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Background: Equitable access to colposcopy services is required if we are to realise the benefit of the introduction of human papilloma virus (HPV) screening in Aotearoa New Zealand. We piloted a community colposcopy clinic, co-located at an urban marae health clinic., Aim: To describe the experiences of wāhine (women) attending the marae-based colposcopy clinic., Methods: An in-depth reflexive thematic analysis from 34 people's accounts was undertaken., Results: Five themes were identified from the experiences of wāhine attending the clinic. Three themes related to how having a local clinic supported access: everyone was welcoming and friendly, the environment was familiar and non-clinical and the clinic was accessible. The fourth theme related to how this contributed to agency. A fifth theme relates to wāhine views about informing the ongoing provision of colposcopy services. The experiences reflected the principles and values practised at the marae health clinic. Wāhine described feeling cared for as soon as they entered the clinic. As the clinic was local, and for some based at their marae, it was a known space where they knew the experience would be safe. Whānau were welcome with spaces for children to play. Being local meant there were fewer logistics to manage, all of which supported access., Discussion: Prioritising wāhine through the provision of culturally safe and accessible colposcopy is feasible. It has the potential to contribute to the elimination of cervical cancer in Aotearoa, New Zealand., (© 2024 The Authors. Australian and New Zealand Journal of Obstetrics and Gynaecology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Spatial life course epidemiological approaches offer promise for prospectively examining the impacts of air pollution exposure on longer-term health outcomes, but existing research is limited. An essential aspect, often overlooked is the comprehensiveness of exposure data across the lifecourse. The primary objective was to meticulously reconstruct historical estimates of air pollution exposure to include prenatal exposure as well as annual exposure from birth to 10 years (1977-1987) for each cohort member. We linked these data from a birth cohort of 1,265 individuals, born in Aotearoa/New Zealand in mid-1977 and studied to age 40, to historical air pollution data to create estimates of exposure from birth to 10 years (1977-1987). Improvements in air quality over time were found. However, outcomes varied by demographic and socioeconomic factors. Future research should examine how inequitable air pollution exposure is related to health outcomes over the life course., Competing Interests: Declaration of competing interest All authors declare no conflicts of interest., (Copyright © 2024. Published by Elsevier Ltd.)

Mental health conditions pose a significant public health challenge, and low area-level socioeconomic status (SES) is a potentially important upstream determinant. Childhood exposure might have influences on later-life mental health. This study, utilises data from the Christchurch Health and Development Study birth cohort, examining the impact of area-level SES trajectories in childhood (from birth to age 16) on mental health at age 16 and from age 18-40 years. Findings revealed some associations between distinct SES trajectories and mental health. The study underscores the importance of using a spatial lifecourse epidemiology framework to understand long-term environmental impacts on later-life health., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

This study investigated associations between change in the food environment and change in measured body mass index (BMI) and waist circumference (WC) in the Christchurch Health and Development Study (CHDS) birth cohort. Our findings suggest that cohort members who experienced the greatest proportional change towards better access to fast food outlets had the slightly larger increases in BMI and WC. Contrastingly, cohort members who experienced the greatest proportional change towards shorter distance and better access to supermarkets had slightly smaller increases in BMI and WC. Our findings may help explain the changes in BMI and WC at a population level., Competing Interests: Declaration of competing interest The authors declare they have nothing to disclose., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The aim of this research is to analyse the spatial epidemiology of Type 2 Diabetes Mellitus (T2DM) and investigate associations with the built environment in urban New Zealand. Data on T2DM was sourced from the New Zealand Virtual Diabetes Register (2016), and data on environmental variables sourced from the Ministry for Primary Industries and Territorial Authorities (2013-2016). Novel measures of the built environment using an enhanced two-step floating catchment area model were established using data on fast food outlets, takeaways, dairy/convenience stores, supermarkets and fruit/vegetable stores. Rates of T2DM per 1000 population and standardised morbidity ratios were computed and visualised for all urban areas. Getis Ord was used to assess spatial clustering, and Bayesian modelling was used to understand associations between T2DM and environmental variables. Results indicate that T2DM is influenced by demographic factors, spatially clustered and associated with accessibility to environmental exposures. Health-promoting resources, such as fruit/vegetable stores, were shown to have a consistently protective effect on T2DM while those considered detrimental to health showed varying, and largely insignificant, associations. This is the first study in New Zealand to spatially quantify the effects of multiple environmental exposures on population level T2DM for all urban areas using a geospatial approach. It has implications for both policy and future research efforts as a deeper knowledge of local environments forms a basis on which to better understand spatial associations between the built environment and health, as well as formulate policy directed toward environmental influences on chronic health conditions., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Volunteering is a way for people to develop meaningful relationships within a social group and can lead to the building of social capital, from which both individuals and the wider group can benefit in the form of enhanced well-being. This study aimed to explore and describe the impact of volunteering on the volunteer coordinators and volunteers themselves in the eastern suburbs of Christchurch, New Zealand, an area particularly impacted by the devastating earthquakes in the period 2010/2011. Data were collected via semi-structured interviews with volunteer coordinators and volunteers (n = 35; 16 men, 19 women) from November 2018 to mid-January 2019. Thematic analysis of data highlighted a key theme of Creating and strengthening valued community connections, with subthemes of Personal growth, Community connections and Role of coordination. The key theme illustrated how formal volunteering created effort and opportunities towards the strengthening of personal and community connectedness. Our study demonstrates the importance of social connection for both individual and community well-being, emphasises the important role of "champions" in facilitating the building of bridging and bonding relationships between individuals and communities, and suggests a role for healthcare professionals to prescribe volunteering as a way to improve individual health and well-being outcomes., (© 2021 John Wiley & Sons Ltd.)

