General practice ethnicity data: evaluation of a tool

INTRODUCTION: There is evidence that the collection of ethnicity data in New Zealand primary care is variable and that data recording in practices does not always align with the procedures outlined in the Ethnicity Data Protocols for the Health and Disability Sector. In 2010, The Ministry of Health funded the development of a tool to audit the collection of ethnicity data in primary care. The aim of this study was to pilot the Ethnicity Data Audit Tool (EAT) in general practice. The goal was to evaluate the tool and identify recommendations for its improvement. METHODS: Eight general practices in the Waitemata District Health Board region participated in the EAT pilot. Feedback about the pilot process was gathered by questionnaires and interviews, to gain an understanding of practices’ experiences in using the tool. Questionnaire and interview data were analysed using a simple analytical framework and a general inductive method. FINDINGS: General practice receptionists, practice managers and general practitioners participated in the pilot. Participants found the pilot process challenging but enlightening. The majority felt that the EAT was a useful quality improvement tool for handling patient ethnicity data. Larger practices were the most positive about the tool. CONCLUSION: The findings suggest that, with minor improvements to the toolkit, the EAT has the potential to lead to significant improvements in the quality of ethnicity data collection and recording in New Zealand general practices. Other system-level factors also need to be addressed

Inequities in adolescent sleep health in Aotearoa New Zealand: Cross-sectional survey findings.

OBJECTIVES: To investigate ethnic inequities in, and social determinants of, adolescent sleep health in Aotearoa New Zealand. METHODS: Analysis of self-report data from a cross-sectional survey of secondary school students (12- to 18-year-olds). Analyses included weighted prevalence estimates of good and poor sleep health stratified by ethnicity, and multivariable logistic regression models concurrently adjusted for ethnicity, school year, gender, rurality, neighborhood deprivation, school decile, housing deprivation, sleeping elsewhere due to lack of adequate housing, unsafe environment, and racism. RESULTS: Inequities in social determinants of health were evident for Māori (Indigenous peoples of Aotearoa New Zealand; n = 1528) and minoritized (Pacific n = 1204; Asian n = 1927; Middle Eastern, Latin American, and African [MELAA] n = 210; and 'Other' ethnicity n = 225) adolescents. A greater proportion of Māori, Pacific, Asian, MELAA, and 'Other' adolescents had short sleep, compared to European (n = 3070). Māori, Pacific, Asian, and MELAA adolescents were more likely to report late bedtimes (after midnight), and Māori, Pacific, and 'Other' adolescents were more likely to report early waketimes (5 AM-6 AM or earlier), on school days. Rurality, neighborhood deprivation, school-level deprivation, housing deprivation, sleeping elsewhere due to inadequate housing, unsafe environments, and racism partially, but not fully, explained associations between ethnicity and short sleep, late bedtimes, and early waketimes. CONCLUSIONS: Ethnic inequities exist in adolescent sleep health in Aotearoa New Zealand. Socio-political actions are needed to address racism and colonialism as root causes of ethnic inequities in adolescent sleep, to ensure all young people are afforded the basic human right of good sleep health and associated mental and physical well-being.fals

Health and wellbeing of Māori secondary school students in New Zealand: trends between 2001, 2007 and 2012

Abstract Objective: To describe the health status over time of Māori secondary school students in New Zealand compared to European students. Methods: Anonymous representative health surveys of New Zealand secondary school students were conducted in 2001, 2007 and 2012 (total n=27,306 including 5,747 Māori). Results: Compared to 2001, Māori students in 2012 experienced improved health, family and school connections. However, considerable inequity persists with Māori students reporting poorer health, greater exposure to violence and socioeconomic adversity compared to European students. When controlling for socioeconomic deprivation, inequity was substantially reduced, although worse Māori health outcomes remained for general health, mental health, contraceptive use, healthy weight, substance use, access to healthcare and exposure to violence. There was some evidence of convergence between Māori and European students on some indicators. Conclusions: There have been significant improvements for Māori youth in areas of health where there has been investment. Priority areas identified require adequate resourcing alongside addressing systematic discrimination and poverty. Implications for public health: Socioeconomic contexts, discrimination, healthcare access and identified priority health areas must be addressed to improve equity for Māori youth. Building on these gains and hastening action on indicators that have not improved, or have worsened, is required

The association between maternal and partner experienced racial discrimination and prenatal perceived stress, prenatal and postnatal depression: findings from the growing up in New Zealand cohort study

