46 results on '"Blakely, Tony"'
Search Results
2. Housing and health: an updated glossary.
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Mansour, Adelle, Bentley, Rebecca, Baker, Emma, Ang Li, Martino, Erika, Clair, Amy, Daniel, Lyrian, Mishra, Shiva Raj, Howard, Natasha J., Phibbs, Peter, Jacobs, David E., Beer, Andrew, Blakely, Tony, and Howden-Chapman, Philippa
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REFERENCE books ,SOCIAL determinants of health ,MEDICAL protocols ,SOCIOECONOMIC factors ,HEALTH ,HOUSING ,POVERTY - Published
- 2022
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3. Closing the gaps in tobacco endgame evidence: a scoping review.
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Puljević, Cheneal, Morphett, Kylie, Hefler, Marita, Edwards, Richard, Walker, Natalie, Thomas, David P., Khan, Md Arifuzzaman, Perusco, Andrew, Le Grande, Michael, Cullerton, Katherine, Ouakrim, Driss Ait, Carstensen, Georgia, Sellars, David, Hoek, Janet, Borland, Ron, Bonevski, Billie, Blakely, Tony, Brolan, Claire, and Gartner, Coral E.
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SMOKING prevention ,HEALTH policy ,ONLINE information services ,CINAHL database ,TAXATION ,SALES personnel ,MEDICAL information storage & retrieval systems ,SYSTEMATIC reviews ,GOVERNMENT policy ,MEDLINE ,TOBACCO products ,TOBACCO - Published
- 2022
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4. Simulating future public health benefits of tobacco control interventions: a systematic review of models.
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Singh, Ankur, Wilson, Nick, and Blakely, Tony
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MATHEMATICAL models ,SYSTEMATIC reviews ,PUBLIC health ,GOVERNMENT policy ,THEORY ,DISEASE prevalence ,MEDLINE ,TOBACCO - Published
- 2021
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5. Elimination could be the optimal response strategy for covid-19 and other emerging pandemic diseases.
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Baker, Michael G., Wilson, Nick, and Blakely, Tony
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PREVENTION of epidemics ,PREVENTION of communicable diseases ,INFECTIOUS disease transmission ,EMERGENCY management ,PUBLIC health ,PUBLIC health surveillance ,STRATEGIC planning ,COVID-19 pandemic - Published
- 2021
6. Ten-year prediction model for post-bronchodilator airflow obstruction and early detection of COPD: development and validation in two middle-aged population-based cohorts.
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Perret, Jennifer L., Vicendese, Don, Simons, Koen, Jarvis, Debbie L., Lowe, Adrian J., Lodge, Caroline J., Bui, Dinh S., Tan, Daniel, Burgess, John A., Erbas, Bircan, Bickerstaffe, Adrian, Hancock, Kerry, Thompson, Bruce R., Hamilton, Garun S., Adams, Robert, Benke, Geza P., Thomas, Paul S., Frith, Peter, McDonald, Christine F., and Blakely, Tony
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- 2021
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7. Impact of tax and tobacco-free generation on health-adjusted life years in the Solomon Islands: a multistate life table simulation.
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Singh, Ankur, Petrović-van der Deen, Frederieke Sanne, Carvalho, Natalie, Lopez, Alan D., and Blakely, Tony
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HEALTH status indicators ,LIFE expectancy ,MEDICAL cooperation ,HEALTH policy ,PEOPLE with disabilities ,POLICY sciences ,RESEARCH ,SMOKING cessation ,STATISTICS ,TAXATION ,TOBACCO ,GOVERNMENT policy ,HUMAN services programs - Published
- 2020
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8. Prospective impact of tobacco eradication and overweight and obesity eradication on future morbidity and health-adjusted life expectancy: simulation study.
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Blakely, Tony, Cleghorn, Cristine, Petrović-van der Deen, Frederieke, Cobiac, Linda J., Mizdrak, Anja, Mackenbach, Johan P., Woodward, Alistair, van Baal, Pieter, and Wilson, Nick
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PREVENTIVE medicine ,PREVENTION of obesity ,SMOKING prevention ,AGE distribution ,HEALTH status indicators ,LIFE expectancy ,LONGITUDINAL method ,MATHEMATICAL models ,OBESITY ,RISK assessment ,THEORY ,BODY mass index ,DISEASE incidence ,DISEASE eradication - Published
- 2020
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9. Restricting tobacco sales to only pharmacies combined with cessation advice: a modelling study of the future smoking prevalence, health and cost impacts.
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Petrović-van der Deen, Frederieke S., Blakely, Tony, Kvizhinadze, Giorgi, Cleghorn, Christine L., Cobiac, Linda J., and Wilson, Nick
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MARKETING laws ,SMOKING prevention ,TRAVEL & economics ,ACQUISITION of property ,AGE distribution ,CONFIDENCE intervals ,COST control ,DRUGSTORES ,ETHNIC groups ,MATHEMATICAL models ,LEGAL status of sales personnel ,MEDICAL care costs ,SEX distribution ,SMOKING ,UNCERTAINTY ,THEORY ,POPULATION health ,TOBACCO products ,DISEASE prevalence ,QUALITY-adjusted life years ,TOBACCO laws - Published
- 2019
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10. Exercise programmes to prevent falls among older adults: modelling health gain, cost-utility and equity impacts.
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Deverall, Eamonn, Kvizhinadze, Giorgi, Pega, Frank, Blakely, Tony, and Wilson, Nick
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AGE distribution ,ELDER care ,CONFIDENCE intervals ,COST effectiveness ,ECONOMIC aspects of diseases ,ETHNIC groups ,EXERCISE ,ACCIDENTAL falls ,HEALTH services accessibility ,HEALTH status indicators ,HOME accident prevention ,HOME care services ,MATHEMATICAL models ,MEDICAL care costs ,SEX distribution ,MEDICAL care of indigenous peoples ,THEORY ,HUMAN services programs ,OLD age - Published
- 2019
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11. Impact of increasing tobacco taxes on working-age adults: short-term health gain, health equity and cost savings.
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Cleghorn, Christine L., Blakely, Tony, Kvizhinadze, Giorgi, van der Deen, Frederieke S., Nhung Nghiem, Cobiac, Linda J., and Wilson, Nick
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TOBACCO products ,COST control ,EMPLOYMENT ,HEALTH attitudes ,HEALTH services accessibility ,MEDICAL care ,RETIREMENT ,TAXATION ,ADULTS ,ECONOMICS - Published
- 2018
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12. A national quitline service and its promotion in the mass media: modelling the health gain, health equity and cost-utility.
