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Introduction: Autism is a lifelong neurodevelopmental condition that is estimated to impact 1 in 44 children. In Aotearoa New Zealand, the rate of autism among Pasifika children and young people (38.6 per 10,000 people) is substantively lower than other ethnic groups (67.5 for European and 47.2 for Māori); however, the complexities associated with Autism diagnosis in Pasifika is unknown. Aim: We compared rates of Autism and co-occurring diagnoses of conditions as a proxy for Autism case complexity between Pasifika and NMNP young people (aged 0-24 years) in Aotearoa New Zealand. Methods: This national, cross-sectional study was undertaken using data from a national database; the Integrated Data Infrastructure (IDI). Three separate indicators were created to reflect different types of complexity for someone with autism: Asperger’s syndrome (identifies those with lower complexity with fewer demands on support services); intellectual disability (higher needs/greater complexity); ORS funding (higher needs/greater complexity). Findings: In this present study, Pasifika in Aotearoa New Zealand had much lower autism identification rates in comparison to Non-Māori Non-Pasifika (NMNP) (53.3 per 10,000 vs 83 per 10,000). After adjusting for socioeconomic differences, Pasifika had significantly lower odds (Odds Ratio (OR) = 0.47) of having an Asperger’s syndrome diagnosis. However, Pasifika had significantly higher odds of having an intellectual disability (OR = 2.23) and being Ongoing Resources Scheme funded (OR = 2.18). Conclusions: Using this method within the IDI, Pasifika children in Aotearoa continue to have lower rates of Autism diagnosis; however, they are more likely to have a higher complexity of autism diagnosis.

Introduction New Zealand health training institutions have an important role in supporting health workforce training programmes in the Pacific Region. Aim To explore the experience of Pacific Island country-based doctors from the Cook Islands, Niue, and Samoa, studying in New Zealand’s University of Otago distance-taught Rural Postgraduate programme. Methods Document analysis (16 documents) was undertaken. Eight semi-structured interviews were conducted with Pacific Island country-based students. Thematic analysis of the interviews was undertaken using the framework method. The two data sources were analysed separately, followed by a process to converge and corroborate findings. Results For Pacific Island countries with no previous option for formal general practice training, access to a recognised academic programme represented a milestone. Immediate clinical relevance and applicability of a generalist medical curriculum with rural remote emphasis, delivered mainly at a distance, was identified as a major strength. Although technologies posed some issues, these were generally easily solved. The main challenges identified related to the provision of academic and other support. Traditional university support services and resources were campus focused and not always easily accessed by this group of students who cross educational pedagogies, health systems and national borders to study in a New Zealand programme. Study for individuals worked best when it was part of a recognised and supported Pacific in-country training pathway. Discussion The University of Otago’s Rural Postgraduate programme is accessible, relevant and achievable for Pacific Island country-based doctors. The programme offers a partial solution for training in general practice for the Pacific region. Student experience could be improved by tailoring and strengthening support services and ensuring their effective delivery.

Children's sleep has been shown to vary by ethnicity, but little is known about children's sleep in multiethnic households. In New Zealand, Pacific families are increasingly ethnically diverse, due to intermarriage and to people identifying as more than 1 ethnicity. Thus, the objective of this work was to explore children's sleep habits, and sleep-related parenting practices, in ethnically diverse Pacific families (EDPF).Ten qualitative interviews with adult members of EDPF were undertaken. Open-ended questioning was used.Informal, conversational interviews conducted in homes and workplaces in southern New Zealand.Fifteen adults from 10 EDPF.Interviews were recorded and transcribed. Thematic open coding was used to analyze transcripts and identify themes.Sleep practices such as bedtime routines and preferred sleep environments varied both within and between EDPF. The EDPF in this sample responded to the context in which they lived, and the demands of everyday life in New Zealand, when managing children's sleep. Respectful communication between parents was key to navigating cultural differences and resolving areas of tension. The families in this study aspired to instill strong multi-cultural knowledge and identities in their children. Some families had sought out resources to help with this, but they were often either difficult to find, or expensive.A variety of sleep habits and related parenting practices were observed in this small sample of EDPF, who recognized that raising children in multi-ethnic families was associated with distinct opportunities as well as challenges.

