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Background: Historical socio-political processes have produced gross inequity of health resource for Aboriginal Australians and New Zealand Māori. Objectives: This paper argues that socio-political factors resulting from the entrenchment of colonialism have produced significant personal and structural barriers to the utilisation of healthcare services and directly impact the health status of these two vulnerable groups. Design: Discussion Paper. Conclusions: Understanding the actual barriers preventing the utilisation of healthcare facilities, as perceived by Indigenous people, is essential in reducing the gross disparity between Indigenous and non-Indigenous morbidity and mortality in Australia and New Zealand. [ABSTRACT FROM AUTHOR]

Past decades have seen a 'peak car' phenomenon which is indicated by a decline in vehicle kilometers traveled (VKT) in many countries. Although the determinants of VKT have been widely discussed, the theoretical arguments remain unresolved, particularly on the role of transport policies, socioeconomic factors and the built environment. This paper aims to contribute to new evidence for these arguments by examining an auto-dependent city, Wellington, New Zealand. A new bottom-up approach is applied to examine the VKT per capita in terms of its four decomposed main elements: trips (T), travel mode (V), travel distance (K), and car ownership (C) based on micro-level regressions. The results of the analysis show VKT per capita is significantly affected by parking supply, public transport quality and the built environment. These effects vary between trip type and population groups. Changing lifestyles are now major factors in the decrease of VKT. [ABSTRACT FROM AUTHOR]

Objectives:The current study aimed to explore if the impact of various risk factors for chronic disease differed for people of Chinese, Indian and New Zealand European and Other (NZEO) ethnicities. Design:Data analysed for this paper was extracted from the 2003–04 and the 2006–07 NZ Health surveys for adults aged 25–70 which used a cross-sectional survey design. Data from both the survey waves were combined and all statistical analysis was done using SAS version 9.2 or 9.3. Ethnicity of participants was coded using a priority-based classification system as (1) Indian, (2) Chinese, (3) Other Asian, (4) NZEO, (5) Maori and (6) Pacific. Only data for Indians, Chinese and NZEO were used for the current study. Prevalence estimates and 95% confidence intervals for chronic disease and the associated risk factors were generated to describe the sample. Logistic regression analysis was used to examine whether the difference in the change in risk of chronic disease with different exposures was different according to ethnicity. Results:Higher deprivation resulted in increased risk of chronic disease in Indian and Chinese males but not in NZEO males (p= .03). There was a weak evidence for a differing effect of physical activity (p = .10) on chronic disease with the protective effect not seen in Indian or Chinese participants. Conclusion:The results of the current study indicate that some factors such as socio-economic deprivation and physical activity may impact differently on the prevalence of chronic disease according to ethnicity. The authors recommend further investigation of these factors using improved and innovative methodology and high-quality ethnicity data to better understand the factors underpinning ethnic disparities in disease prevalence among Asian sub-groups. [ABSTRACT FROM PUBLISHER]

To inform a larger research programme on informal teaching and learning in everyday settings in Aotearoa New Zealand, two parallel pilot studies were conducted to determine an appropriate method for capturing the everyday learning of culturally and socio-economically diverse children. The studies took place during the six-week holiday break between school years. In one, three Māori children participated, in the other three Tongan children. This paper discusses the unanticipated issues that arose as a result of the ‘ethic of cultural responsiveness’ that the research team developed during the course of the research. These included: the insights made visible by culturally informed interpretation of unremarkable everyday activities; the effects on family dynamics of the research; and responsibilities to participants. It is argued that for Māori and Tongan children culture and family are central to everyday learning and therefore the research process and interpretation of data must be culturally informed. [ABSTRACT FROM AUTHOR]

The increased use of information technology in health care allows researchers to generate data on rates of medication use among population groups, raising questions as to whether these rates are too high or too low. This paper presents findings from a study of records of all prescription medication dispensed in one New Zealand region (Te Tāirawhiti) over a one year period. The study examined patterns of psychotropic medication use amongst older people, by age, gender, ethnicity and socio-economic position. It concludes that the chances of being defined as needing psychotropic medication, that is, of being 'medicalised', are not evenly spread through the elderly population. Gender, age and ethnicity impacted significantly on whether prescriptions were received. Our results suggest the need for a nuanced understanding of the medicalisation of unhappiness and deviant behaviour amongst the elderly which takes into account barriers to treatment for some social groups. [ABSTRACT FROM AUTHOR]