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Nhung Nghiem, Cleghorn, Christine L., Leung, William, Nair, Nisha, van der Deen, Frederieke S., Blakely, Tony, and Wilson, Nick
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COST control ,ETHNIC groups ,HEALTH promotion ,MASS media ,SEX distribution ,SMOKING cessation ,HEALTH of indigenous peoples ,HEALTH equity ,QUALITY-adjusted life years ,CONFOUNDING variables - Published
- 2018
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13. Impact of five tobacco endgame strategies on future smoking prevalence, population health and health system costs: two modelling studies to inform the tobacco endgame.
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van der Deen, Frederieke S., Wilson, Nick, Cleghorn, Christine L., Kvizhinadze, Giorgi, Cobiac, Linda J., Nhung Nghiem, and Blakely, Tony
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COST control ,SMOKING ,DATA analysis software ,DESCRIPTIVE statistics - Published
- 2018
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14. Tobacco retail outlet restrictions: health and cost impacts from multistate life-table modelling in a national population.
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Pearson, Amber L., Cleghorn, Christine L., van der Deen, Frederieke S., Cobiac, Linda J., Kvizhinadze, Giorgi, Nghiem, Nhung, Blakely, Tony, and Wilson, Nick
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SMOKING prevention ,TRAVEL & economics ,COST control ,COST effectiveness ,MAORI (New Zealand people) ,PUBLIC health ,SALES personnel ,GOVERNMENT regulation ,TOBACCO products ,QUALITY-adjusted life years - Published
- 2017
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15. Home safety assessment and modification to reduce injurious falls in community-dwelling older adults: cost-utility and equity analysis.
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Pega, Frank, Kvizhinadze, Giorgi, Blakely, Tony, Atkinson, June, and Wilson, Nick
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ACCIDENTAL fall prevention ,COST effectiveness ,HEALTH promotion ,HEALTH status indicators ,RESEARCH funding ,RISK assessment ,SAFETY ,COST analysis ,HOME environment ,HUMAN services programs ,INDEPENDENT living ,QUALITY-adjusted life years ,DESCRIPTIVE statistics ,OLD age - Published
- 2016
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16. A Multilevel Analysis of Socioeconomic (Small Area) Differences in Household Food Purchasing Behaviours
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Turrell, Gavin, Blakely, Tony, Patterson, Carla, Oldenburg, Brian, Turrell, Gavin, Blakely, Tony, Patterson, Carla, and Oldenburg, Brian
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Study objective: To examine the association between area- and individual-level socioeconomic status (SES) and food purchasing behaviour. Design: The sample comprised 1000 households and 50 small areas, selected using a stratified two-stage cluster design. Data were collected by face-to-face interview (66.4% response rate). SES was measured using a composite area index of disadvantage (mean 1026.8, sd=95.2) and household income. Purchasing behaviour was scored as continuous indices ranging from 0 to 100 for three food-types: fruits (mean 50.5, sd=17.8), vegetables (61.8, 15.2), and grocery items (51.4, 17.6), with higher scores indicating purchasing patterns more consistent with dietary guideline recommendations. Setting: Brisbane metropolitan region, Australia, 2000 Participants: Persons aged 16-94 who were primarily responsible for their household’s food purchasing. Main results: Controlling for age, gender, and household income, a two standard deviation increase on the area-based SES measure was associated with a 2.01 unit-increase on the fruit purchasing index (95% CI -0.49 to 4.50). The corresponding associations for vegetables and grocery foods were 0.60 (-1.36 to 2.56) and 0.94 (-1.35 to 3.23). Prior to controlling for household income, significant area-level differences were found for each food, suggesting that clustering of household income within areas (a composition effect) accounted for the food purchasing variability between them. Conclusions: Living in a socioeconomically disadvantaged area was associated with a tendency to have a healthier food purchasing profile, however, the magnitude of the association was weak-to-moderate and the 95% confidence intervals for area-SES included the null. Even though urban areas in Brisbane are differentiated on the basis of their socioeconomic characteristics, it seems unlikely that where you live shapes your procurement of food over and above your personal characteristics. This is in contrast to metropolitan regions
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- 2004
17. Modelling the implications of regular increases in tobacco taxation in the tobacco endgame.
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Cobiac, Linda J., Tak Ikeda, Nhung Nghiem, Blakely, Tony, and Wilson, Nick
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SMOKING cessation -- Law & legislation ,TOBACCO products ,MARKETING ,RESEARCH funding ,SMOKING ,TAXATION ,DATA analysis software ,DESCRIPTIVE statistics ,ECONOMICS - Abstract
Objective We examine the potential role for taxation in the tobacco endgame in New Zealand, where the goal is to become 'smokefree' (less than 5% smoking prevalence) by 2025. Design Modelling study using a dynamic population model. Setting and participants New Zealand, Māaori and non-Māaori men and women. Interventions Annual increases in tobacco excise tax of 5%, 10%, 15% and 20% (with 10% reflecting the annual increase recently legislated by the New Zealand Government to 2016). Results With a continued commitment to annual 10% increases in tobacco excise tax, in addition to on-going Quitline and cessation support, New Zealand's smoking prevalence is projected to fall from 15.1% in 2013 to 8.7% (95% uncertainty interval 8.6% to 8.9%) by 2025. This is compared to 9.9% without any further tax rises. With annual tax increases of 20%, the prevalence is projected to fall to 7.6% (7.5% to 7.7%) by 2025. The potential reductions in smoking prevalence are substantial for both Māaori and non-Māaori populations, although annual tax increases as high as 20% will still only see Māaori smoking prevalence in 2025 approaching the non-Māaori smoking levels for 2013. Scenario analyses did not suggest that growth of the illicit tobacco market would substantively undermine the impact of tobacco tax rises. Nevertheless, unknown factors such as the gradual denormalisation of smoking and changes to the 'nicotine market' may influence sensitivity to changes in tobacco prices in the future. Conclusions Regular increases in tobacco taxation could play an important role in helping to achieve tobacco endgames. However, this modelling in New Zealand suggests that a wider range of tobacco endgame strategies will be needed to achieve a smokefree goal of less than 5% prevalence for all social groups--a conclusion that could also apply in other countries. [ABSTRACT FROM AUTHOR]
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- 2015
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18. Research paper. What will it take to get to under 5% smoking prevalence by 2025? Modelling in a country with a smokefree goal.