Background: The COVID-19 pandemic has asked unprecedented questions of governments around the world. Policy responses have disrupted usual patterns of movement in society, locally and globally, with resultant impacts on national economies and human well-being. These interventions have primarily centred on enforcing lockdowns and introducing social distancing recommendations, leading to questions of trust and competency around the role of institutions and the administrative apparatus of state. This study demonstrates the unequal societal impacts in population movement during a national 'lockdown'., Methods: We use nationwide mobile phone movement data to quantify the effect of an enforced lockdown on population mobility by neighbourhood deprivation using an ecological study design. We then derive a mobility index using anonymised aggregated population counts for each neighbourhood (2253 Census Statistical Areas; mean population n=2086) of national hourly mobile phone location data (7.45 million records, 1 March 2020-20 July 2020) for New Zealand (NZ)., Results: Curtailing movement has highlighted and exacerbated underlying social and spatial inequalities. Our analysis reveals the unequal movements during 'lockdown' by neighbourhood socioeconomic status in NZ., Conclusion: In understanding inequalities in neighbourhood movements, we are contributing critical new evidence to the policy debate about the impact(s) and efficacy of national, regional or local lockdowns which have sparked such controversy., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Declining childhood immunization represents a serious public health problem globally and in New Zealand. To guide efforts to increase immunization coverage, this study monitors nationwide change in immunization coverage since the introduction of the National Immunisation Register (NIR) in 2005 and spatiotemporal patterns of immunization coverage from 2006 to 2017., Methods: The study population consisted of 4 482 499 individual immunization records that were obtained from the NIR (2005-2017). Data on yearly and average immunization coverage in census area units (CAUs) in New Zealand were calculated by milestone age (6/8/12/18/24/60/144 months). Data for 2005 were excluded due to missing records in the introductory period of the NIR. We analyzed spatial and spatiotemporal patterns using Gi* and SaTScan methods., Results: Immunization coverage improved since the introduction of the NIR in 2005, reaching a peak in 2014 and 2015 with a slight decrease in 2016 and 2017. Well and insufficiently immunized areas were identified with spatial autocorrelation analyses highlighting several hot- and cold-spots. Comparison of CAUs with neighbouring CAUs allowed for the identification of places where immunization coverage was significantly higher or lower than expected, over both time and space., Conclusion: We provide the first spatiotemporal analysis of childhood immunization in New Zealand that utilizes a large sample of over 4.4 million individual immunization records. Our spatial analyses enable policymakers to understand the development of childhood immunization coverage and make more effective prevention strategies in New Zealand., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Background: Accounting for the co-occurrence of multiple environmental influences is a more accurate reflection of population exposure than considering isolated influences, aiding in understanding the complex interactions between environments, behaviour and health. This study examines how environmental 'goods' such as green spaces and environmental 'bads' such as alcohol outlets co-occur to develop a nationwide area-level healthy location index (HLI) for New Zealand., Methods: Nationwide data were collected, processed, and geocoded on a comprehensive range of environmental exposures. Health-constraining 'bads' were represented by: (i) fast-food outlets, (ii) takeaway outlets, (iii) dairy outlets and convenience stores, (iv) alcohol outlets, (v) and gaming venues. Health-promoting 'goods' were represented by: (i) green spaces, (ii) blue spaces, (iii) physical activity facilities, (iv) fruit and vegetable outlets, and (v) supermarkets. The HLI was developed based on ranked access to environmental domains. The HLI was then used to investigate socio-spatial patterning by area-level deprivation and rural/urban classification., Results: Results showed environmental 'goods' and 'bads' co-occurred together and were patterned by area-level deprivation. The novel HLI shows that the most deprived areas of New Zealand often have the most environmental 'bads' and less access to environmental 'goods'., Conclusions: The index, that is now publicly available, is able to capture both inter-regional and local variations in accessibility to health-promoting and health-constraining environments and their combination. Results in this study further reinforce the need to embrace the multidimensional nature of neighbourhood and place not only when designing health-promoting places, but also when studying the effect of existing built environments on population health.