AIMS Pacific peoples have higher rates of chronic kidney disease (CKD) and are five times more likely to commence kidney replacement therapy compared with New Zealand (NZ) Europeans. As the majority live Auckland, this study looked at the prevalence of CKD in two Auckland Pacific Island health providers caring for a large proportion of Pacific peoples, of which almost 50% are Samoan, as well as NZ Europeans. METHODS De-identified information was requested on individuals who had two or more CKD tests (serum creatinine and urinary albumin creatinine ratios) more than 3 months apart. CKD prevalence across different demographic groups was determined. Logistic regression was used to look at associations of known risk factors and CKD. RESULTS Data from 25 127 patients was evaluated. Of the total sample, 7451 individuals identified as Samoans. The prevalence of CKD amongst all Samoans in this sample was 17.8% increasing to 36.3% in those Samoans that had been tested for CKD. The prevalence of CKD in this total sample was 13% increasing to 27.5% considering only those who had CKD testing. The odds of Samoans having CKD (adjOR: 1.9 [95%CI 1.7, 2.2]), all other Pacific Island ethnicities identified and NZ Maori (adjOR:1.5 [95%CI 1.3, 1.8]), were increased compared with non-Māori-non-Pacific (likelihood p value

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.

Aim: The aims of this paper are to quantify the impact of parental education on the five-year incidence of mental health conditions (MHC) in Pacific young people and to investigate the influence of other factors. Method: The analyses in this paper used data extracted from Aotearoa/New Zealand’s Integrated Data Infrastructure (IDI). Data relating to 383,595 young people (48,768 Pacific), identified in the 2013 Census, aged 12-24 years, and their parents’ were used. Logistic regression models were used to investigate the incidence of children with MHC from 2013-2018. Results: Mental health conditions were identified in one of five Pacific young people. Irrespective of ethincity, increased parental education was associated with decreased MHC. However, the association was only significant for those in specialist mental health care (OR=0. 897, 95%CI:0.881-0.913) but not for those seen in other health settings (OR=0. 989, 95%CI:0.974-1.004). The association, for specialist settings, was not mediated by the contribution of other factors (OR=0.941, 95%CI:0.926-0.958). However, increased parents education with the addition of social, cultural and economic advantages the number of Pacific children seen in the specialist mental health setting could be nearly halved. Conclusion: The findings show that a parental educational advantage exists for children who access specialist mental health care. However, there are more complex but far greater opportunities for the health of Pacific families if a coordinated education, housing, employment and health solution were possible. The gains from a multi-disciplinary Pacific solution exist in terms of reduced severity for and level of care to Pacific children with MHC.

ObjectivesIn 2019, under the World Kidney Day theme of ‘Kidney health for everyone everywhere’, the National Kidney Foundation of Samoa undertook an extensive community screening campaign to detect the estimated prevalence of chronic kidney disease (CKD) and its associated risk factors in the community.SettingFifteen screening sites, with 11 urban and rural sites on the main island of Upolu, and 4 in different rural areas on the island of Savaii.ParticipantsAll participants were self-referrals to the various screening sites. In total, 1163 Samoans were screened, with similar numbers from both urban and rural areas and similar numbers of female and male.Screening activitiesAll participants were screened for CKD using point of care serum creatinine determinations, with calculation of estimated glomerular filtration rate using the CKD-EPI formula and dipstix urinalysis. A standardised screening survey was used to capture demographic and medical history with associated risk factors of obesity, diabetes, using point of care determination of HbA1c and hypertension. Logistic regression was used to investigate the association of CKD with risk factors.ResultsIn total, 1163 people were screened for CKD within the month of March 2019. The prevalance of CKD (grades 1–5) was 44.5% (95% CI 41.6% to 47.4) with individual grade prevalence CKD 1: 3.7%, CKD 2: 6.1%, CKD 3: 30.7%, CKD 4: 2.9% and CKD 5: 1.0%. The prevalence of obesity (body mass index ≥32), diabetes and hypertension was 66.3%, 30.8% and 54.3%, respectively.ConclusionsThis is the first paper to report the estimated prevalence of CKD in Samoa or any other Pacific Island nation. It reveals an urgent need for further studies on the epidemiology of CKD in Samoa, to develop country-specific prevention strategies to mitigate this growing burden and prevent subsequent CKD associated complications including development of kidney failure and premature death.

We are drawn to this Talanoa in response to the call from Pacific Health Dialogue for frank and open discussion. Our contribution to the conversation is some reflections about our experience of academic health research as a collective of Māori and Pacific researchers trying to navigate within a large national research programme. Alongside this we will share the voyaging framework we developed to help locate ourselves as a collective, and articulate our needs and aspirations as early to mid-career researchers. Our collective met in the context of working with A Better Start – E tipu e rea, a National Science Challenge created by the New Zealand government.1 Better Start focuses on the health of children and young people across five key areas; healthy weight, resilient teens, successful literacy and learning, big data and Vision Mātauranga. Our team came together as collaborators within the Big Data theme, to explore the Integrated Data Infrastructure (IDI) as an area of possibility and challenge for both Māori and Pacific communities.