Background A growing number of studies document the association between maternal experiences of racial discrimination and adverse children’s outcomes, but our understanding of how experiences of racial discrimination are associated with pre- and post-natal maternal mental health, is limited. In addition, existent literature rarely takes into consideration racial discrimination experienced by the partner. Methods We analysed data from the Growing Up in New Zealand study to examine the burden of lifetime and past year experiences of racial discrimination on prenatal and postnatal mental health among Māori, Pacific, and Asian women in New Zealand (NZ), and to study the individual and joint contribution of mother’s and partner’s experiences of lifetime and past year racial discrimination to women’s prenatal and postnatal mental health. Results Our findings show strong associations between lifetime and past year experiences of ethnically-motivated interpersonal attacks and unfair treatment on mother’s mental health. Māori, Pacific, and Asian women who had experienced unfair treatment by a health professional in their lifetime were 66 % more likely to suffer from postnatal depression, compared to women who did not report these experiences. We found a cumulative effect of lifetime experiences of ethnically-motivated personal attacks on poor maternal mental health if both the mother and the partner had experienced a racist attack. Conclusions Experiences of racial discrimination have severe direct consequences for the mother’s mental health. Given the importance of mother’s mental health for the basic human needs of a healthy child, racism and racial discrimination should be addressed

Ethnic equity in Aotearoa New Zealand's COVID-19 response: A descriptive epidemiological study

Objectives: Aotearoa New Zealand employed one of the most stringent public health pandemic responses internationally. We investigated whether ethnic health equity was achieved in the response and outcomes, from COVID-19 elimination in June 2020 through to Omicron-response easing, including international border reopening, in 2022. Study design: Descriptive epidemiology study. Methods: All COVID-19 cases, patients tested for SARS-CoV-2 and people vaccinated against COVID-19 between 9 June 2020 and 13 April 2022 were examined over three response periods: by demographic features and COVID-19 outcomes, transmission and vaccination patterns, time-to-vaccination and testing rates. Results: There were 15,693 cases per 100,000, 138·7 hospitalisations per 100,000, and 9·8 deaths per 100,000 people. Pacific peoples and Indigenous Māori had, respectively, 9·3 to 35-fold and 1·5 to 8·3-fold higher risk of COVID-19, 5·1-fold and 2·6-fold higher age-standardised risk of hospitalisation and 9-fold and 4-fold higher age-standardised risk of death, than European or Other. Māori and Pacific peoples had lower vaccination coverage at critical points in the response, and slower access to vaccination (Adjusted Time Ratios for two doses 1·32 (95% CI 1·31–1·32) and 1·14 (1·14–1·14), respectively), than European or Other. Testing rates remained high, especially among Māori and Pacific peoples. Conclusions: Despite achieving a low overall burden of disease by international comparisons, the multi-faceted New Zealand response did not prevent stark ethnic inequities in access to vaccination and COVID-19 outcomes. Policies which address disparities in upstream determinants, early vaccine programme planning and implementation with high-risk communities, and prioritisation that addresses systematic ethnic disadvantage and promotes health equity in response decisions is recommended.fals

Human papillomavirus self-testing among unscreened and under-screened Māori, Pasifika and Asian women in Aotearoa New Zealand: A preference survey among responders and interviews with clinical-trial nonresponders

© 2022 The AuthorsINTRODUCTION: Māori, Pasifika and Asian women are less likely to attend cervical screening and Māori and Pasifika women are more likely to be diagnosed with later-stage cervical cancer than other women in Aotearoa New Zealand. This study-with under-screened women taking part in a randomized-controlled trial comparing self-testing and standard screening-explored the acceptability of a human papillomavirus (HPV) self-test kit and the preferred method for receiving it. METHODS: Māori, Pasifika and Asian women (N= 376) completed a cross-sectional postal questionnaire. Twenty-six women who had not accepted the trial invitation were interviewed to understand their reasons for nonparticipation. RESULTS: Most women found the self-test kit easy and convenient to use and reported that they did not find it painful, uncomfortable or embarrassing. This was reflected in the preference for a self-test over a future smear test on the same grounds. Most women preferred to receive the kit by mail and take the test themselves, rather than having it done by a doctor or nurse. There was a range of preferences relating to how to return the kit. Phone calls with nonresponders revealed that, although most had received the test kit, the reasons for not choosing to be involved included not wanting to, being too busy or forgetting. CONCLUSION: HPV self-testing was acceptable for Māori, Pasifika and Asian women in Aotearoa New Zealand. HPV self-testing has considerable potential to reduce the inequities in the current screening programme and should be made available with appropriate delivery options as soon as possible. PATIENT OR PUBLIC CONTRIBUTION: This study explored the acceptability of HPV self-testing and their preferences for engaging with it among Māori, Pasifika and Asian women. Thus, women from these underserved communities were the participants and focus of this study.Publishe

Treatment drop-in in a contemporary cohort used to derive cardiovascular risk prediction equations.