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Takayoshi Ikeda, Cobiac, Linda, Wilson, Nick, Carter, Kristie, and Blakely, Tony
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SMOKING prevention ,CONFIDENCE intervals ,ETHNIC groups ,MAORI (New Zealand people) ,PANEL analysis ,RESEARCH funding ,SMOKING cessation ,HARM reduction ,STATISTICAL models - Abstract
Background New Zealand has a goal of becoming a smokefree nation by the year 2025. Smoking prevalence in 2012 was 17%, but is over 40% for M_aori (indigenous New Zealanders). We forecast the prevalence in 2025 under a business-as-usual (BAU) scenario, and determined what the initiation and cessation rates would have to be to achieve a <5% prevalence. Methods A dynamic model was developed using Census and Health Survey data from 1981 to 2012 to calculate changes in initiation by age 20 years, and net annual cessation rates, by sex, age, ethnic group and time period. Similar parameters were also calculated from a panel study for sensitivity analyses. ‘Forecasts' used these parameters, and other scenarios, applied to the 2011-2012 prevalence. Findings Since 2002-2003, prevalence at age 20 years has decreased annually by 3.1% (95% uncertainty interval 0.8% to 5.7%) and 1.1% (−1.2% to 3.2%) for non-M_aori males and females, and by 4.7% (2.2% to 7.1%) and 0.0% (−2.2% to 1.8%) for M_aori, respectively. Annual net cessation rates from the dynamic model ranged from −3.0% to 6.1% across demographic groups, and from 3.0% to 6.0% in the panel study. Under BAU, smoking prevalence is forecast to be 11% and 9% for non-M_aori males and females by 2025, and 30% and 37% for M_aori, respectively. Achieving <5% by 2025 requires net cessation rates to increase to 10% for non-M_aori and 20% for M_aori, accompanied by halving or quartering of initiation rates. Conclusions The smokefree goal of <5% prevalence is only feasible with large increases in cessation rates. [ABSTRACT FROM AUTHOR]
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- 2015
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19. Research paper .Do changes in income, deprivation, labour force status and family status influence smoking behaviour over the short run? Panel study of 15 000 adults.
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Blakely, Tony, van der Deen, Frederieke S., Woodward, Alistair, Kawachi, Ichiro, and Carter, Kristie
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SMOKING & psychology , *CONFIDENCE intervals , *EMPLOYMENT , *FAMILIES , *INCOME , *RESEARCH funding , *LOGISTIC regression analysis , *SOCIOECONOMIC factors , *DATA analysis software , *DESCRIPTIVE statistics , *ODDS ratio - Abstract
BACKGROUND: Improving social circumstances (eg, an increase in income, finding a job or moving into a good neighbourhood) may reduce tobacco use, but robust evidence on the effects of such improvements is scarce. Accordingly we investigated the link between changing social circumstances and changing tobacco smoking using repeated measures data. METHODS: 15 000 adults with at least two observations over three waves (each 2 years apart) of a panel study had data on smoking status, family, labour force, income and deprivation (both neighbourhood and individual). Fixed effects regression modelling was used. FINDINGS: The odds of smoking increased 1.42-fold (95% CI 1.16 to 1.74) for a one log-unit increase in personal income among 15-24-year-olds, but there was no association of increased smoking with an increase in income among 25+ year olds. Moving out of a family nucleus, increasing neighbourhood deprivation (eg, 1.83-fold (95% CI 1.18 to 2.83) increased odds of smoking for moving from least to most deprived quintile of neighbourhoods), increasing personal deprivation and moving into employment were all associated with increased odds of smoking. The number of cigarettes smoked a day changed little with changing social circumstances. INTERPRETATION: Worsening social circumstances over the short run are generally associated with higher smoking risk. However, there were counter examples: for instance, decreasing personal income among young people was associated with decreased odds of smoking, a finding consistent with income elasticity of demand (the less one's income, the less one can consume). This paper suggests that improving social circumstances is not always pro-health over the short run; a more nuanced approach to the social determinants of health is required. [ABSTRACT FROM AUTHOR]
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- 2014
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20. Smoking uptake is associated with increased psychological distress: results of a national longitudinal study.
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Carter, Kristie N., van der Deen, Frederieke S., Wilson, Nick, and Blakely, Tony
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CONFIDENCE intervals ,LONGITUDINAL method ,REGRESSION analysis ,RESEARCH funding ,SMOKING ,SMOKING cessation ,PSYCHOLOGICAL stress ,DATA analysis software ,DESCRIPTIVE statistics - Abstract
Background There is evidence that smoking is associated with poorer mental health. However, the underlying mechanisms for this remain unclear. We used longitudinal data to assess whether smoking uptake, or failed quit attempts, are associated with increased psychological distress. Methods Data were used from Waves 3 (2004/05), 5 (2006/07) and 7 (2008/09) of the longitudinal New Zealand Survey of Family, Income and Employment. Fixed-effects linear regression analyses were performed to model the impact of changes in smoking status and quit status (exposure variables) on changes in psychological distress (Kessler 10 (K10)). Results After adjusting for time-varying demographic and socioeconomic covariates, smoking uptake was associated with an increase in psychological distress (K10: 0.22, 95% CI 0.01 to 0.43). The associations around quitting and distress were in the expected directions, but were not statistically significant. That is, smokers who successfully quit between waves had no meaningful change in psychological distress (K10: -0.05, 95% CI -0.34 to 0.23), whereas those who tried but failed to quit, experienced an increase in psychological distress (K10: 0.18, 95% CI -0.05 to 0.40). Conclusions The findings provide some support for a modest association between smoking uptake and a subsequent increase in psychological distress, but more research is needed before such information is considered for inclusion in public health messages. [ABSTRACT FROM AUTHOR]
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- 2014
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21. The impact of in-work tax credit for families on self-rated health in adults: a cohort study of 6900 New Zealanders.
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Pega, Frank, Carter, Kristie, Kawachi, Ichiro, Davis, Peter, Gunasekara, Fiona Imlach, Lundberg, Olle, and Blakely, Tony
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TAXATION statistics ,TAXATION ,CONFIDENCE intervals ,HEALTH status indicators ,LONGITUDINAL method ,RESEARCH funding ,SURVEYS ,DATA analysis software ,DESCRIPTIVE statistics - Abstract
Background In-work tax credit (IWTC) for families, a welfare-to-work policy intervention, may impact health status by improving income and employment. Most studies estimate that IWTCs in the USA and the UK have no effect on self-rated health (SRH) and several other health outcomes, but these estimates may be biased by confounding. The current study estimates the impact of one such IWTC intervention (called In-Work Tax Credit) on SRH in adults in New Zealand, controlling more fully for confounding. Methods We used data from seven waves (2002-2009) of the Survey of Family, Income and Employment, restricted to a balanced panel of adults in families. The exposures, eligibility for IWTC and the amount of IWTC a family was eligible for, were derived for each wave by applying government eligibility and entitlement criteria. The outcome, SRH, was collected annually. We used fixed effects regression analyses to eliminate time-invariant confounding and adjusted for measured time-varying confounders. Results Becoming eligible for IWTC was associated with no detectable change in SRH over the past year (β=0.001, 95% CI .0.022 to 0.023). A $1000 increase in the IWTC amount a family was eligible for increased SRH by 0.003 units (95% CI .0.005 to 0.011). Conclusions This study found that becoming eligible for IWTC or a substantial increase in the IWTC amount was not associated with any detectable difference in SRH over the short term. Future research should investigate the impact of IWTC on health over the longer term. [ABSTRACT FROM AUTHOR]
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- 2013
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22. Misclassification of the mediator matters when estimating indirect effects.