Many western countries have experienced increased rates of youth suicide over recent years. This has been an issue of particular concern in New Zealand, since it had the highest rate of youth suicide among OECD countries in the mid-1990s. However, while attention is drawn to the now declining youth suicide rate by politicians and policy-makers, what is obscured is a cohort effect. In this paper we will argue that a cohort effect is clearly visible; suicide rates among 15-24 year olds came to the fore in the mid-1980s, peaking 10 years later, and were displaced by that among 25-35 year olds by the late-1990s. Further, this century has been characterised by the rise of suicide rates among 35-44 year olds. This effect correlates with a dramatic downturn in the New Zealand economy in a five-year period bracketing 1970. We argue for an increased focus on social and economic factors underlying suicide. [ABSTRACT FROM AUTHOR]

To describe access to and engagement with cervical and breast screening services for women who are Deaf or live with a physical or sensory disability in Aotearoa New Zealand (NZ). We carried out an online survey on a convenience sample of 84 women. Tests of association were undertaken between socio-demographics and cervical and breast screening; and between disability type, and health outcomes and barriers to screening respectively. Participants also reported specific barriers to screening. Living without family/partner and unemployment were associated with never having a cervical smear. Non-English preferred language, and urban residence were related to lower levels of breast self-examination; having insufficient income was related to never having a mammogram. Disability type was not related to either smear or mammogram on eligibility, uptake ever, or uptake timeframe. A higher proportion of those with multiple disability types experienced service environment barriers to having a cervical smear. Specific barriers to screening covered accessibility, service environment, and information. This study, unique in Aotearoa, provides insights into disabled women's access to and engagement with screening services and suggests factors that may inhibit or facilitate participation. Women with multiple disabilities may be disadvantaged in the seeking and delivery of screening. Rehabilitation and other practitioners need to be attuned to how women living with multiple disabilities may be disadvantaged in the seeking of, and, more importantly, the delivery of breast or cancer screening. Practitioners need to discuss with disabled women what supports or resources they need to have screening procedures, and to advocate for these supports for their clients. Practitioners need to ensure accessibility that encompasses the whole screening journey from the initial invitation to the obtaining of results. For practitioners to be able to provide equitable service delivery, the government and institutional policies and procedures that are developed must take into consideration the multiple needs of women living with disabilities. [ABSTRACT FROM AUTHOR]

To understand how suspected suicides are investigated in New Zealand we conducted a thematic analysis of in-depth interviews with coroners. Coroners identified the inquisitorial nature of the coronial system and coroners' wide powers of jurisdiction as key strengths of the system. Important influences in key areas of coronial decision making in cases of suspected suicides included; the need for more evidence – especially to determine intent, and family factors, including therapeutic jurisprudence. Coroners identified lack of follow up and monitoring of recommendations, poorly resourced coronial training and the personal impact of suicides as challenges of working in the coronial system. [ABSTRACT FROM AUTHOR]

This paper investigates gender differences in voting for the two major parties (Labour and National) and the two main small parties (Green and New Zealand First) at the 2011 New Zealand general election. In contrast to the gender gap found in many post-industrial societies with women being more likely to lean towards the left than men, this study reveals limited differences in party preferences among men and women in New Zealand. The only substantial gender difference is found in relation to voting for New Zealand First, with women being substantially less supportive of the populist party than men. This gap is robust and remains substantial even when gender differences in socioeconomic characteristics and issue positions related to the role of government, the welfare state and the presence of immigrants are taken into account. Interestingly, while no gender gap occurs at first sight in support for the mainstream right-wing party National, a gap does arise once gender differences in policy issue positions are controlled for, with women being more likely to support National than men. [ABSTRACT FROM PUBLISHER]

An integral part of colonisation is the suppression and marginalisation of indigenous knowledges. The indigenous health system within Aotearoa (New Zealand) was supplanted with a colonial infrastructure and praxis which has proven ineffective in addressing systemic health inequities created by the processes of colonisation. This novel study interrogates discursive representations of Māori (Indigenous peoples of Aotearoa) within colonial public health policy between 2006 and 2016. Colonial policy refers to generic or mainstream policy that are designed for 'all' New Zealanders. We utilised thematic analysis to examine 106 policies and, after excluding 13 ethnic specific policies, identified 68 policies containing no mention of Māori. The analysis highlights five themes relating to discursive representations of Māori. These were: i) silence about Māori health; ii) Māori as especially at risk; iii) Crown (lack of) responsiveness to te Tiriti o Waitangi obligations; iv) recognition of Māori philosophical approaches to service provision; and v) utilising mātauranga Māori (Māori knowledge). These findings suggest colonial policy presents a barrier to the pursuit of health equity and is poorly aligned to global Indigenous human rights declarations. Within the context of Aotearoa it echoes the sentiments of the key Waitangi Tribunal [WAI 2575] finding that health policy is contributing to health inequities and failing Māori. Health policy must be decolonised to better engage with human rights declarations and te Tiriti o Waitangi obligations in order to achieve health equity. [ABSTRACT FROM AUTHOR]