BACKGROUND: No routinely recommended cardiovascular disease (CVD) risk prediction equations have adjusted for CVD preventive medications initiated during follow-up (treatment drop-in) in their derivation cohorts. This will lead to underestimation of risk when equations are applied in clinical practice if treatment drop-in is common. We aimed to quantify the treatment drop-in in a large contemporary national cohort to determine whether equations are likely to require adjustment. METHODS: Eight de-identified individual-level national health administrative datasets in Aotearoa New Zealand were linked to establish a cohort of almost all New Zealanders without CVD and aged 30-74 years in 2006. Individuals dispensing blood-pressure-lowering and/or lipid-lowering medications between 1 July 2006 and 31 December 2006 (baseline dispensing), and in each 6-month period during 12 years' follow-up to 31 December 2018 (follow-up dispensing), were identified. Person-years of treatment drop-in were determined. RESULTS: A total of 1 399 348 (80%) out of the 1 746 695 individuals in the cohort were not dispensed CVD medications at baseline. Blood-pressure-lowering and/or lipid-lowering treatment drop-in accounted for 14% of follow-up time in the group untreated at baseline and increased significantly with increasing predicted baseline 5-year CVD risk (12%, 31%, 34% and 37% in <5%, 5-9%, 10-14% and ≥15% risk groups, respectively) and with increasing age (8% in 30-44 year-olds to 30% in 60-74 year-olds). CONCLUSIONS: CVD preventive treatment drop-in accounted for approximately one-third of follow-up time among participants typically eligible for preventive treatment (≥5% 5-year predicted risk). Equations derived from cohorts with long-term follow-up that do not adjust for treatment drop-in effect will underestimate CVD risk in higher risk individuals and lead to undertreatment. Future CVD risk prediction studies need to address this potential flaw

Youth Gambling: The health and wellbeing of New Zealand secondary school students in 2012

Gambling has become a widely available activity in today’s society (Hardoon & Derevensky, 2002; Turchi & Derevensky, 2006). In fact, many researchers “have noted that an entire generation has now grown up in an era when lottery and casino gambling is widely available and heavily advertised” (Volberg, Gupta, Griffiths, Ólason, & Delfabbro, 2010, p. 3). Evidence suggests that it has become a popular past-time not only for adults, but also for children and young people (Derevensky & Gupta, 2000; Gupta & Derevensky, 1998a; Hardoon & Derevensky, 2002; Jacobs, 2000; Splevins, Mireskandari, Clayton, & Blaszczynski, 2010; Turchi & Derevensky, 2006). Moreover, research indicates that gambling is one of the first risky activities that adolescents become involved with (i.e. they begin gambling prior to experimentation with alcohol, drugs, sexual behaviour) (Volberg, et al., 2010). Whilst for many youth involvement in gambling does not result in problematic behaviour, others go on to experience serious problems (Dickson, Derevensky, & Gupta, 2003). A vast range of adolescent gambling prevalence studies that have been undertaken over the past 25 years, across different countries, and incorporating general populations as well as youth specifically. Rates of youth problem gambling have often been found to be higher than the rates identified for adults (Huang & Boyer, 2007; Shaffer & Hall, 1996; Welte, Barnes, Tidwell, & Hoffman, 2008; Williams, Page, Parke, & Rigbye, 2008), with some estimating them to be more than double those of adults (Gupta & Derevensky, 1998a; Jackson, Dowling, Thomas, Bond, & Patton, 2008; Lesieur, et al., 1991), or up to three times as high (Rigbye, 2010). However, it has also been recognised that there is far less research in this field compared to that which has explored other youth risk behaviours such as substance use (Blinn-Pike, Worthy, & Jonkman, 2010). The gap in New Zealand-based information regarding prevalence of youth gambling has been identified previously (Bellringer, et al., 2003; Rossen, Tse, & Vaidya, 2009) and in 2003 it was recommended that research be undertaken to measure the involvement of New Zealand youth in gambling as well as associated factors and gambling-related problems (Bellringer, et al., 2003). A limited body of research has since employed various sources of data to consider youth gambling in New Zealand (e.g. Gray, 2010; Ministry of Health, 2008, 2009; Rossen, 2008; Rossen, Butler, & Denny, 2011). An extremely valuable source of information on New Zealand youth is the University of Auckland’s (UoA) National youth health and wellbeing surveys. To date, the UoA’s Adolescent Health Research Group (AHRG) has completed three National youth health and wellbeing surveys. The Youth2000 Survey Series aim to provide nationally representative information on the health and wellbeing of young people attending New Zealand secondary schools. The Survey Series includes a wide range of questions about issues that contribute to the health and wellbeing of young people (such as substance use, injuries and violence, home and family) and allow researchers to take an ecological approach to identifying overall risk and protective factors in young people’s lives. Youth’12, a survey of 8,500 secondary school students throughout New Zealand, is the most recent survey to be undertaken by the AHRG. The inclusion of gambling items in the Youth’12 survey provides a unique opportunity to examine the impacts of gambling and problem gambling on secondary school students throughout New Zealand within an ecological framework. This report was commissioned by the Ministry of Health and begins with a comprehensive review of the local and international youth gambling literature, followed by an overview of the Youth2000 Survey Series and methodology for Youth’12. A thorough analysis of Youth’12 gambling items was undertaken with results being reported under the following eight categories (detailed results for each set of analyses are also provided in the appendices): - Students and their own gambling (Section Five); - Unhealthy gambling amongst students (Section Six); - Attitudes and motivating factors towards gambling (Section Seven); - The impacts of others’ gambling on students (Section Eight); and, - Risk and protective factors for student gambling (Section Nine); - Gambling and Māori taitamariki in Aotearoa (Section 10); - Gambling and Pacific young people in New Zealand (Section 11); and, - Gambling and Asian young people in New Zealand (Section 12). Finally, a discussion chapter provides an overview of the findings and implications