Using the Integrated Data Infrastructure (IDI) to investigate or research various social, cultural, health, or other related outcomes is appealing and has a lot of potential. The IDI offers sufficient numbers for researchers to investigate outcomes in Pacific communities to a level of detail not available in many studies. Additionally, it allows organisations to upload their own data to supplement measures in the IDI. The overall aim of this paper is discuss the appropriate values for research projects involving Pacific communities using IDI data; issues around ownership of data from Pacific communities; consent; identification; and other ethical considerations. Although the IDI has a great deal of potential for Pacific health research, many findings based on research using IDI data have been recognised as deficit-framed and polarising for the communities they describe. Some would argue that such findings highlight discrepancies in health or social equity and point to deficiencies that should be the responsibility of governmental organisations. Most analyses stop short of investigating practical pathways for communities to find solutions that are sympathetic to the values or established infrastructure of those communities. Instead, most communities found themselves characterised by deficit and feeling solely responsible for their poor situation. This paper proposes an extension to the Tivaivai/Tivaevae research framework and shows how it incorporates values that should be reflected in Pacific research using IDI data. With applications in a range of disciplines, the Tivaivai framework, like many Pacific research models, has been applied to quantitative or small mixed-methods projects, and usually restricted to Cook Islands research. This paper shows its usefulness can be applied to a strictly quantitative research framework, making it sympathetic to wider Pacific values as well as consistent with other familiar Pacific research frameworks. These concepts will be incorporated into a research project for an HRC funded Post-doctoral study investigating the value of education to health outcomes for Pacific families. It is hoped that this paper may provide a starting point for other quantitative Pacific research projects involving administrative or other big data.

Nakiro'anga ite au meitaki o tei 'āpi'i ia no te ora'anga pu'apinga no tātou te Vakevake a Te Moana Nui o Kiva e no'o nei i Aotearoa (Meitaki o te ‘Api'i) is a programme of research examining the benefits of education to health outcomes for Pacific families in Aotearoa using the Integrated Data Infrastructure (IDI) and it is an Health Research Council Pacific post-doctoral project. As a part of Meitaki o te ‘Api'i, the present study plans to investigate the relationship between parental education and child health outcomes in Pacific families. Using linked health, income, and Census data, the present study will model the influence of parental education levels on child health outcomes adjusted for other key factors. In this methodological paper, we provide details about this project that is in a relatively new data space for Pacific research and we describe our participants. Most children in the study were born in New Zealand and nearly all could speak English. Pacific children were slightly younger, more likely to be able to speak a Pacific or other languages, and most likely to live in areas of socio-ecenomic deprivation compared to non-Pacific children. Pacific children who identified with solely Pacific and Pacific with other ethnicities. Parents of children with solely Pacific ethnicity, more than a third of whom were born in New Zealand, over 60% spoke a Pacific language and four out of five held christian beliefs. By comparison, parents of children with Pacific with other ethnicities were; younger, New Zealand born, less likely to speak another language and half held christian beliefs. Compared with parents of children from Other ethnicities, parents of Pacific children had lower median incomes, were less likely to own their home and had fewer total years of education. It is important to note that the overall purpose of this study is not to highlight the differences between Pacific and other non Pacific families, but to look at the relationship between parental education and the health of children.

Introduction Donation of human tissue is essential for biomedical research to improve our understanding of the causes and treatment of diseases. To facilitate this, researchers need to understand what approaches and processes make donation and storage more acceptable for various communities. This study explores the perspectives of Pacific peoples living in Dunedin, New Zealand on the use of human tissues for biomedical research. Methods In April 2018, four focus groups (total of 18 participants) were held with members of the Pacific community in Dunedin. Each group was demographically different, with groups consisting of; elders of mixed ethnicity, university students, medical doctors and one Tongan group of mixed ages. An open-ended questioning style was used, with specific prompts about participant’s perceptions of the purpose and processes for donating tissues for research and things that might make them more or less likely to donate. Findings There were a diverse range of views expressed, reflecting the diversity of participants across different ethnicities and ages. While participant responses varied widely in terms of enthusiasm or caution towards different types of donation, similar themes emerged regarding the importance of detailed informed consent, and respect and trust towards both the donors and/or their tissues. The importance of culture and religion on the attitudes or perspectives towards donation was also highlighted. Finally, it was perceived that donation is likely to be more acceptable if researchers are able to explain why their work is meaningful in a Pacific context and adapt to Pacific situations and/or concerns within the research protocols. Conclusions For Pacific peoples to derive the most benefit from research initiatives it is important that processes to collect human tissue are respectful of cultural protocols and expectations to support participation. This study provides useful information to support the evolution of guidelines within the NZ research context.