Purpose: Purpose in life and capabilities are two significant individual elements that enhance quality of life among older people. Capabilities refers to the extent to which older people are free to make choices that are important to them. At present, it is not known how purpose in life interacts with capabilities to influence quality of life for those living with a disability. This study examined the extent to which purpose in life and capabilities interacts with health status to affect quality of life, particularly for older people with a disability. Methods: Self-report data from participants in a longitudinal cohort study of older New Zealanders were analyzed. Responses from 452 older people with a disability were compared with 3299 age- and gender-matched older people without a disability on indicators related to health and aging. The associations were tested using hierarchical regression. Mediational impact of purpose in life and capabilities were tested via path analysis. Results: Mental health, physical health, purpose in life, and capabilities accounted for a significant amount of variance in quality of life for older people with a disability. Purpose in life and capabilities were significant unique mediators for older people with a disability. Conclusions: Purpose in life may help older people with a disability to deal with early onset stressors or changes in mental and physical health to maintain overall quality of life. The role of capabilities suggests that the social environment and access to resources and choices are important in ensuring that older people aging with or into a disability achieve quality of life in a socially just environment. Purpose in life and capability are unique mediators of the relationship between health status and quality of life. Purpose in life may act as an effective buffering mechanism to deal with disability in later life while capability can empower older people with a disability to achieve quality of life in a just environment. The notion of successful aging with disability should be re-defined as using psychological, social support, and healthcare resources to live a life consistent with personal values in the context of disability Rather than emphasizing structural factors and physical functioning in activity participation, older people with disability should be supported to decide and pursue their own preferences. Rehabilitation professionals can work flexibly with older people with disability to maximize their resilience, dignity, autonomy and choice, and positive connection to others. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the prevalence of hearing loss and ear problems in Pacific children, and investigate current and past demographic, health and social factors potentially associated with hearing and ear problems. Design: A cross-sectional observational study design nested within a birth cohort was employed. Study sample: Nine-hundred-twenty Pacific children aged 11 years were audiologically assessed. Using average hearing thresholds at 500, 1k and 2k Hz, 162 (18%) right and 197 (21%) left ears had ≥20 dB hearing loss. Hearing loss was mild (20-39 dB) in most cases; 2% of ears had moderate to moderate-severe (40-69 dB) hearing loss. However, only 101 (11%) children had normal peripheral hearing defined by passing hearing threshold, tympanogram and distortion product otoacoustic emission assessments. Those with confirmed middle ear disease at age 2 years had significantly increased odds of a non-Type A tympanogram (adjusted odds ratio: 2.00; 95% confidence interval: 1.56, 2.50) when re-assessed at age 11 years. Conclusions: Hearing loss, abnormal tympanograms, and auditory processing difficulties were present in many Pacific children. Interventions are also urgently needed to mitigate the effect of the longstanding ear disease likely to be present for many Pacific children. [ABSTRACT FROM AUTHOR]

This study examined the direct and indirect effects of cognitions and anxiety associated with aftershocks on psychological symptoms (anxiety, depression, acute stress) and daily functioning (general and relationship). Participants were 600 adults from Christchurch, New Zealand. Data collection was approximately four months after the fatal 2011 earthquake. Path analysis was used for modelling. Socioeconomic status was directly associated with appraisals of uncontrollability of response to aftershocks. These cognitions were directly related to aftershock anxiety, which heightened general anxiety, depression, and acute stress symptoms. These symptoms were directly associated with relationship and general life dysfunction. Aftershock anxiety plays a significant role in ongoing psychological distress associated with earthquakes. [ABSTRACT FROM AUTHOR]

It is widely recognized that chronic illnesses pose significant challenges for health care systems around the world. In response, most governments have set health policies in order to manage (or better, reduce) demand and improve the health of their populations. A discourse analysis of four policy documents that shape these strategies in New Zealand reveals that the policies construct the chronically ill as “others,” that is, as deviant or different from the “normal” population. The discourse further serves to blame the chronically ill both for being sick, and for placing a serious financial burden on society. We identify problems that arise from this discourse. They relate to (a) the fact that chronic illnesses are so prevalent, (b) the fallacy of categorizing all chronic illnesses as the same, (c) tensions between a blaming discourse and current clinical best practice directions, and (d) a lack of recognition of the wider social factors that impact on health. [ABSTRACT FROM PUBLISHER]