This study combines data on the location of health-constraining 'bads' (i: fast-food outlets, ii: takeaway outlets, iii: dairy outlets and convenience stores, iv: alcohol outlets, and v: gaming venues) and health-promoting 'goods' (i: green spaces, ii: blue spaces, iii: physical activity facilities, and iv: fruit and vegetable outlets) into a nationwide Healthy Living Index. This was applied to pooled (2015/16-2017/18) nationally representative New Zealand Health Survey data, with mental health conditions (depression, bipolar, and anxiety) and psychological distress as population-level outcomes. Mental health was associated with proximity to environmental 'goods' and 'bads'. Compared to those individuals who reside within the unhealthiest environments, there was a steady reduction in the odds of adverse mental health outcomes and psychological distress as the environment became more health-promoting., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: The prevalence of children with elevated weight or obesity is concerning for public health due to associated comorbidities. This study investigates associations between parental adiposity, physical activity (PA), fruit and vegetable consumption, and child adiposity and moderation by both child and parent gender., Methods: Cross-sectional nationally representative data from the New Zealand Health Survey were pooled for the years 2013/14-2016/17. Parent and child surveys were matched resulting in 13,039 child (2-14 years) and parent (15-70 years) dyads. Parent and child, height (cm), weight (kg) and waist circumference (WC) were measured objectively. Height and weight were used to calculate BMI. Linear regression, accounting for clustered samples (b [95% CI]) investigated associations between parental characteristics and child BMI z-score and WC. Interactions and stratification were used to investigate effect moderation by parent gender, child gender, and parent adiposity., Results: Parental PA and fruit and vegetable consumption were unrelated to child adiposity. Overall, higher parent BMI was related to a higher child BMI z-score (b = 0.047 [0.042, 0.052]) and higher parental WC was related to a higher child WC (0.15 [0.12, 0.17]). A three-way interaction revealed no moderation by parent gender, child gender, and parent BMI for child BMI z-score ((b = 0.005 [-0.017, 0.027], p = 0.318). However, a three-way interaction revealed moderation by parent gender, child gender, and parent WC for child WC (b = 0.13 [0.05, 0.22]). The slightly stronger associations were seen between father-son WC (b = 0.20 [0.15, 0.24]) and mother-daughter WC (b = 0.19 [0.15, 0.22])., Conclusions: The findings are highly relevant for those wishing to understand the complex relationships between child-parent obesity factors. Findings suggest that family environments should be a key target for obesity intervention efforts and show how future public health interventions should be differentiated to account for both maternal and paternal influences on child adiposity.

Background: Immunisation is a safe and effective way of protecting children and adults against harmful diseases. However, immunisation coverage of children is declining in some parts of New Zealand., Aim: Use a nationwide sample to first, examine the socioeconomic and demographic determinants of immunisation coverage and spatial variation in these determinants. Second, it investigates change in immunisation coverage in New Zealand over time., Methods: Individual immunisation records were obtained from the National Immunisation Register (NIR) (2005-2017; 4,482,499 events). We calculated the average immunisation coverage by year and milestone age for census area units (CAU) and then examined the immunisation coverage by selected socioeconomic and demographic determinants. Finally, local variations in the association between immunisation coverage and selected determinants were investigated using geographically weighted regression., Results: Findings showed a decrease of immunisation rates in recent years in CAUs with high immunisation coverage in the least deprived areas and increasing immunisation rates in more deprived areas. Nearly all explanatory variables exhibited a spatial variation in their association with immunisation coverage. For instance, the strongest negative effect of area-level deprivation is observed in the northern part of the South Island, the central-southern part of the North Island, around Auckland, and in Northland., Conclusion: Our findings show that childhood immunisation coverage varies by socioeconomic and demographic factors across CAUs. We also identify important spatial variation and changes over time in recent years. This evidence can be used to improve immunisation related policy in New Zealand., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