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Blakely, Tony, Mckenzie, Sarah, and Carter, Kristie
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EPIDEMIOLOGY research methodology , *CLASSIFICATION , *COMPUTER simulation , *EPIDEMIOLOGY , *MATHEMATICAL statistics , *RESEARCH funding , *DATA analysis , *MEASUREMENT errors , *PARAMETERS (Statistics) , *RESEARCH bias , *CROSS-sectional method , *STATISTICAL models - Abstract
Background Confounding of mediator–outcome associations resulting in collider biases causes systematic error when estimating direct and indirect effects. However, until recently little attention has been given to the impact of misclassification bias. Objective To quantify the impact of non-differential and independent misclassification of a dichotomous exposure and a dichotomous mediator on three target parameters: the total effect of exposure on outcome; the direct effect (by conditioning on the mediator); and the indirect effect (identified by the percentage reduction in the excess OR on adjusting for the mediator). Methods Simulations were conducted for varying strength of associations between exposure, mediator and outcome, varying ratios of exposed to unexposed and mediator present to mediator absent, and varying sensitivity and specificity of exposure and mediator classification.Results ORs before (total effect) and after adjustment (direct effect) for the mediator are both biased towards the null by non-differential misclassification of the exposure, but the percentage reduction in the excess OR is little affected by misclassification of exposure. Conversely, misclassification of the mediator rapidly biases the percentage reduction of the excess OR (indirect effect) downwards.Conclusions If the research objective is to quantify the proportion of the total association that is due to mediation (ie, indirect effect), then minimising nondifferential misclassification bias of the mediator is more important than that for the exposure. Misclassification bias is an important source of error when estimating direct and indirect effects. [ABSTRACT FROM AUTHOR]
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- 2013
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23. Potential advantages and disadvantages of an endgame strategy: a ‘sinking lid’ on tobacco supply.
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Wilson, Nick, Thomson, George W., Edwards, Richard, and Blakely, Tony
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- 2013
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24. Theoretical impacts of a range of major tobacco retail outlet reduction interventions: modelling results in a country with a smoke-free nation goal.
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Pearson, Amber L., van der Deen, Frederieke S., Wilson, Nick, Cobiac, Linda, and Blakely, Tony
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SMOKING prevention ,TRAVEL & economics ,LEGAL status of sales personnel ,POPULATION geography ,RESEARCH funding ,SMOKING ,TOBACCO ,COST analysis ,DESCRIPTIVE statistics ,ECONOMICS - Abstract
Objective To inform endgame strategies in tobacco control, this study aimed to estimate the impact of interventions that markedly reduced availability of tobacco retail outlets. The setting was New Zealand, a developed nation where the government has a smokefree nation goal in 2025. Methods Various legally mandated reductions in outlets that were phased in over 10 years were modelled. Geographic analyses using the road network were used to estimate the distance and time travelled from centres of small areas to the reduced number of tobacco outlets, and from there to calculate increased travel costs for each intervention. Age-specific price elasticities of demand were used to estimate future smoking prevalence. Results With a law that required a 95% reduction in outlets, the cost of a pack of 20 cigarettes (including travel costs) increased by 20% in rural areas and 10% elsewhere and yielded a smoking prevalence of 9.6% by 2025 (compared with 9.9% with no intervention). The intervention that permitted tobacco sales at only 50% of liquor stores resulted in the largest cost increase (∼$60/ pack in rural areas) and the lowest prevalence (9.1%) by 2025. Elimination of outlets within 2 km of schools produced a smoking prevalence of 9.3%. Conclusions This modelling merges geographic, economic and epidemiological methodologies in a novel way, but the results should be interpreted cautiously and further research is desirable. Nevertheless, the results still suggest that tobacco outlet reduction interventions could modestly contribute to an endgame goal. [ABSTRACT FROM AUTHOR]
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- 2013
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25. The relationship between income and health using longitudinal data from New Zealand.
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Imlach Gunasekara, Fiona, Carter, Kristie N., Liu, Ivy, Richardson, Ken, and Blakely, Tony
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CONFIDENCE intervals ,STATISTICAL correlation ,EPIDEMIOLOGY ,HEALTH status indicators ,INCOME ,INTERVIEWING ,LONGITUDINAL method ,POVERTY ,RESEARCH funding ,SURVEYS ,MATHEMATICAL variables ,LOGISTIC regression analysis ,DATA analysis ,EFFECT sizes (Statistics) - Abstract
Background Evidence for a cross-sectional relationship between income and health is strong but is probably biased by substantial confounding. Longitudinal data with repeated income and health measures on the same individuals can be analysed to control completely for time-invariant confounding, giving a more accurate estimate of the impact of short-term changes in income on health. Methods 4 years of annual data (2002--2005) from the New Zealand longitudinal Survey of Family, Income and Employment were used to investigate the relationship between annual household income and self-rated health (SRH) using a fixed-effects ordinal logistic regression model. Possible effect modification of the income--SRH relationship by poverty and baseline health was tested with interactions. Results An increase in income of $10 000 over the past year increased the odds of reporting better SRH by 1% (OR 1.01, 95% CI 1.00 to 1.02). Poor baseline health significantly modified the association between income and SRH. A $10 000 increase in income increased the odds of better SRH by 10% for those with two or more chronic conditions. Poverty or deprivation did not modify the income--health association. Conclusions The overall small, positive, but statistically non-significant, income--health effect size is consistent with similar analyses from other longitudinal studies. Despite the overwhelming consensus that income matters for health over the medium and long-term, evidence free of time-invariant confounding for the short-run association remains elusive. However, measurement error in income and health has probably biased estimates towards the null. [ABSTRACT FROM AUTHOR]
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- 2012
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26. Air pollution and mortality in New Zealand: cohort study.
