales. Key stakeholder concerns included the undermining of classroom health education and perceptions that schools were endorsing product consumption. Suggestions to address these concerns included increasing co-ordination and awareness, alternative sources of funding, and policy guidelines or legislation. Conclusions: Most schools were involved in some sort of sponsorship, incentive and fundraising initiatives, some of which had the potential to have a negative impact on the health of students. Implications: There is an urgent need for co-operation between the health and education sectors to ensure that these funding partnerships do not compromise student health.

Melanoma and skin cancer are largely attributable to over-exposure to solar ultraviolet radiation (UVR). Reports of UVR levels within media weather forecasts appear to be well received by the public and have good potential to communicate the need for appropriate sun protection to a broad audience. This study describes provision of UVR messages by New Zealand newspapers, radio and TV stations over a 4-year period, and examines the impact of an intervention which aimed to address media concerns about the financial costs of accessing UVR information for broadcast. Newspaper and radio presentation of UVR information increased immediately after these costs were removed; however, among radio stations it dropped in subsequent years. Among those media that were presenting UVR, this information was broadcast throughout the summer period and repeated throughout the day. Furthermore, most reports included concomitant, behavioral sun protection messages. At the final assessment (summer 2001/02), 66% of radio stations, both TV channels and 48% of newspapers reported UVR information in summertime weather reports. Efforts to further increase UVR presentation will need to address media concerns about time constraints on weather forecasts and media perceptions of poor audience demand or understanding of some UVR messages. [Authors]

Although concurrent influences on adolescent physical activity are well documented, longitudinal studies offer additional insights about early life antecedents of participation. The aim of this study was to examine associations between childhood and contemporaneous factors and patterns of physical activity participation during adolescence.Physical activity participation at ages 15 and 18 was assessed among members of the Dunedin Multidisciplinary Health and Development Study cohort using the interview-based Minnesota Leisure Time Physical Activity Questionnaire. Logistic regression was used to examine associations between childhood factors (socioeconomic status, family "active-recreation" orientation, home activities, motor ability, intelligence, and psychiatric disorder), contemporaneous factors (parental health, body mass index, predicted VO(2 max), general health, television viewing, smoking, and alcohol use) and "persistent inactivity," "declining participation," or "persistent activity" during adolescence.In multivariate models, persistent inactivity during adolescence was associated with lower childhood family active-recreation orientation, and poorer cardiorespiratory fitness and general health during adolescence. Declining participation was more likely among those who reported fewer activities at home during childhood. Persistent activity was associated with better cardiorespiratory fitness and watching less television during adolescence.This study found that childhood and contemporaneous factors were associated with persistent inactivity, persistent activity and declining participation during adolescence. The findings highlight several factors from the family and home environment of potential importance in early intervention programs to support adolescent participation in physical activity.

Objective: To examine predictors of sunburn and sun protection practices during summer weekends within a sample of NZ adolescents. Method: Phone interviews were conducted with 203 participants aged 12–17 years. Questions were asked about behaviour from 11am to 4pm during the previous weekend. Results: Less than half of the sample outside during peak radiation hours wore sunscreen and only a quarter wore hats. Sunburn was experienced by 31% of adolescents and was associated with spending longer times outside and use of sunscreen without reapplication. Wearing a sunhat was predicted by being younger and male, while sunscreen use was predicted by being female. Conclusions: There is a lack of appropriate sun protection among many NZ adolescents, and correspondingly high rates of sunburn. Possible opportunities to address this are through increasing the efficacy of sunscreen and sun hat use, and creating outdoor environments that support sun avoidance.

We describe the development, implementation and evaluation of a pilot programme to increase physical activity, through cycling, among children. The programme, implemented in Dunedin, New Zealand, during 2003, comprised three components. The first was a free community based programme to promote safe cycling, it was open to all children aged 4–12 to register for, required access to a safe cycle and helmet, and was conducted on a weeknight at a local park (n=101). The second component targeted children from a low socioeconomic schoolwhowere less likely to have access to the community programme and less likely to have access to a cycle or helmet (n=20). The third and final component was the donatea- bike programme; this componentwas designed to provide cycles for those children from the low SES school who would otherwise not be able to cycle. The lead author was approached to help redesign an existing unstructured cycling programme for children, provided one night each week, lacking trained volunteers, and having a negligible number of children from low socio-economic schools. The objectives of the old programme were to promote cycling as a sport and to teach children skills to improve their safety in cycling.