This nationwide study investigated the relationship between proximity to alcohol outlets (off-licence, on-licence, and other-licence) and two adverse outcomes; hazardous drinking and crime (common assault, non-aggravated sexual assault, aggravated sexual assault, and tobacco and liquor offences). After adjustment for important individual- and area-level factors, close proximity to alcohol outlets was associated with increased risk of hazardous drinking, with strong associations for on-licence outlets. Proximity alcohol outlets was also strongly associated with all crime outcomes, often with a dose-response relationship. Nationally representative New Zealand data showed that close proximity to alcohol outlets was associated with increased crime and hazardous drinking., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Social and natural capital are fundamental to people's wellbeing, often within the context of local community. Developing communities and linking people together provide benefits in terms of mental well-being, physical activity and other associated health outcomes. The research presented here was carried out in Christchurch - Ōtautahi, New Zealand, a city currently re-building, after a series of devastating earthquakes in 2010 and 2011. Poor mental health has been shown to be a significant post-earthquake problem, and social connection has been postulated as part of a solution. By curating a disparate set of community services, activities and facilities, organised into a Geographic Information Systems (GIS) database, we created i) an accessibility analysis of 11 health and well-being services, ii) a mobility scenario analysis focusing on 4 general well-being services and iii) a location-allocation model focusing on 3 primary health care and welfare location optimisation. Our results demonstrate that overall, the majority of neighbourhoods in Christchurch benefit from a high level of accessibility to almost all the services; but with an urban-rural gradient (the further away from the centre, the less services are available, as is expected). The noticeable exception to this trend, is that the more deprived eastern suburbs have poorer accessibility, suggesting social inequity in accessibility. The findings presented here show the potential of optimisation modelling and database curation for urban and community facility planning purposes.

Background: We examined the association between area-level deprivation and dental ambulatory sensitive hospitalizations (ASH) and considered the moderating effect of community water fluoridation (CWF). The hypothesis was that higher levels of deprivation are associated with higher dental ASH rates and that CWF will moderate this association such that children living in the most deprived areas have greater health gain from CWF., Methods: Dental ASH conditions (dental caries and diseases of pulp/periapical tissues), age, gender and home address identifier (meshblock) were extracted from pooled cross-sectional data (Q3, 2011 to Q2, 2017) on children aged 0-4 and 5-12 years from the National Minimum Dataset, New Zealand (NZ) Ministry of Health. CWF was obtained for 2011 and 2016 from the NZ Institute of Environmental Science and Research. Dental ASH rates for children aged 0-4 and 5-12 years (/1000) were calculated for census area units (CAUs). Multilevel negative binomial models investigated associations between area-level deprivation, dental ASH rate and moderation by CWF status., Results: Relative to CWF (2011 and 2016), no CWF (2011 and 2016) was associated with increased dental ASH rates in children aged 0-4 [incidence rate ratio (IRR) = 1.171 (95% confidence interval 1.064, 1.288)] and aged 5-12 years [IRR = 1.181 (1.084, 1.286)]. An interaction between area-level deprivation and CWF showed that the association between CWF and dental ASH rates was greatest within the most deprived quintile of children aged 0-4 years [IRR = 1.316 (1.052, 1.645)]., Conclusions: CWF was associated with a reduced dental ASH rate for children aged 0-4 and 5-12 years. Children living in the most deprived areas showed the greatest effect of CWF on dental ASH rates, indicating that the greater health gain from CWF occurred for those with the highest socio-economic disadvantage. Variation in CWF contributes to structural inequities in oral-health outcomes for children., (© The Author(s) 2020; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.)