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Hales, Simon, Blakely, Tony, and Woodward, Alistair
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MORTALITY , *AIR pollution , *CONFIDENCE intervals , *EPIDEMIOLOGY , *LONGITUDINAL method , *METROPOLITAN areas , *PROBABILITY theory , *RESEARCH funding , *LOGISTIC regression analysis , *DATA analysis , *ENVIRONMENTAL exposure , *SOCIOECONOMIC factors - Abstract
Background Few cohort studies of the health effects of urban air pollution have been published. There is evidence, most consistently in studies with individual measurement of social factors, that more deprived populations are particularly sensitive to air pollution effects. Methods Records from the 1996 New Zealand census were anonymously and probabilistically linked to mortality data, creating a cohort study of the New Zealand population followed up for 3 years. There were 1.06 million adults living in urban areas for which data were available on all covariates. Estimates of exposure to air pollution (measured as particulate matter with an aerodynamic diameter less than 10 &mgr;m, PM10) were available for census area units from a previous land use regression study. Logistic regression analyses were conducted to investigate associations between causespecific mortality rates and average exposure to PM10 in urban areas, with control for confounding by age, sex, ethnicity, social deprivation, income, education, smoking history and ambient temperature. Results The odds of all-cause mortality in adults (aged 30e74 years at census) increased by 7% per 10 μg/m3 increase in average PM10 exposure (95% CI 3% to 10%) and 20% per 10 μg/m3 among Maori, but with wide CI (7% to 33%). Associations were stronger for respiratory and lung cancer deaths Conclusions An association of PM10 with mortality is reported in a country with relatively low levels of air pollution. The major limitation of the study is the probable misclassification of PM10 exposure. On balance, this means the strength of association was probably underestimated. The apparently greater association among Maori might be due to different levels of co-morbidity. INSETS: What is already known on this subject;What this study adds. [ABSTRACT FROM AUTHOR]
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- 2012
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27. Seasonal patterns of mortality in relation to social factors.
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Hales, Simon, Blakely, Tony, Foster, Rache H., Baker, Michael G., and Howden-Chapman, Philippa
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MORTALITY , *CLIMATOLOGY , *COMMUNICABLE diseases , *CONFIDENCE intervals , *EPIDEMIOLOGY , *LONGITUDINAL method , *METROPOLITAN areas , *POPULATION geography , *RESEARCH funding , *SEASONS , *LOGISTIC regression analysis , *DATA analysis , *RESIDENTIAL patterns , *SOCIOECONOMIC factors , *RETROSPECTIVE studies , *DESCRIPTIVE statistics ,MORTALITY risk factors - Abstract
Background: New Zealand is a temperate country with substantial excess winter mortality. We investigated whether this excess winter mortality varies with social factors.Methods: Records from New Zealand censuses in 1981,1986, 1991, 1996 and 2001 were each anonymously and probabilistically linked to 3 years of subsequent mortality data creating five cohort studies of the New Zealand adult population (age 30-74 years at census) each with3 years' follow-up. Logistic regression analysis was used to model the risk of dying in winter compared to summer with winter deaths classified '1' and summer deaths '0'.There were 75 138 eligible mortality records with complete data on social variables recorded for 58 683(78%).Results: Adjusting for age, sex, census year, ethnicity and tenure, those in the lowest tertile of income were at increased risk of winter death compared to those in the highest tertile: OR 1.13 (95% CI 1.08 to 1.19). Compared to home owners, people living in rented accomadation were at greater risk of winter death: OR 1.05 (95% CI1.01 to 1.10). Urban dwellers were also at significantlyincreased risk. The strongest associations were seen for infectious diseases.Conclusions: There was an increased risk of dying in winter for most New Zealanders, but more so among low-income people, those living in rented accommodation and those living in cities. Exact casual mechanisms are not known but possibly include correlated poorer health status, low indoor temperatures and household crowding. [ABSTRACT FROM AUTHOR]
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- 2012
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28. Do effects of price discounts and nutrition education on food purchases vary by ethnicity, income and education? Results from a randomised, controlled trial.
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Blakely, Tony, Mhurchu, Cliona Ni, Jiang, Yannan, Matoe, Leonie, Funaki-Tahifote, Mafi, Eyles, Helen C., Foster, Rachel H., McKenzie, Sarah, and Rodgers, Anthony
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NATURAL foods , *HYPOTHESIS , *ANALYSIS of covariance , *ANALYSIS of variance , *BAR codes , *CONFIDENCE intervals , *STATISTICAL correlation , *DECISION making , *ETHNIC groups , *FOOD preferences , *INCOME , *INGESTION , *LONGITUDINAL method , *MAORI (New Zealand people) , *EVALUATION of medical care , *NUTRITION education , *SCIENTIFIC observation , *RESEARCH funding , *SCANNING systems , *WHITE people , *SATURATED fatty acids , *EDUCATIONAL attainment , *RANDOMIZED controlled trials , *REPEATED measures design , *ECONOMICS - Abstract
Background: Reducing health inequalities requires interventions that work as well, if not better, among disadvantaged populations. The aim of this study was to determine if the effects of price discounts and tailored nutrition education on supermarket food purchases (percentage energy from saturated fat and healthy foods purchased) vary by ethnicity, household income and education. Method: A 2×2 factorial trial of 1104 New Zealand shoppers randomised to receive a 12.5% discount on healthier foods and/or tailored nutrition education (or no intervention) for 6 months. Results: There was no overall association of price discounts or nutrition education with percentage energy from saturated fat, or nutrition education with healthy food purchasing. There was an association of price discounts with healthy food purchasing (0.79 kg/week increase; 95% CI 0.43 to 1.16) that varied by ethnicity (p=0.04): European/other 1.02 kg/week (n=755; 95% CI 0.60 to 1.43); Pacific 1.20 kg/week (n=101; 95% CI 0.06 to 2.34); Maori --0.15 kg/week (n=248; 95% CI --1.10 to 0.80). This association of price discounts with healthy food purchasing did not vary by household income or education. Conclusions: While a statistically significant variation by ethnicity in the effect of price discounts on food purchasing was found, the authors caution against a causal interpretation due to likely biases (eg, attrition) that differentially affected Maori and Pacific people. The study highlights the challenges in generating valid evidence by social groups for public health interventions. The null findings for tailored nutritional education across all social groups suggest that structural interventions (such as price) may be more effective. [ABSTRACT FROM AUTHOR]