Pacific people continue to carry a disproportionately heavy social and health burden relative to their non-Pacific peers in New Zealand, and those with less formal education are experiencing social and health declines. Improving education and educational needs is seen as being central to decreasing these health inequities. While expansive, the empirical evidence-base supporting this stance is relatively weak and increasingly conflicting. Using a large birth cohort of 1,368 eligible Pacific children, together with their mothers and fathers, this study longitudinally investigates the relationship between paternal education levels and sentinel measures of their children’s physical health, mental health and health risk taking behaviours during late childhood and early adolescence. In adjusted analyses, it was found that mothers and fathers who undertook further schooling over the 0–6 years postpartum period had children with significantly lower logarithmically transformed body mass index increases at 11-years and 14-years measurement waves compared to 9-years levels than those who did not study (p = 0.017 and p = 0.022, respectively). Furthermore, fathers who undertook further schooling over this 0–6 years postpartum period also had children with significantly lower odds of risk taking behaviours (p = 0.013). These results support policy aimed at increasing educational opportunities for Pacific people in New Zealand.

INTRODUCTION Pacific populations in New Zealand are aging, but little is known in the health-care environment about their experiences with cognitive impairment. AIM The aim was to explore the needs of Pacific peoples affected by age-related cognitive decline from the perspectives of health-care providers. METHODS Six health-care service providers from organisations focused on Pacific patients were interviewed to determine services available to aged Pacific peoples, access, and whether they met Pacific people’s needs. RESULTS Three areas of concern were identified by all participants: access to services; getting a diagnosis; and communication and language. Many experienced a lack of information and poor access to services. Diagnosis of cognitive impairment was frequently made difficult by inconsistent access to general practitioners in lower socio-economic areas. Communication was hindered by poor access to information in Pacific languages. DISCUSSION Common themes noted by all participating health-care providers indicated the needs of aged Pacific people experiencing cognitive decline were often not being met.

Recent evidence indicates a slight decline in the overall prevalence of obesity in New Zealand children (including Māori), but it is unknown whether this pattern is reflected across all iwi. We examined obesity prevalence (body mass index (BMI) ≥95th percentile) among 4-year-old children of Ngāti Whātua descent (n = 2031) enrolled in the B4 School Check from 2010 to 2016. Possible differences according to sociodemographic factors were examined. There was no evidence that obesity prevalence among Ngāti Whātua children changed throughout the study period. Mean prevalence was 21.2%, but there was marked yearly variation, ranging from 17.5% to 23.2%. Overall, mean prevalence differed according to sociodemographic factors, being higher in boys than girls (24.5% vs 17.9%) and among children from most deprived compared to least deprived households (25.5% vs 16.2%). Their overall mean BMI z-score was 0.88 (95%CI 0.84, 0.93), with sociodemographic differences mirroring those for prevalence: boys 0.99 vs girls 0.78; and most deprived 0.90 vs least deprived households 0.76. In conclusion, In contrast to national figures, obesity prevalence among Ngāti Whātua children appeared to be unchanged throughout the study period, indicating national data from the larger Māori population in New Zealand cannot be assumed to reflect the trends within individual iwi.

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/objectives Whether variation in sleep and physical activity explain marked ethnic and socioeconomic disparities in childhood obesity is unclear. As time spent in one behaviour influences time spent in other behaviours across the 24-hour day, compositional analyses are essential. The aims of this study were to determine how ethnicity and socioeconomic status influence compositional time use in children, and whether differences in compositional time use explain variation in body mass index (BMI) z-score and obesity prevalence across ethnic groups. Methods In all, 690 children (58% European, 20% Māori, 13% Pacific, 9% Asian; 66% low-medium deprivation and 34% high deprivation) aged 6-10 years wore an ActiGraph accelerometer 24-hours a day for 5 days yielding data on sedentary time, sleep, light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA). Height and weight were measured using standard techniques and BMI z-scores calculated. Twenty-four hour movement data were transformed into isometric log-ratio co-ordinates for multivariable regression analysis and effect sizes were back-transformed. Results European children spent more time asleep (predicted difference in minutes, 95% CI: 16.1, 7.4-24.9) and in MVPA (6.6 min, 2.4-10.4), and less time sedentary (-10.2 min, -19.8 to -0.6) and in LPA (-12.2 min, -21.0 to -3.5) than non-European children. Overall, 10% more sleep was associated with a larger difference in BMI z-score (adjusted difference, 95% CI: -0.13, -0.25 to -0.01) than 10% more MVPA (-0.06, -0.09 to -0.03). Compositional time use explained 35% of the increased risk of obesity in Pacific compared with European children after adjustment for age, sex, deprivation and diet, but only 9% in Māori and 24% in Asian children. Conclusions Ethnic differences in compositional time use explain a relatively small proportion of the ethnic differences in obesity prevalence that exist in children.