Aim.To investigate the influence of ethnicity on immediate and long-term (five years post-partum) foetal, maternal and injury-related outcomes. Methods.A retrospective, population-based study analysing maternal discharge records linked to birth/death certificates for women aged 25 years and under. Discharge records were grouped according to ethnicity (Maori and non-Maori) and as follows: (1) a pregnancy-related hospital admission, but no associated or subsequent assault recorded (pregnant only); (2) an assault-related hospital admission event after the pregnancy, but within five years of the index pregnancy (assault after pregnancy); and (3) an assault recorded within the same hospital admission event as the pregnancy (assault during pregnancy). Generalised linear models for the binomial family were conducted to explore increased risk ratios of pregnancy-related and subsequent injury outcomes depending on ethnicity and group assignment. Results.Compared with the pregnancy-only group, rate ratios (RRs) for maternal and foetal outcomes were higher in the assault after pregnancy group and the assault during pregnancy group. For injury outcomes in the five years after the injury event, RRs for the assault after pregnancy group exceeded both the pregnancy-only and the assault during pregnancy groups. RRs for non-Maori women assaulted after pregnancy were higher for injury hospitalisations, fracture and intracranial injury than those for Maori women. Conclusion.Given that Maori women experience a higher prevalence of severe intimate partner violence and more difficulties accessing health care, we suggest that the findings highlight potential problems for health care access for Maori women experiencing violence. [ABSTRACT FROM AUTHOR]

Objective: Depression is common post-TBI, yet has not been studied longitudinally, nor at a population level. This study examined prevalence of depression in a population-based sample across the first year post-TBI. Design and methods: Prospective follow-up of 315 adults (>16 years) with assessments (Hospital Anxiety Depression Scale, DSM-IV criteria) at 1-, 6- and 12-months post-TBI. Demographic and injury-related predictors of depression at 1-year post-TBI were also explored. Results: The number of individuals identified as depressed reduced significantly between baseline and 12-months post-TBI from 21-12.4% using the HADS and 49-34% using DSM-IV criteria; with only 10 of the 28 individuals initially meeting criteria on the HADS continuing to do so at 12-month follow-up. Meeting HADS depression criteria was linked to pre-morbid depression and/or anxiety; while those meeting DSM-IV criteria were older, but not significantly so. Conclusions: The findings suggest depression is common post-TBI and that clinicians/researchers use caution in its diagnosis, as existing criteria have significant overlap with common TBI sequels. [ABSTRACT FROM AUTHOR]

This study investigated alcohol use, hazardous and binge drinking prevalence, and their relationships to socio-demographic variables in community dwelling older Māori adults in New Zealand. Alcohol use, hazardous drinking, and binge drinking were assessed with the AUDIT-C in a cross-sectional postal survey of 1042 older Māori people randomly selected from the New Zealand Electoral Roll. A total of 41.2% of all participants reported drinking at hazardous levels. Odds ratios from binomial logistic regression showed hazardous drinking was significantly more likely to occur among males, current smokers, and those with higher local self-contained network scores. Binge drinking was reported by 19.6% of the sample, with odds ratios indicating that males, current smokers, and those with higher Māori cultural identification scores were significantly more likely to report binge drinking. The high rates of hazardous and binge drinking prevalence reported in the current study raise issues of concern when considering the health of older Māori people. Results indicate that social networks, gender, smoking status, and Māori cultural identification may influence hazardous and binge drinking alcohol use. However, limitations of the present study also highlight the need for more focused and in-depth research to be conducted with older Māori people to understand the sociocultural context in which alcohol use occurs. [ABSTRACT FROM PUBLISHER]