Racism as a determinant of health: a systematic review and meta-analysis

Despite a growing body of epidemiological evidence in recent years documenting the health impacts of racism, the cumulative evidence base has yet to be synthesized in a comprehensive meta-analysis focused specifically on racism as a determinant of health. This meta-analysis reviewed the literature focusing on the relationship between reported racism and mental and physical health outcomes. Data from 293 studies reported in 333 articles published between 1983 and 2013, and conducted predominately in the U.S., were analysed using random effects models and mean weighted effect sizes. Racism was associated with poorer mental health (negative mental health: r = -.23, 95% CI [-.24,-.21], k = 227; positive mental health: r = -.13, 95% CI [-.16,-.10], k = 113), including depression, anxiety, psychological stress and various other outcomes. Racism was also associated with poorer general health (r = -.13 (95% CI [-.18,-.09], k = 30), and poorer physical health (r = -.09, 95% CI [-.12,-.06], k = 50). Moderation effects were found for some outcomes with regard to study and exposure characteristics. Effect sizes of racism on mental health were stronger in cross-sectional compared with longitudinal data and in non-representative samples compared with representative samples. Age, sex, birthplace and education level did not moderate the effects of racism on health. Ethnicity significantly moderated the effect of racism on negative mental health and physical health: the association between racism and negative mental health was significantly stronger for Asian American and Latino(a) American participants compared with African American participants, and the association between racism and physical health was significantly stronger for Latino(a) American participants compared with African American participants.<br /

Human papillomavirus (HPV) self-sampling among never- and under-screened indigenous Māori, Pacific and Asian women in Aotearoa New Zealand: A Feasibility Study

In Aotearoa New Zealand the majority of cervical cancer cases occur in women who have never been screened or are under-screened. Wāhine Māori, Pacific and Asian women have the lowest rate of cervical screening. Self-sampling for human papillomavirus (HPV-SS) has been shown to increase participation in cervical-cancer screening. A whole-of-system approach, driven by evidence in the most effective delivery of HPV-SS, is required to mitigate further widening of the avoidable gap in cervical screening access and outcomes between groups of women in Aotearoa. This single-arm feasibility and acceptability study of HPV self-sampling invited never- and under-screened (≥5 years overdue) 30-69-year-old women from general practices in Auckland, Aotearoa. Eligible women were identified by data matching between the National Cervical Programme (NCSP) Register and practice data. Focus groups were additionally held with eligible wāhine Māori, Asian and Pacific women to co-design new patient information materials. Questionnaires on HPV knowledge and post-test experience were offered to women. Our follow-up protocols included shared decision-making principles and we committed to follow-up ≥90% of women who tested positive for HPV. Data matching identified 366 eligible never- and under-screened wāhine Māori, Pacific and Asian women in participating practices. We were only able to contact 114 women and 17 on discussion were found to be ineligible. Identifying and contacting women overdue for a cervical screen was resource intensive, with a high rate of un-contactability despite multiple attempts. We found the best uptake of self-sampling was at focus groups. Of the total 84 HPV-SS tests, there were 5 positive results (6%), including 1 participant with HPV18 who was found to have a cervical adenocarcinoma at colposcopy. In our feasibility study, self-sampling was acceptable and effective at detecting HPV and preventing cervical cancer in under-screened urban wāhine Māori, Pacific and Asian women in Aotearoa. This is the first report of a cervical adenocarcinoma (Grade 1B) as a result of an HPV-18 positive self-sample in Aotearoa. We co-designed new patient information materials taking a health literacy and ethnicity-specific approach. This work provides policy relevant information to the NCSP on the resources required to implement an effective HPV self-sampling programme to improve equity in national cervical cancer screening