- Published
- 2011
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- View/download PDF
29. Ending appreciable tobacco use in a nation: using a sinking lid on supply.
- Author
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Thomson, George, Wilson, Nick, Blakely, Tony, and Edwards, Richard
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INDUSTRIES & economics ,SMOKING ,SMOKING prevention ,HEALTH promotion ,NICOTINE ,SMOKING cessation ,TOBACCO ,GOVERNMENT regulation ,ECONOMICS - Abstract
We discuss some of the practical and ethical questions that may arise for a jurisdiction where a sinking lid endgame strategy for tobacco supply is implemented. Such a strategy would involve regular required reductions in the amount of tobacco released to the market for sale, sufficient to achieve the desired level of commercial sales by a target date. Tobacco manufacturers would periodically bid to the government for a residual quota. Prices would increase as supply reduced. The price level would be influenced by demand, which in turn would reflect the impact of other interventions to reduce demand and the changing normality of smoking. Higher priced tobacco could result in increased smuggling, theft, illegal sales and short-to-medium-term aggravation of some social inequalities. We suggest that the strategy be introduced in conjunction with a range of complementary interventions that would help reduce demand, and thus help ensure that the possible adverse effects are minimised. These complementary interventions include: providing comprehensive best practice smoking cessation support, better information to smokers and the public, strengthened regulation of tobacco retailing and supply, further controlling the pack and product design, measures to restrict supplies that bypass the increases in product price, strengthened enforcement and combating industry attacks. General prerequisites for a sinking lid strategy include public support for the goal of a tobacco-free society, and strong political leadership. The likely context for initial success in jurisdictions includes geographical isolation and/or strong border controls, absence of significant tobacco production and/or manufacturing and low government corruption. [ABSTRACT FROM AUTHOR]
- Published
- 2010
- Full Text
- View/download PDF
30. Inequalities in mortality during and after restructuring of the New Zealand economy: repeated cohort studies.
- Author
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Blakely, Tony, Tobias, Martin, and Atkinson, June
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- *
MORTALITY , *ECONOMIC reform , *ECONOMIC policy -- Social aspects , *SOCIAL history ,INCOME & society - Abstract
Objectives To determine whether disparities between income and mortality changed during a period of major structural and macroeconomic reform and to estimate the changing contribution of different diseases to these disparities. Design Repeated cohort studies. Data sources 1981,1986,1991,1996, and 2001 censuses linked to mortality data. Population Total New Zealand population, ages 1-74 years. Methods Mortality rates standardised for age and ethnicity were calculated for each census cohort by level of household income. Standardised rate differences and rate ratios, and slope and relative indices of inequality (S11 and R11), were calculated to measure disparities on both absolute and relative scales. Results All cause mortality rates declined over the 25 year study period in all groups stratified by sex, age, and income, except for 25-44 year olds of both sexes on low incomes among whom there was little change. In all age groups pooled, relative inequalities increased from 1981-4 to 1996-9 (Rlls increased from 1.85 (95% confidence interval 1.67 to 2.04) to 2.54 (2.29 to 2.82) for males and from 1.54 (1.35 to 1.76) to 2.12 (1.88 to 2.39) for females), then stabilised in 2001-4 (Rlls of 2.60 (2.34 to 2.89) and 2.18 (1.93 to 2.45), respectively). Absolute inequalities were stable over time, with a possible fall from 1996-9 to 2001-4. Cardiovascular disease was the major contributor to the observed disparities between income and mortality but decreased in importance from 45% in 1981-4 to 33% in 2001-4 for males and from 50% to 29% for females. The corresponding contribution of cancer increased from 16% to 22% for males and from 12% to 25% for females. Conclusions During and after restructuring of the economy disparities in mortality between income groups in New Zealand increased in relative terms (but not in absolute terms), but it is difficult to confidently draw a causal link with structural reforms. The contribution of different causes of death to this inequality... [ABSTRACT FROM AUTHOR]
- Published
- 2008
- Full Text
- View/download PDF
31. Effect of insulating existing houses on health inequality: cluster randomised study in the community.
- Author
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Howden-Chapman, Pilippa, Matheson, Anna, Crane, Julian, Viggers, Helen, Cunningham, Malcolm, Blakely, Tony, Cunningham, Chris, Woodward, Alistair, Saville-Smith, Kay, O'Dea, Des, Kennedy, Martin, Baker, Michael, Waipara, Nick, Chapman, Ralph, and Davie, Gabrielle
- Subjects
THERMAL insulation ,HOME heating & ventilation ,POOR people ,HEALTH status indicators ,RANDOMIZED controlled trials - Abstract
ABSTRACT Objective To determine whether insulating existing houses increases indoortemperatures and improves occupants' health and wellbeing. Design Community based, cluster, single blinded randomised study. Setting Seven low income communities in New Zealand. Participants 1350 households containing 4407 participant Intervention Installation of a standard retrofit insulation package. Main outcome measures Indoor temperature and relative humidity, energy consumption, self reported health, wheezing, days off school and work, visits to general practitioners, and admissions to hospital. Results Insulation was associated with a small increase in bedroom temperatures during the winter (0.5°C) and decreased relative humidity (-2.3%), despite energy consumption in insulated houses being 81% of that in uninsulated houses. Bedroom temperatures were below 10°C for 1.7 fewer hours each day in insulated homes than in uninsulated ones. These changes were associated with reduced odds in the insulated homes of fair or poor self rated health (adjusted odds ratio 0.50,95% confidence interval 0.38 to 0.68), self reports of wheezing in the past three months (0.57,0.47 to 0.70), self reports of children taking a day off school (0.49,0.31 to 0.80), and self reports of adults taking a day off work (0.62,0.46 to 0.83). Visits to general practitioners were less often reported by occupants of insulated homes (0.73,0.62 to 0.87). Hospital admissions for respiratory conditions were also reduced (0.53,0.22 to 1.29), but this reduction was not statistically significant (P=0.16). Conclusion Insulating existing houses led to a significantly warmer, drierindoorenvironmentand resulted in improved self rated health, self reported wheezing, days off school and work, and visits to general practitioners as well as a trend for fewer hospital admissions for respiratory conditions. Trial registration Clinical Trials NCT00437541. [ABSTRACT FROM AUTHOR]
- Published
- 2007
- Full Text
- View/download PDF
32. Do social and economic reforms change socioeconomic inequalities in child mortality? A case study: New Zealand 1981-1999.