Primary objective: This study investigated psychological disorders for patients receiving traumatic brain injury (TBI) rehabilitation within a community-based TBI service in New Zealand. Research design: Cross-sectional study involving retrospective review of clinical notes for all referrals received in a 6-month period. This methodology was selected to gain a sample of individuals reflective of the range of patients seen in TBI rehabilitation services in New Zealand. Methods and procedures: The clinical records for 279 patients were reviewed for formal psychiatric diagnoses and references to moderate or severe psychological symptoms. Main outcomes and results: Of the clinical records, 57.7% noted significant psychological problems post-injury ( n = 161) and 8.6% had a psychiatric diagnosis recorded, with 10.8% reporting psychological disorders pre-injury. In comparison, 15.1% had input from a clinical psychologist and 2.2% had involvement from a mental health team. Conclusions: The rate of psychological symptoms was significantly higher post-TBI than pre-TBI and few of the patients reporting significant psychological symptoms were receiving intervention from mental health professionals. Further research is needed regarding the ability of TBI rehabilitation professionals in New Zealand to identify and respond to the psychological implications of TBI and on the ability of TBI and mental health teams to liaise effectively. [ABSTRACT FROM AUTHOR]

A major challenge for education policymakers and educators globally is the strong and persistent impact of student socio-economic status (SES) on learning. This is a challenge that will not be addressed solely by school-focused reform. However, one policy initiative that could make a positive difference in this regard, and could bring other benefits to schools and communities, is equipping schools to act as hubs for a range of social and health services for their students, families, and communities. Schools as community hubs can not only act to mitigate the impact of poverty on learners, but can position schools at the centre of communities, and build community resilience and capacity. [ABSTRACT FROM AUTHOR]

Teacher education programs face significant challenges in preparing future teachers for diverse classroom settings. Rising student socioeconomic and ethnic diversity is sharply juxtaposed against a relatively homogenous preservice teacher population. This article advances arguments that support the incorporation of service-learning experiences into New Zealand Preservice Teacher Education programs to mediate the ethnic, cultural, and socioeconomic polarization of pupils and their teachers by providing additional preparation for teaching in disadvantaged school contexts. The benefits of including service learning into New Zealand teacher education programs will be discussed as they relate to best practices for preservice teachers and by association the schools and pupils they serve. [ABSTRACT FROM AUTHOR]

This study investigated the relation between multidimensional aspects of high school students' perceptions of their parental involvement and their achievement. It explored differences in socio-economic backgrounds, ethnicity, gender, and higher and lower achieving students, and a structural model was developed to further investigate these relations. A parental involvement questionnaire and measures of efficacy, liking and achievement in mathematics and reading were administered to a sample of 1,554 New Zealand high school students from 59 schools. In the view of students, there is support for parents to be talking to their children about learning and schooling and having high expectations of them and their future in learning, especially for lower achieving students. Students who claim that their parents are talking with their teachers or attending school meetings are more likely to have lower achievement. The implications from this study relate to developing student self-regulation for learning in home, providing more surface than deeper learning as homework, and assisting parents to learn the language of learning and schooling. [ABSTRACT FROM AUTHOR]

A qualitative analysis of the accounts of 29 adults who grew up in a controversial New Zealand community identified positive and negative experiences and their psychological implications. In addition to highly publicized child sexual abuse that occurred at Centrepoint, children also experienced parental neglect, psychological manipulation, illegal drug use and stigma from the broader society. These factors created an adverse matrix that facilitated sexual abuse. Positive experiences included support for vulnerable families and children, recreational activities, and the opportunity to develop communication skills. While there may be positive experiences for children living in intentional communities such as this one, it is important to be aware of the potential for psychological harm to children in communities with powerful, shared systems of belief, skepticism about the broader society, and strong dynamics of dependence. These findings may have implications for other similar communities operating elsewhere in the world. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To examine relationships between body mass index (BMI) and cardiovascular risk factors in 279 Europeans and 231 Polynesian Pacific Islanders in New Zealand. METHODS: Participants were recruited from Seventh-Day Adventist church meetings or camps, and were surveyed by self-administered questionnaire. Blood pressure, weight and height were measured. Fasting blood samples were analysed for lipids, glucose and fructosamine. RESULTS: Age-adjusted BMI was higher in Pacific Islanders than in Europeans: 32.8(0.3) versus 25.6(0.3); means(SE); p = 0.0001). In Europeans, BMI was positively associated with systolic and diastolic blood pressures, triglycerides, total cholesterol, LDL cholesterol and fasting blood glucose, and negatively associated with HDL cholesterol. In Pacific Islanders, BMI was associated only with systolic and diastolic blood pressures, and with HDL cholesterol. These associations were stronger in Europeans than in Pacific Islanders. CONCLUSIONS: In this group of Pacific Islanders, the association between BMI and cardiovascular risk factors was weaker than in Europeans. This suggests that either BMI is a poor measure of adiposity in Pacific Islanders, or that adiposity may be less strongly linked to cardiovascular disease in Pacific Islanders. [ABSTRACT FROM AUTHOR]