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Background: Nutrition labeling is a prominent policy to promote healthy eating. Objective: We aimed to evaluate the effects of 2 interpretive nutrition labels compared with a noninterpretive label on consumer food purchases. Design: In this parallel-group randomized controlled trial, we enrolled household shoppers across New Zealand who owned smartphones and were aged ≥18 y. Eligible participants were randomly assigned (1:1:1) to receive either traffic light labels (TLLs), Health Star Rating labels (HSRs), or a control [nutrition information panel (NIP)]. Smartphone technology allowed participants to scan barcodes of packaged foods and to receive allocated labels on their smartphone screens. The primary outcome was the mean healthiness of all packaged food purchases over the 4-wk intervention period, which was measured by using the Food Standards Australia New Zealand Nutrient Profiling Scoring Criterion (NPSC). Results: Between October 2014 and November 2015, 1357 eligible shoppers were randomly assigned to TLL (n = 459), HSR (n = 443), or NIP (n = 455) labels. Overall difference in the mean transformed NPSC score for the TLL group compared with the NIP group was 20.20 (95% CI: 20.94, 0.54; P = 0.60). The corresponding difference for HSR compared with NIP was 20.60 (95% CI: 21.35, 0.15; P = 0.12). In an exploratory per-protocol analysis of participants who used the labeling intervention more often than average (n = 423, 31%), those who were assigned to TLL and HSR had significantly better NPSC scores [TLL compared with NIP: 21.33 (95% CI: 22.63, 20.04; P = 0.04); HSR compared with NIP: 21.70 (95% CI: 22.97, 20.43; P = 0.01)]. Shoppers who were randomly assigned to HSR and TLL also found the labels significantly more useful and easy to understand than the NIP (all P values <0.001). Conclusions: At the relatively low level of use observed in this trial, interpretive nutrition labels had no significant effect on food purchases. However, shoppers who used interpretive labels found them to be significantly more useful and easy to understand, and compared with frequent NIP users, frequent TLL and HSR users had significantly healthier food purchases. This trial was registered at the Australian New Zealand Clinical Trials Registry (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id= 366446&isReview=true) as ACTRN12614000644662. [ABSTRACT FROM AUTHOR]

The importance of neighbourhoods for health and wellbeing may vary according to an individual's reliance on their local resources, but this assertion is rarely tested. We investigate whether greater neighbourhood ‘exposure’ through reliance on or engagement with the residential setting magnifies neighbourhood-health associations. Methods Three built environment characteristics (destination density, streetscape (attractiveness of built environment) and street connectivity) and two physical activity components (weekday and weekend accelerometer counts) were measured for 2033 residents living in 48 neighbourhoods within four New Zealand cities in 2009–2010, giving six different built environment–physical activity associations. Interactions for each built environment–physical activity association with four individual-level characteristics (acting as proxies for exposure: gender, working status, car access, and income) were assessed with multi-level regression models; a total of 24 ‘tests’. Results Of the 12 weekday built environment–physical activity tests, 5 interaction terms were significant (p < 0.05) in the expected direction (e.g. stronger streetscape–physical activity among those with restricted car access). For weekend tests, one association was statistically significant. No significant tests were contradictory. Pooled across the 12 weekday physical activity ‘tests’, a 1 standard deviation increase in the walkability of the built environment was associated with an overall 3.8% (95% CI: 3.6%–4.1%) greater increase in weekday physical activity across all the types of people we hypothesised to spend more time in their residential neighbourhood, and for weekend physical activity it was 4.2% (95% CI 3.9%–4.5%). Conclusions Using multiple evaluation methods, interactions were in line with our hypothesis, with a stronger association seen for proxy exposure indicators (for example, restricted car access). Added to the wider evidence base, our study strengthens causal evidence of an effect of the built environment on physical activity, and highlights that health gains from improvements of the residential neighbourhood may be greater for some people. [ABSTRACT FROM AUTHOR]

Highlights: [•] We assessed cost-effectiveness of different programme intensity and equity impacts. [•] Intensifying New Zealand's current school girls only programme is probably cost-effective. [•] A mandatory law is not cost-effective at the margin given current vaccine prices. [•] Māori (indigenous population) should have a greater health gain in absolute terms for all vaccination programmes. [ABSTRACT FROM AUTHOR]