- Author
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Shaw, Caroline, Blakely, Tony, Atkinson, June, and Crampton, Peter
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- *
SOCIAL action , *SOCIAL problems , *EQUALITY , *INCOME inequality , *SOCIOECONOMIC factors , *ECONOMIC policy , *PUBLIC welfare - Abstract
Background: Socioeconomic inequalities in child mortality are known to exist; however the trends in these inequalities have not been well examined. This study examines the trends in child mortality inequality between 1981 and 1999 against the background of the rapid and dramatic social and economic restructuring in New Zealand during this time period. Methods: Record linkage studies of census and mortality records of all New Zealand children aged 0-14 years on census night 1981, 1986, 1991, 1996, each followed up for three years for mortality between ages 1-14 years. Socioeconomic position was measured using maternal education, household income, and highest occupational class in the household. Standardised mortality rates, rate ratios, and rates differences as well as regression based measures of inequality were calculated. Results: Mortality in all socioeconomic groups fell between 1981 and 1999. Socioeconomic inequality in child mortality existed by all measures of socioeconomic position, however only trends by income suggested a change over time: the relative index of inequality increased from 1 .5 in 1981-84 to 1.8 in 1996-99 (p trend 0.06), but absolute inequality remained stable (slope index of inequality 15/100000 in 1981-84 and 14/100 000 in 1996-99. Conclusions: Dramatic changes in income in New Zealand possibly translated into increasing relative inequality in child mortality by income, but not by education or occupational class. The a priori hypothesis that socioeconomic inequalities in child mortality would have increased in New Zealand during a period of rapid structural reform and widening income inequalities was only partly supported. [ABSTRACT FROM AUTHOR]
- Published
- 2005
- Full Text
- View/download PDF
33. Compression, expansion, or dynamic equilibrium? The evolution of health expectancy in New Zealand.
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Graham, Pafrick, Blakely, Tony, Davis, Peter, Sporle, Andrew, and Pearce, Neil
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- *
PUBLIC health , *DISEASES , *INSTITUTIONAL care , *HEALTH expectancy , *EPIDEMIOLOGY - Abstract
Study objective: To evaluate the New Zealand evidence for three theories of population health change: compression of morbidity, expansion of morbidity, and dynamic equilibrium. Design: Using the Sullivan method, repeated cross sectional survey information on functional limitation prevalence was combined with population mortality data and census information on the utilisation of institutional care to produce health expectancy indices for 1981 and 1996. Setting: The adult population of New Zealand in 1981 and 1996. Participants: 6891 respondents to the 1981 social indicators survey; 8262 respondents to the 1996 household disability survey. Main results: As a proportion of overall life expectancy at age 15 the expectation of non-institutionalised mobility limitations increased from 3.5% to 6% for men, and from 4.5% to 8% for women; the expectation of agility limitation increased from 3% to 7.5% for men and from 4.5% to 8.5% for women, and the expectation of self care limitations increased from 2.0% to 4.5% for men and from 3.0% to 6.0% for women. These changes were primarily attributable to increases in the expectation of moderate functional limitation. Conclusion: The dynamic equilibrium scenario provides the best fit to current New Zealand evidence on changes in population health. Although an aging population is likely to lead to an increase in demand for disability support services, the fiscal impact of this increase may be partially offset by a shift from major to moderate limitations, with a consequential reduction in the average levels of support required. [ABSTRACT FROM AUTHOR]
- Published
- 2004
- Full Text
- View/download PDF
34. Ecological effects in multi-level studies.
- Author
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Blakely, Tony A and Woodward, Alistair J
- Abstract
Multi-level research that attempts to describe ecological effects in themselves (for example, the effect on individual health from living in deprived communities), while also including individual level effects (for example, the effect of personal socioeconomic disadvantage), is now prominent in research on the socioeconomic determinants of health and disease. Such research often involves the application of advanced statistical multi-level methods. It is hypothesised that such research is at risk of reaching beyond an epidemiological understanding of what constitutes an ecological effect, and what sources of error may be influencing any observed ecological effect. This paper aims to present such an epidemiological understanding. Three basic types of ecological effect are described: a direct cross level effect (for example, living in a deprived community directly affects individual personal health), cross level effect modification (for example, living in a deprived community modifies the effect of individual socioeconomic status on individual health), and an indirect cross level effect (for example, living in a deprived community increases the risk of smoking, which in turn affects individual health). Sources of error and weaknesses in study design that may affect estimates of ecological effects include: a lack of variation in the ecological exposure (and health outcome) in the available data; not allowing for intraclass correlation; selection bias; confounding at both the ecological and individual level; misclassification of variables; misclassification of units of analysis and assignment of individuals to those units; model mis-specification; and multicollinearity. Identification of ecological effects requires the minimisation of these sources of error, and a study design that captures sufficient variation in the ecological exposure of interest. [ABSTRACT FROM PUBLISHER]
- Published
- 2000
- Full Text
- View/download PDF
35. What are the elements of the tobacco endgame?
- Author
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Thomson, George, Edwards, Richard, Wilson, Nick, and Blakely, Tony
- Subjects
SMOKING prevention ,GOAL (Psychology) ,HEALTH promotion ,INDUSTRIES ,LEADERSHIP ,HEALTH policy ,POLICY sciences ,PUBLIC administration ,PUBLIC opinion ,SMOKING cessation ,TOBACCO ,DISEASE prevalence - Abstract
The available literature on tobacco endgames tends to be limited to discussing means, targets and difficulties. This article offers additional ideas on the key elements of endgame strategies and the circumstances in which these are likely to be adopted and implemented. We suggest such strategies will include explicit plans, will define the nature of 'the end of tobacco use/sale' and have target dates within 20 years. The likely circumstances for endgame strategy development include low (probably under 15% adult smoking) prevalence and/or rapid prevalence reductions, wide support and strong political leadership. Even with some or all these circumstances, opposition from business, internal government forces and international factors may influence results. [ABSTRACT FROM AUTHOR]
- Published
- 2012
- Full Text
- View/download PDF
36. Iconography and Commission on The social Determinants of Health (and health inequity).
- Author
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Blakely, Tony
- Subjects
- *
PUBLIC health , *HEALTH , *HEALTH equity - Abstract
The author reflects on the report of the Commission on Social Determinants of Health (CSDH) regarding the social determinants of health and health equity. He mentions that social determinants of health can be considered through observation of health trends regarding economic, social and health policies. He also states that the report's potential to become a landmark document for public health depend on the response of the World Health Organization (WHO) and its member countries.
- Published
- 2008
- Full Text
- View/download PDF
37. Reflections from the antipodes on the English strategy to reduce health inequalities and Mackenbach's analysis.
- Author
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Blakely, Tony and Carter, Kristie
- Subjects
- *
INFANT mortality , *PUBLIC health methodology , *GOAL (Psychology) , *HEALTH outcome assessment , *PREVENTIVE health services , *PUBLIC housing , *SOCIOECONOMIC factors , *COMMUNITY-based social services , *HUMAN services programs , *PREVENTION - Abstract
The author comments on the critique by author J. P. Mackenbach on perceived ineffectiveness of the English 1997-2000 strategy to reduce health inequalities in a 2011 issue of "Journal of Epidemiology and Community Health." In his view, such inequalities would still worsen despite the absence of the strategy. He stresses that such inequalities lie on various determinants than policy alone. He urges researchers to consider indirect evidence and modeling aside from direct empirical evidence.