Objective This study reports on the characteristics of individuals conducting health service research (HSR) in Australia and New Zealand, the perceived accessibility of resources for HSR, the self-reported impact of HSR projects and perceived barriers to conducting HSR. Methods A sampling frame was compiled from funding announcements, trial registers and HSR organisation membership. Listed researchers were invited to complete online surveys. Close-ended survey items were analysed using basic descriptive statistics. Goodness of fit tests determined potential associations between researcher affiliation and access to resources for HSR. Open-ended survey items were analysed using thematic analysis. Results In all, 424 researchers participated in the study (22% response rate). Respondents held roles as health service researchers (76%), educators (34%) and health professionals (19%). Most were employed by a university (64%), and 57% held a permanent contract. Although 63% reported network support for HSR, smaller proportions reported executive (48%) or financial (26%) support. The least accessible resources were economists (52%), consumers (49%) and practice change experts (34%); researchers affiliated with health services were less likely to report access to statisticians (P<0.001), economists (P<0.001), librarians (P=0.02) and practice change experts (P=0.02) than university-affiliated researchers. Common impacts included conference presentations (94%), publication of peer-reviewed articles (87%) and health professional benefits (77%). Qualitative data emphasised barriers such as embedding research culture within services and engaging with policy makers. Conclusions The data highlight opportunities to sustain the HSR community through dedicated funding, improved access to methodological expertise and greater engagement with end-users. What is known about the topic? HSR faces several challenges, such as inequitable funding allocation and difficulties in quantifying the effects of HSR on changing health policy or practice. What does this paper add? Despite a vibrant and experienced HSR community, this study highlights some key barriers to realising a greater effect on the health and well-being of Australian and New Zealand communities through HSR. These barriers include limited financial resources, methodological expertise, organisational support and opportunities to engage with potential collaborators. What are the implications for practitioners? Funding is required to develop HSR infrastructure, support collaboration between health services and universities and combine knowledge of the system with research experience and expertise. Formal training programs for health service staff and researchers, from short courses to PhD programs, will support broader interest and involvement in HSR.

Introduction Despite improvements in oral health outcomes in New Zealand over the last number of decades, there are still high levels of preventable tooth decay in adults and children. We investigate the prevalence and spatial variation of non-fluoride toothpaste use in a nationally representative sample of adults and children in New Zealand.Method Individual-level self-reported data were sourced from the New Zealand Health Survey (2017/18). Both child (n = 4,723) and adult (n = 13,869) data were used. Data included sociodemographic (for example, age), socioeconomic (for example, area-level deprivation) and dental-related (for example, type of toothpaste used) variables.Results Overall, 6.8% of adults and 6.4% of children use non-fluoride toothpaste. When split by deprivation, the highest prevalence of non-fluoride toothpaste use for children and adults was in the moderate to least deprived areas, while the lowest prevalence was in the most deprived areas. When disaggregated by ethnicity, the Asian population had the highest prevalence of non-fluoride toothpaste use for both adults and children compared to Māori, Pacific and European/Other. There was little difference in prevalence by rural/urban classification; however, prevalence varied geographically across the study area.Conclusion This is the first study that uses a nationally representative sample of adults and children to show variation in the use of non-fluoride toothpaste in New Zealand.

Objectives: To investigate risk factors for women with obesity of childbearing age., Methods: A cross-sectional survey of New Zealand women (15-49 years) with measured height and weight was used [unweighted (n = 3625) and weighted analytical sample (n = 1,098,372)] alongside sociodemographic-, behavioural- and environmental-level predictors. Multilevel logistic regression weighted for non-response of height and weight data was used., Results: Meeting physical activity guidelines (AOR (adjusted odds ratio) 0.66, 95% CI 0.54-0.80), Asian (AOR 0.15, 95% CI 0.10-0.23) and European/other ethnicity (AOR 0.46, 95% CI 0.36-0.58) and an increased availability of public greenspace (Q4 AOR 0.55, 95% CI 0.41-0.75) were related to decreased obesity risk. Older age (45-49 years AOR 3.01, 95% CI 2.17-4.16), Pacific ethnicity (AOR 2.81, 95% CI 1.87-4.22), residing in deprived areas (AOR 1.65, 95% CI 1.16-2.35) or secondary urban areas (AOR 1.49, 95% CI 1.03-2.18) were related to increased obesity risk. When examined by rural/urban classification, private greenspace was only related to increased obesity risk in main urban areas., Conclusions: This study highlights factors including but not limited to public greenspace, which inform obesity interventions for women of childbearing age in New Zealand.