Poisoning is a common type of injury in New Zealand. The New Zealand National Poisons Centre (NZNPC) offers a free 24/7 specialist assessment service for enquiries about substance exposures for all New Zealanders. This study aimed to characterise calls to the NZNPC relating to Pasifika patients to explore the potential for unmet need or health disparity in this area.A retrospective analysis of 2018-2019 human exposure call data was performed. Patients were stratified into three groups: those with at least one Pacific ethnicity listed (Pasifika); those with known ethnicities but no Pacific ethnicity listed (non-Pasifika); those of unknown ethnicity (unknown). Demographic variables and substance groups were described.Of the 40,185 human exposure patients, 1,367 (3.4%) were Pasifika, 24,892 (61.9%) were non-Pasifika and 13,926 (34.7%) were of unknown ethnicity. The median age of Pasifika patients was 2.0 years, with 78.0% aged 0-5, and the exposure most commonly involved a liquid product (46.6%) and a simple analgesic (8.3%).The NZNPC receives a relatively small number of calls about exposures to Pasifika patients, especially given the youthful population demographic. It is unclear whether there is unmet need for this service, and this study suggests the need for further research.

The stakes for understanding sleep practices are rising as health inequalities related to sleep become more apparent. Pacific peoples in Aotearoa New Zealand face disproportionate challenges around poverty and health and sleep is one growing area of importance in addressing health inequalities. Through a qualitative study of 17 Pacific families in Aotearoa New Zealand, we provide a rare and valuable glimpse into the familial, cultural, social and economic context of sleep for Pacific families and children in New Zealand. These Pacific families uphold a core value of responsiveness to family, community, culture and faith. These values feed wellbeing in a variety of ways, especially when health is considered through Pacific, holistic frameworks. These families apply the same responsiveness to economic pressures, often taking on shiftwork. We show how responsiveness to family and culture, as well as limited economic means, permeates sleep practices within these Pacific households. These broader shaping factors must be acknowledged, considered, respected and integrated into any healthy sleep initiatives and interventions, in order to ensure benefit - and not harm - is achieved., Highlights • A rare, valuable and intimate glimpse into the familial, cultural, social and economic context of sleep for Pacific families in New Zealand. • Many health initiatives and interventions do not account for cultural variation and do not reach the populations that need them most. • A qualitative study, integrating the Fonofale Model of health, informing culturally relevant sleep interventions for Pacific families. • Pacific families value family, community, faith and culture; they are also disproportionately affected by economic hardship. Both impact sleep.

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.

Introduction: Falls are a common cause of injury in New Zealand. However, falls risk and prevalence have not been investigated in Pacific peoples. To address this knowledge gap, a literature review, falls risk screening, and attitudes towards exercise as falls prevention questionnaires were conducted in a Pacific population in the southern regional town of Dunedin. Aims: To identify the attitudes towards strength and balance exercise as falls prevention within Pacific Islands peoples in Dunedin, New Zealand. Methods: Participants aged 55+ were recruited from Pacific Trust Otago, flyers, at church groups and existing exercise classes. Falls screening was assessed by the New Zealand Health Quality and Safety Commission’s Ask, Assess, Act questionnaire. Attitudes towards exercise as falls prevention intervention, was assessed using a culturally adapted version of the Attitudes to Falls-Related Intervention Scales (AFRIS). Both questionnaires were verbally administered in the participants’ native tongue. Results: Fifty respondents (mean age: 68.69, males: 39.58%, females: 60.42%) completed the questionnaires. Just over 56% indicated falls risk (62.07% female and 52.63% male) and 30% reported a fall in the last 12 months (31.03% females and 21.05% males). AFRIS highest mean score, was 6.69 (out of 7) for readiness to engage in strength and balance exercise to prevent falls. The lowest score (6.4) was ease of exercise participation. The total mean AFRIS score was 38.96 out of a possible 42. Conclusions: Self-reported falls in the past year and risk within this population was comparable to other groups and highlights the need for falls prevention that caters to cultural needs. The positive response to adding strength and balance exercise provides supporting evidence of incorporating strength and balance exercises into existing programmes