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- 2011
- Full Text
- View/download PDF
38. Does housing policy influence health?
- Author
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Blakely, Tony, Baker, Michael G., and Howden-Chapman, Philippa
- Subjects
- *
POVERTY areas , *HEALTH status indicators , *HOSPITAL care , *HOUSING , *HEALTH outcome assessment , *GOVERNMENT policy , *COMMUNITY-based social services - Abstract
The authors comment on the role of housing policy in public health based on a study by G. Jackson et al. in New Zealand published in a 2011 issue of "Journal of Epidemiology and Community Health." With improved housing structures, ventilation and insulation, it has found that acute hospitalisation among 5-34-year-olds was 23% lower after health interventions. They applaud the study but it failed to determine which aspect of housing intervention was important and if the health status changed.
- Published
- 2011
- Full Text
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39. Confounding by socioeconomic position remains after adjusting for neighbourhood deprivation: an example using smoking and mortality.
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Blakely, Tony, Hunt, Darren, and Woodward, Alistair
- Subjects
- *
NEIGHBORHOODS , *DEPRIVATION (Psychology) , *SOCIAL status , *PSYCHOLOGICAL adaptation , *POPULATION - Abstract
The article reports an example in which residual confounding by personal socioeconomic position remains after adjusting for neighborhood deprivation. Neither indices of neighborhood socioeconomic deprivation nor single individual socioeconomic factors fully characterize socioeconomic position. With regard to deprivation indices, the example used a New Zealand index of socioeconomic deprivation constructed for very small areas with population about 100. Where deprivation indices are constructed for larger groupings of people, the problem of residual confounding is likely to be greater than that shown in the study.
- Published
- 2004
- Full Text
- View/download PDF
40. Mortality among 'never smokers"living with smokers: two cohort studies,1981-4 and 1996-9.
- Author
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Hill, Sarah E., Blakely, Tony A., Kawachi, Ichiro, and Woodward, Alistair
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- *
MORTALITY , *PASSIVE smoking , *CIGARETTE smokers , *PATIENTS , *NONSMOKING areas , *NUMERICAL analysis , *SOCIAL indicators ,ENVIRONMENTAL aspects - Abstract
Presents a research paper on the mortality of "never smokers" living with smokers. How the patients were chosen for this study; Use of the Poisson regression to make adjustments to standard mortality rates; Finding that the never-smokers had a modest but consistent association with mortality when living with smokers; Limitations of the study.
- Published
- 2004
- Full Text
- View/download PDF
41. What is the lag time between income inequality and health status?
- Author
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Blakely, Tony A., Kennedy, Bruce P., Glass, Roberta, and Kawachi, Ichiro
- Published
- 2000
- Full Text
- View/download PDF
42. Improving the reporting of interactions or effect measure modification.
- Author
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Blakely, Tony
- Subjects
- *
PUBLIC welfare , *MENTAL depression , *JOB stress - Abstract
A letter to the editor is presented in response to an analysis of the cross-country variations in work stress and the associations between work stress and depression, published in a previous issue of the "Journal of Epidemiology & Community Health."
- Published
- 2012
- Full Text
- View/download PDF
43. Educational inequalities in mortality over four decades in Norway: prospective study of middle aged men and women followed for cause specific mortality, 1960-2000.
- Author
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Strand, Bjørn Heine, Grøholt, Else-Karin, Steingrímsdóttir, Ólóf Anna, Blakely, Tony, Graff-Iversen, Sidsel, and Næss, Øyvind
- Subjects
COHORT analysis ,MORTALITY ,CAUSES of death ,LUNG cancer ,RESPIRATORY infections - Abstract
The article discusses a prospective cohort study which investigated educational inequalities in mortality during 1960 to 2000 in Norway. The study involved the whole population of the country aged 45 to 64 years in 1960, 1970, 1980, and 1990 followed up over 10 years. It was found that the causes of death that were the main reasons for the disparity included lung cancer and chronic lower respiratory tract diseases.
- Published
- 2010
- Full Text
- View/download PDF
44. Survival disparities in Indigenous and non-Indigenous New Zealanders with colon cancer: the role of patient comorbidity, treatment and health service factors.
- Author
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Hill, Sarah, Sarfati, Diana, Blakely, Tony, Robson, Bridget, Purdie, Gordon, Chen, Jarvis, Dennett, Elizabeth, Cormack, Donna, Cunningham, Ruth, Dew, Kevin, McCreanor, Tim, and Kawachi, Ichiro
- Subjects
COLON cancer ,COMORBIDITY ,HEALTH service areas ,CANCER treatment ,ETHNOLOGY ,MEDICAL care - Abstract
Background Ethnic disparities in cancer survival have been documented in many populations and cancer types. The causes of these inequalities are not well understood but may include disease and patient characteristics, treatment differences and health service factors. Survival was compared in a cohort of Maori (Indigenous) and non-Maori New Zealanders with colon cancer, and the contribution of demographics, disease characteristics, patient comorbidity, treatment and healthcare factors to survival disparities was assessed. Methods Maori patients diagnosed as having colon cancer between 1996 and 2003 were identified from the New Zealand Cancer Registry and compared with a randomly selected sample of non-Maori patients. Clinical and outcome data were obtained from medical records, pathology reports and the national mortality database. Cancer-specific survival was examined using Kaplan—Meier survival curves and Cox hazards modelling with multivariable adjustment. Results 301 Maori and 328 non-Maori patients with colon cancer were compared. Maori had a significantly poorer cancer survival than non-Maori (hazard ratio (HR)=1.33, 95% CI 1.03 to 1.71) that was not explained by demographic or disease characteristics. The most important factors contributing to poorer survival in Maori were patient comorbidity and markers of healthcare access, each of which accounted for around a third of the survival disparity. The final model accounted for almost all the survival disparity between Maori and non-Maori patients (HR=1.07, 95% CI 0.77 to 1.47). Conclusion Higher patient comorbidity and poorer access and quality of cancer care are both important explanations for worse survival in Maori compared with non-Maori New Zealanders with colon cancer. [ABSTRACT FROM AUTHOR]
- Published
- 2010
- Full Text
- View/download PDF
45. Unemployment and mortality: learning from the past in times of resurging unemployment.
- Author
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Blakely, Tony
- Subjects
- *
UNEMPLOYMENT , *MORTALITY of men - Abstract
The author comments on the article "Unemployment and Mortality--A Longitudinal Prospective Study on Selection and Causation in 49,321 Swedish Middle-Aged Men."
- Published
- 2010
- Full Text
- View/download PDF
46. Mortality in poorer areas.
- Author
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BLAKELY, TONY
- Published
- 1999
- Full Text
- View/download PDF
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