Aims: Rotaviruses have long been recognised as the most common cause of diarrhoea-related childhood morbidity and mortality worldwide. The benefits of national rotavirus vaccination programmes have been proven, with estimates of the reduction in hospital stays ranging from 70% to 90%. Previous work has found spatial variation in rotaviral rates between areas in Australia and Germany. This study sought to identify spatial and spatio-temporal variation in clustering of high and low neighbourhood rates of paediatric hospital admissions for RV disease in Auckland, New Zealand for the period 2006-2011., Methods: Annual clusters of rotavirus hospitalisations were identified using a Local Moran's I Index from ArcGIS. Spatio-temporal variation during the study period used a retrospective spatial variation in temporal trends scan statistic in SatScan., Results: Annual clusters of high and low rotavirus rates were identified for each year of the study and the spatio-temporal scan statistic confirmed that spatial clustering of rotavirus rates had shifted significantly during the study period., Conclusions: This research suggests that targeted rotaviral intervention is inappropriate and supports the introduction of a fully funded rotavirus vaccine in New Zealand in 2014.

Objectives: The determinants of health and mortality inequalities in New Zealand and Australia have been subjected to research, with the influence of a range of socio-economic and demographic influences (deprivation, social class, ethnicity) receiving notable attention. Both countries are considered privileged, positioned amongst the world leaders in rankings of mortality and life expectancy. This paper reports on observed rates of mortality and views how the countries have fared over time with respect to one another., Study Design, Observational, Methods: This study derives comparable rates of mortality for both New Zealand and Australia, disaggregated by age and sex for the time period 1948-2008. The age-standardised rates are visualised using the Lexis mapping software program, showing the relative differences between the countries over time whilst simultaneously highlighting age, period and cohort effects., Results: Relative to Australia, New Zealand had advantageous rates of mortality across almost all age groups between the years 1948 and 1980 (approximately). For both sexes, a dramatic reversal of fortunes in New Zealand has followed relative to Australia. For example, for younger males in New Zealand, the reversal is startling. Over the time period observed, males aged 10-20 years in New Zealand have moved from an advantageous position of having a mortality rate 20% lower than Australia to a relative position of 50% higher., Conclusions: The social and economic forces in both New Zealand and Australia which may have driven the divergence require further scrutiny. It is argued here, that the changing fortunes of the populations are linked to the process of selective migration and the large-scale population movements between the countries facilitated by the Trans-Tasman Travel Arrangement. These findings have important implications for policy formation and service planning, if the inequality in mortality between the areas of study is to be addressed., (Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Objective: To detect spatial clusters of high infant mortality rates in New Zealand for Māori and non-Māori populations and verify if these clusters are stable over a certain time period (1995-2008) and similar between the two populations., Method: We applied the Kulldorff's spatial scan statistics on data collected by New Zealand Ministry of Health (1995 to 2008) at the territorial local authorities (TLA) level. Kappa coefficient was used to assess the concordance between clusters obtained for Māori and non-Māori populations. T-test analyses were conducted to identify associations between spatial clusters and two predictors (population density and deprivation score)., Results: There are some significant spatial clusters of infant mortality in New Zealand for both Māori and Non-Māori. The concordance of the cluster locations between the two populations is strong (kappa=0.77). Unsurprisingly, infant mortality clusters for both Māori and Non-Māori are associated with the deprivation score. The population density predictor is only significantly and positively associated with clusters obtained for the non-Māori population. After controlling for deprivation the presence of spatial clusters is all but eliminated., Conclusions: Infant mortality patterns are geographically similar for both Māori and Non-Māori. However, there are differences geographically between the two populations after accounting for deprivation., Implications: Health services that can affect infant mortality should be aware of the geographical differences across NZ. Deprivation is an important factor in explaining infant mortality rates and policies that ameliorate its effects should be pursued, as it is the major determinant of the geographical pattern of infant mortality in NZ., (© 2014 The Authors. ANZJPH © 2014 Public Health Association of Australia.)