AIM To evaluate New Zealand media articles on their coverage of key issues regarding health interventions and whether it is consistent with available evidence. METHODS A retrospective analysis was carried out of all articles published in five New Zealand media sources over a 6-week period between 15 October and 26 November 2014. Articles were included if their primary focus was on health interventions involving medications, devices or in-hospital procedures. Articles were assessed for coverage of key issues using previously validated 10-point criteria. A literature review was performed to compare content with scientific evidence. RESULTS We identified 30 articles for review. Only 4 of 30 articles covered indications, benefits and risks, and of these, two were consistent with available evidence (7%, 95% CI 1%-22%). For articles that discussed at least one of indications, benefits or risks, and there was corresponding evidence available, there was a high level of consistency with the evidence (89%, 95% CI 77%-95%). The overall mean value of coverage from the 10-point criteria was 51% (95% CI 45%-58%). Single questions regarding the potential harm, costs associated with the intervention and the availability of alternative options were particularly poorly covered. They were rated as 'satisfactory' in 13%, 23% and 33% of the 30 articles respectively. CONCLUSION New Zealand news articles covering medical treatments and interventions are largely consistent with available evidence but are incomplete. Vital information is being consistently missed, especially around the potential harms and costs of medical interventions.

Summary This review investigated whether randomised controlled trials attempting to improve sleep or prevent sleep problems in 0–5 year olds influenced nocturnal sleep duration, day-time naps, or 24-h sleep. Medline (Ovid), EMBASE, and CINAHL were searched from inception until 9 July 2020 and supplemented with hand searching. Search results were screened, eligible data were extracted, and risk of bias was assessed by at least two reviewers. Of 8571 publications considered, 32 trials which used a variety of subjective and objective sleep measurements were included in generic inverse variance random effects meta-analysis of nocturnal (n = 24), day-time (n = 14), and 24-h (n = 13) sleep duration. Overall, sleep interventions increased nocturnal sleep duration by a mean of 9 min (95% CI 4.1 to 13.8, I228%) per night when compared with no sleep intervention. Increases were predominantly seen in sleep-only, rather than multi-component interventions. Total 24-h sleep duration tended to increase by a similar amount (8.6 min (95% CI -2.7 to 19.8, I2 = 59%)), but this was mainly only seen in studies that assessed sleep using diaries. There was no evidence that interventions changed day-time sleep duration. Future studies should involve sleep-only rather than multi-component interventions, and use objective sleep measures (reviewregistry857).

This paper describes a qualitative survey of professional statisticians carried out in New Zealand in 2014. The aim of the study was to find out if the issues this group faced were consistent with those identified in the literature. The issues identified were integrity, legitimacy, isolation, workforce shortage, communication, and marginalisation. They represent points of frustration for statisticians that may impact on the future of the profession as it responds to increasing demands and higher expectations. We found that these issues resonated for many of the statisticians included in our study and we have discussed a number of strategies to address them. They include raising our profile, attracting a broader range of people to the profession, increasing our communication skills, raising the statistical literacy of the people we work with, and a commitment to making it easy to engage with our colleagues. First published November 2017 at Statistics Education Research Journal Archives

The Integrated Data Infrastructure (IDI) incorporates national data collected by many of New Zealand’s government agencies, some non-government organisations, Census and other national surveys. Using the IDI for research into social, cultural, health, or other outcomes has become much more common, reflecting its research potential. The primary aim of this paper is to discuss the utility of the IDI for use by Pacific researchers. We use the experiences from a research project collaboration between Pasifika Futures and a University of Otago study. A second aim for this paper is to discuss whether Pacific researchers should consider integrating their own data with data in the IDI. This is an option available to some organisations within the IDI, to supplement their own data with that of other government agencies. For Pacific researchers, the IDI offers sufficient numbers to investigate outcomes to a level of detail that was available to only a handful of previous studies. With its ability to draw information from multiple sources, it seems a valuable addition to the information requirements of Pacific health research. But it is not without its limitations and it falls well short of being the total solution to all Pacific data needs and the need for other contextual research is likely to remain necessary. Furthermore, from a Pacific perspective, it also comes with several caveats that can reduce its usefulness for many Pacific communities. It is particularly lacking in terms of measures that reflect the value of Pacific culture. The IDI offers a cost effective, secure and timely alternative to that process. We argue that it is important that as a community we encourage Pacific researchers to take leadership in shaping the stories that emerge from the IDI. To uphold Pacific world-views, prevent deficit-framed findings and even add value in terms of measures indicating strength of culture.

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.