The objective of this longitudinal analysis was to estimate funding loss in terms of tax revenue to the New Zealand (NZ) government from disease and injury among working age adults. Linked national health and tax data sets of the usually resident population between 2006 and 2016 were used to model 40 disease states simultaneously in a fixed-effects regression analysis to estimate population-level tax loss from disease and injury. To estimate tax revenue loss to the NZ government, we modeled a counterfactual scenario where all disease/injury was cause deleted. The estimated tax paid by all 25- to 64-year-olds in the eligible NZ population was $15 773 million (m) per annum (US dollar 2021), or $16 446 m for a counterfactual as though no one had any disease disease-related income loss (a 4.3% or $672.9 m increase in tax revenue per annum). The disease that—if it had no impact on income—generated the greatest impact was mental illness, contributing 34.7% ($233.3 m) of all disease-related tax loss, followed by cardiovascular (14.7%, $99.0 m) and endocrine (10.2%, $68.8 m). Tax revenue gains after deleting all disease/injury increased up to 65 years of age, with the largest contributor occurring among 60- to 64-year-olds ($131.7 m). Varied results were also observed among different ethnicities and differing levels of deprivation. This study finds considerable variation by disease on worker productivity and therefore tax revenue in this high-income country. These findings strengthen the economic and government case for prevention, particularly the prevention of mental health conditions and cardiovascular disease. • Maintaining a healthy society is an important determinant of national economic status, with the health of the working population determining a substantial proportion of tax revenue. • In a scenario of no disease or injury in New Zealand among working age adults, we estimate that tax revenue gains may increase by 4.3% or US $672 9 million. • This modeling provides support for health policies that prioritize preventive interventions to reduce disease burden, particularly from mental health and cardiovascular disease. [ABSTRACT FROM AUTHOR]

Abstract: Like many OECD countries New Zealand has experienced a large increase in the number of working-age people receiving incapacity benefits in the last 3 decades, despite apparent improvements in population health. This paper examines trends in mortality rates of people receiving sickness benefit or invalid’s benefit (SBIB) between 1981 and 2004 using repeated cohort studies (linking the 1981, 1986, 1991, 1996, and 2001 censuses to mortality data). Mortality rates, standardised for age and ethnicity, were calculated for each census cohort for 25–64 year olds by benefit receipt status. Standardised rate differences and rate ratios and 95% confidence intervals were calculated to measure disparities on both absolute and relative scales. Between 1981 and 2004 overall SBIB receipt increased from 2% to 5% of the working age population. Mortality rates were at least three times higher in the SBIB than the non-SBIB group at all points in time for men and women. Mortality rates declined in all groups, for example in men receiving SBIB, mortality decreased from 2354/100 000 in the 1981–84 cohort to 1371/100 000 in the 2001–04 cohort. Absolute inequalities between SBIB and non-SBIB declined in both men and women (for example in women standardised rate differences decreased from 954/100 000 to 688/100 000) but relative inequalities remained largely stable (for example in men the risk ratio increased from 4.27 to 4.54). Mortality rates declined more in sickness benefit than invalid’s benefit recipients. The substantial expansion of SBIB receipt in New Zealand has not been accompanied by any reduction in the excess mortality risk experienced by SBIB recipients. These findings are likely to reflect the changing nature of the economy, labour force and disability experience in New Zealand. [ABSTRACT FROM AUTHOR]

Abstract: We hypothesised that ethnic and socio-economic inequality in mortality might vary by region in New Zealand. Linked 2001–2004 census-mortality data were stratified by region (District Health Boards or DHBs), sex, age and ethnic groups, and income quintiles. To accommodate data sparseness, and to achieve accurate estimates of DHB-specific mortality rates and rate ratios by ethnicity and income, we used hierarchical Bayesian methods. To aid presentation of results, we used posterior mortality rates from the models to calculate directly standardised rates and rate ratios, with credible intervals. Māori-European/Other mortality rate ratios were often similar across DHBs, but Waitemata and Canterbury DHBs (both predominantly urban areas with low Māori population) had significantly lower rate ratios. In contrast, Bay of Plenty and Waikato DHBs (heterogeneous by both ethnicity and socio-economic position) had significantly higher rate ratios. There was little variation in mortality inequalities by income across DHBs. Examining the underlying rates for ethnic and income groups separately, there were significant variations across DHBs, but these were often correlated such that the ethnic or income rate ratio was similar across DHBs. The application of hierarchical Bayesian allowed more definitive conclusions than routine empirical methods when comparing small populations such as social groups across regions. The range of hierarchical Bayesian estimates of Māori mortality and Māori:European rate ratios across regions was considerably narrower than empirical standardisation estimates. [Copyright &y& Elsevier]