Objective: To examine the association between hospitalisations for otitis media and area-level measures of household crowding among children in New Zealand., Methods: Counts of hospital admissions for otitis media by census area unit were offset against population data from the 2006 national census. Area-level household crowding, exposure to tobacco smoke in the home, equivalised income and individual-level characteristics age and sex were adjusted for. To examine effect modification by ethnicity, three separate poisson models were examined for the total, Māori and non-Māori populations., Results: Household crowding was significantly associated with hospital admissions for otitis media after adjustment in all three models. Neighbourhoods with the highest compared to the lowest proportion of crowded homes exhibited incidence rate ratios of 1.25 (95%CI 1.12-1.37) in the total population, 1.59 (95%CI 1.21-2.04) in the Māori restricted model and 1.17 (95%CI 1.06-1.32) in the non-Māori restricted model., Conclusions: Otitis media hospitalisations are associated with area-level measures of household crowding and other risk factors in this ecological study. The largest increase in otitis media incidence relative to neighbourhood rates of household crowding was exhibited among Māori cases of otitis media., Implications: This study adds weight to the growing body of literature linking infectious disease risk to overcrowding in the home., (© 2014 The Authors. ANZJPH © 2014 Public Health Association of Australia.)

Objective: To examine the association between geographic access to alcohol outlets and serious violent crime in New Zealand., Methods: A national study of alcohol outlet access and serious violent crime used a cross-sectional ecological analysis. Serious violence offences recorded between 2005 and 2007 were aggregated for 286 police station areas. Using Geographical Information Systems (GIS), 9,320 licensed premises were geocoded and road travel distances to the closest alcohol outlet type/category were calculated for each area. Negative binomial regression models measured the association between the distance to the closest alcohol outlet and the number of serious violent offences in each police station area, controlling for area-level measures of social deprivation, Māori population, young males 15-29 years and population density., Results: There were significant negative associations between distance (access) to licensed outlets and the incidence of serious violent offences with greater levels of violent offending recorded in areas with close access to any licensed premises compared to those areas with least access (IRR 1.5, 95% CI 1.10-2.03); with on-licensed premises (IRR 1.6, 95% CI 1.16-2.08); and off-licensed premises (IRR 1.4, 95% CI 1.05-1.93)., Conclusion: Having greater geographic access to alcohol outlets was associated with increased levels of serious violent offending across study areas., Implications: Alcohol availability and access promoted under the current liberalised licensing regime are important contextual determinants of alcohol-related harm within New Zealand communities., (© 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia.)

Aims: Drawn from a study aimed at exploring students' drinking behaviour and attitudes, this article focuses upon findings that revealed how heavy-drinking students monitored and managed their experiences of alcohol intoxication., Methods: 819 students residing within three university student residences were invited to participate in three phases of data collection. Utilising a combination of qualitative and quantitative research methods, a total of 15 focus group interviews and 18 indepth interviews were undertaken, and 501 students (61%) completed a written survey questionnaire., Results: Sixty percent of students agreed with the statement "I usually know beforehand if I am going to get drunk". One-half of male drinkers and one-third of female drinkers reported they were intoxicated on a weekly basis. When drinking to intoxication, the majority of students monitored a range of drinking effects (a total of 14 were identified) which they considered were signals for the need to either slow down or stop drinking., Conclusions: The majority of drinkers in this study who consume alcohol with the intention of getting intoxicated, typically drink to a predetermined level of intoxication, and maintain that level by monitoring a range of drinking effects--this behaviour has been termed controlled intoxication. Future harm-minimisation strategies could be developed that encourage heavy-drinkers to adopt 'safer' drinking-effect signals as indicators to slow down or stop drinking.

Objectives: To describe the demographic, clinical and management aspects of an outbreak of tuberculosis (TB) within a paediatric Pacific Island community in Auckland, New Zealand, in 2002-2003., Methods: The index and source case are described along with details of the extensive contact tracing that was undertaken in this community., Results: A total of 24 children were diagnosed with TB over an 11-month period. All cases were found to be epidemiologically linked to the one source case, mother of the index case. This total included 22 children with pulmonary disease, 1 case of miliary disease (index case) and 1 of cervical adenitis. Only 58% had symptoms at diagnosis and only 5 presented to medical attention with symptoms, the remainder had symptoms disclosed after contact tracing occurred. The Mycobacterium tuberculosis isolate was fully sensitive and all children (excluding the child with miliary disease) received short course directly observed therapy. One child developed hepatotoxicity requiring modification of his drug regimen., Conclusions: Children are at high risk of developing active disease after exposure to TB. The study describes the minimal symptoms manifested in many of the children with significant radiological changes consistent with pulmonary TB. This highlights the need to consider Mantoux testing and chest X-rays for children presenting with persistent respiratory symptoms in high-risk populations. Issues of contact tracing and adherence were also a problem in this population.