ObjectivesGiven recent increases in awareness and uptake of electronic nicotine delivery systems (ENDS), we aimed to explore ENDS users’ information needs and search behaviours and whether information gaps exist.DesignQualitative study using semistructured interviews that probed participants’ smoking behaviours and ENDS use; data in this study examine ENDS information-seeking behaviours. We used qualitative description to analyse interview transcripts.Participants and settingWe recruited 39 current ENDS users (20 dual users and 19 exclusive ENDS users who reported having previously smoked cigarettes regularly) aged 18 and over, from three urban centres in New Zealand.ResultsSeveral participants used Google to search for information on ENDS’ health effects, but described the material they retrieved as vague or contradictory. Some interpreted the absence of information on long-term health effects as evidence ENDS did not pose potential health risks, and several perceived e-liquids as benign. Many relied on information sourced from other ENDS users, gleaned from online forums, YouTube or from discussions with friends and acquaintances; these sources typically presented ENDS positively. Several participants found specialist ENDS retailers provided valuable advice; non-specialist store staff generally lacked detailed product knowledge and sometimes offered inaccurate information.ConclusionPeople seeking information on ENDS’ health effects are more likely to retrieve recommendations, product reviews and endorsements from online sources or through exchanges with other users, than they are to find scientific data. Health authorities could help meet potential users’ information needs by, first, creating and frequently updating objective lay summaries of the latest scientific evidence; second, by mandating licensing for retailers with guidelines to disclose uncertainty over ENDS’ efficacy for cessation and longer-term health effects, and the need for complete substitution of ENDS for combustible cigarettes among those who use these products.

Literacy success is critical to unlocking a child’s potential and enhancing their future wellbeing. Thus, the early identification and redressing of literacy needs is vital. Pacific children have, on average, the lowest literacy achievement levels in New Zealand. However, this population is very diverse. This study sought to determine whether the current national health screening programme of pre-school children could be used as an early detection tool of Pacific children with the greatest literacy needs. Time-to-event analyses of literacy intervention data for Pacific children born in years 2005–2011 were employed. A multivariable Cox proportional hazard model was fitted, and predictive assessment made using training and test datasets. Overall, 59,760 Pacific children were included, with 6,861 (11.5%) receiving at least one literacy intervention. Tongan (hazard ratio [HR]: 1.33; 95% confidence interval [CI]: 1.23, 1.45) and Cook Island Māori (HR: 1.33; 95% CI: 1.21, 1.47) children were more likely to receive an intervention than Samoan children; whereas those children with both Pacific and non-Pacific ethnic identifications were less likely. However, the multivariable model lacked reasonable predictive power (Harrell’s c-statistic: 0.592; 95% CI: 0.583, 0.602). Regardless, important Pacific sub-populations emerged who would benefit from targeted literacy intervention or policy implementation.

Background: Beliefs about cancer risk and experience of early detection and treatment can impact on willingness to engage with these initiatives. This study describes changes in perceptions of cancer mortality, early detection and treatment among adult New Zealanders (NZ) between two cross-sectional studies conducted in 2001 and 2014/5. Methods: Data was collected via telephone interviews conducted by trained interviewers in 2001 (231 females and 207 males, 64% response rate) and 2014/5 (588 females and 476 males, 64% response rate). Participants were asked to identify the most common three causes of cancer mortality among women and then men. They were also asked to note their agreement or otherwise with statements about early detection and treatment of cancer. Results: There was an increase in proportions of men who correctly identified prostate cancer as one of the top three causes of cancer mortality among men, and also an increase among women who correctly identified bowel cancer as one of the top three. Most participants agreed that there were benefits from early detection for cancer outcomes. Over time, there was a significant decline in proportions which felt that most cancer treatment is “so terrible it is worse than death” and that alternative therapy has an “equal or better chance of curing cancer.” Conclusion: Internationally, there is little information available about changes in cancer perceptions over time, these findings suggest some changes in perceptions of treatment and awareness of types of cancer with the highest mortality in NZ, which should support timely engagement with early detection and treatment services.

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.

Objective: Cancer risk reduction messages are a part of cancer control efforts around the world. The complex reality is that risk factors differ for different types of cancer, making clear communication of desired behavioural changes more difficult. This study aims to describe awareness of risk factors for breast, bowel, cervical, prostate and lung cancer and cutaneous melanoma among New Zealanders in 2014/15 and identify changes in awareness since 2001. Methods: Two national telephone surveys, the first (CAANZ01) conducted in 2001, included 438 adults (231 females and 207 males, 64% response rate). The second, conducted in 2014/15 (CAANZ15), included 1064 adults (588 females and 476 males, 64% response rate). Results: In 2014/5, most participants could identify evidence-based risk factors for lung cancer and melanoma. In contrast, many participants were unable to name any risk factors (evidence-based or otherwise) for bowel (34.8%), breast (48.8%), cervical (53.9%) and prostate cancer (60.9%). Between 2001 and 2014/5 there were increases in the proportion of individuals identifying sunbeds as increasing melanoma risk, and alcohol consumption and family history as increasing risk for bowel and breast cancer. Conclusions: Effective communication of risk information for specific cancers remains a challenge for cancer control. Although some positive changes in awareness over the 14 year period were observed, there remains substantial room for progressing awareness of evidence-based risk factors.

To evaluate New Zealand media articles on their coverage of key issues regarding health interventions and whether it is consistent with available evidence.A retrospective analysis was carried out of all articles published in five New Zealand media sources over a 6-week period between 15 October and 26 November 2014. Articles were included if their primary focus was on health interventions involving medications, devices or in-hospital procedures. Articles were assessed for coverage of key issues using previously validated 10-point criteria. A literature review was performed to compare content with scientific evidence.We identified 30 articles for review. Only 4 of 30 articles covered indications, benefits and risks, and of these, two were consistent with available evidence (7%, 95% CI 1%-22%). For articles that discussed at least one of indications, benefits or risks, and there was corresponding evidence available, there was a high level of consistency with the evidence (89%, 95% CI 77%-95%). The overall mean value of coverage from the 10-point criteria was 51% (95% CI 45%-58%). Single questions regarding the potential harm, costs associated with the intervention and the availability of alternative options were particularly poorly covered. They were rated as 'satisfactory' in 13%, 23% and 33% of the 30 articles respectively.New Zealand news articles covering medical treatments and interventions are largely consistent with available evidence but are incomplete. Vital information is being consistently missed, especially around the potential harms and costs of medical interventions.

To determine whether sleep patterns (duration, timing, efficiency) differ by ethnicity.Longitudinal study.Dunedin, New Zealand.A total of 939 children (48% male) aged 4-12 years (572 European, 181 Māori, 111 Pacific, 75 Asian).All measurements were obtained at months 0, 12, and 24. Anthropometry was obtained using standard techniques, and parents completed questionnaires assessing demographics, dietary intake, and television habits of children. Sleep and physical activity were measured using Actigraph accelerometers over 1 week. Differences in sleep outcomes according to ethnicity were adjusted for demographics, weight status, and behavioral variables using mixed models.Pacific children had greater body mass index and were more likely to live in deprived areas than children from other ethnic groups (all P.001), but few differences were observed in behavioral variables. Pacific Island children slept 16 (95% confidence interval, 7-25) minutes less per night than New Zealand European children, predominantly as a result of later bedtimes (29; 20-38 minutes). By contrast, sleep efficiency did not differ by ethnicity or over time (all P≥.118). Māori children did not show the same relative deficits in sleep, displaying similar results to European children. Sleep duration decreased by 8 minutes (95% confidence interval, 6-10) a night each year over 2 years, and change over time did not differ by ethnicity (all P≥.165).From a young age, Pacific children had poorer sleep patterns than European children, and these patterns were maintained over 2 years.

IntroductionAchieving effective integration of healthcare across primary, secondary and tertiary care is a key goal of the New Zealand (NZ) Health Strategy. NZ’s regional District Health Board (DHB) groupings are fundamental to delivering integration, bringing the country’s 20 DHBs together into four groups to collaboratively plan, fund and deliver health services within their defined geographical regions. This research aims to examine how, for whom and in what circumstances the regional DHB groupings work to improve health service integration, healthcare quality, health outcomes and health equity, particularly for Māori and Pacific peoples.Methods and analysisThis research uses a mixed methods realist evaluation design. It comprises three linked studies: (1) formulating initial programme theory (IPT) through developing programme logic models to describe regional DHB working; (2) empirically testing IPT through both a qualitative process evaluation of regional DHB working using a case study design; and (3) a quantitative analysis of the impact that DHB regional groupings may have on service integration, health outcomes, health equity and costs. The findings of these three studies will allow refinement of the IPT and should lead to a programme theory which will explain how, for whom and in what circumstances regional DHB groupings improve service integration, health outcomes and health equity in NZ.Ethics and disseminationThe University of Otago Human Ethics Committee has approved this study. The embedding of a clinician researcher within a participating regional DHB grouping has facilitated research coproduction, the research has been jointly conceived and designed and will be jointly evaluated and disseminated by researchers and practitioners. Uptake of the research findings by other key groups including policymakers, Māori providers and communities and Pacific providers and communities will be supported through key strategic relationships and dissemination activities. Academic dissemination will occur through publication and conference presentations.

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.