Improvements in cancer survival may be distributed inequitably throughout populations and across time. We assessed trends in cancer survival inequalities in New Zealand by ethnic and income group. 126,477 people diagnosed with cancer between 1991 and 2004, followed-up to 2006, were included. First, inequalities pooled over time were measured with excess mortality rate ratios (EMRRs). Second, interpretation of changes in inequalities over time can differ depending on whether one uses EMRRs, excess mortality rate differences (EMRD) or absolute differences in relative survival risks (RSRD); we estimated all three by cancer-site and (for EMRRs only) pooled across all sites. We found that pooled over time and all sites, Māori had an EMRR of 1.29 (95% CI, 1.24-1.34) compared to non-Māori. The low compared to high-income EMRR was 1.12 (95% CI, 1.09-1.15). Pooled over cancers, there was no change in the ethnic EMRR over time but the income EMRR increased by 9% per decade (1-17%). Changes over time in site-specific inequalities were imprecisely measured, but the direction of change was usually consistent across EMRRs, EMRDs and RSRDs. There were persistent ethnic inequalities in cancer survival over time, and slower improvements for low-income people. [ABSTRACT FROM AUTHOR]

Background: Obesogenic environments may be an important contextual explanation for the growing obesity epidemic, including its unequal social distribution. The objective of this study was to determine whether geographic access to fast-food outlets varied by neighborhood deprivation and school socioeconomic ranking, and whether any such associations differed to those for access to healthier food outlets. Methods: Data were collected on the location of fast-food outlets, supermarkets, and convenience stores across New Zealand. The data were geocoded and geographic information systems used to calculate travel distances from each census meshblock (i.e., neighborhood), and each school, to the closest fast-food outlet. Median travel distances are reported by a census-based index of socioeconomic deprivation for each neighborhood, and by a Ministry of Education measure of socioeconomic circumstances for each school. Analyses were repeated for outlets selling healthy food to allow comparisons. Results: At the national level, statistically significant negative associations were found between neighborhood access to the nearest fast-food outlet and neighborhood deprivation (p<0.001) for both multinational fast-food outlets and locally operated outlets. The travel distances to both types of fast food outlet were at least twice as far in the least socially deprived neighborhoods compared to the most deprived neighborhoods. A similar pattern was found for outlets selling healthy food such as supermarkets and smaller food outlets (p<0.001). These relationships were broadly linear with travel distances tending to be shorter in more-deprived neighborhoods. Conclusions: There is a strong association between neighborhood deprivation and geographic access to fast food outlets in New Zealand, which may contribute to the understanding of environmental causes of obesity. However, outlets potentially selling healthy food (e.g., supermarkets) are patterned by deprivation in a similar way. These findings highlight the importance of considering all aspects of the food environment (healthy and unhealthy) when developing environmental strategies to address the obesity epidemic. [Copyright &y& Elsevier]

Abstract: Personal or household income predicts mortality risk, with each additional dollar of income conferring a slightly smaller decrease in the mortality risk. Regardless of whether levels of income inequality in a society impact on mortality rates over and above this individual-level association (i.e., the ‘income inequality hypothesis’), the current consensus is that narrowing income distributions will probably improve overall health status and reduce socio-economic inequalities in health. Our objective was to quantify this impact in a national population using 1.3 million 25–59-year-old respondents to the New Zealand 1996 census followed-up for mortality over 3 years. We modelled 10–40% shifts of everyone''s income to the mean income (equivalent to 10–40% reductions in the Gini coefficient). The strength of the income–mortality association was modelled using rate ratios from Poisson regression of mortality on the logarithm of equivalised household income, adjusted for confounders of age, marital status, education, car access, and neighbourhood socio-economic deprivation. Overall mortality reduced by 4–13% following 10–40% shifts in everyone''s income, respectively. Inequalities in mortality reduced by 12–38% following 10–40% shifts in everyone''s income. Sensitivity analyses suggested that halving the strength of the income–mortality association (i.e., assuming our multivariable estimate still overestimated the causal income–mortality association) would result in 2–6% reductions in overall mortality and 6–19% reductions in inequalities in mortality in this New Zealand setting. Many commentators have noted the non-linear association of income with mortality predicts that narrowing the income distribution will both reduce overall mortality rates and reduce inequalities in mortality. Quantifying such reductions can only be done with considerable uncertainty. Nevertheless, we tentatively suggest that the gains in overall mortality will be modest (although still potentially worthwhile from a policy perspective) and the reductions in inequalities in mortality will be more substantial. [Copyright &y& Elsevier]

Abstract: The aim of this paper is to determine the extent of undercounting of Mäori and Pacific deaths in New Zealand during the 1980s and 1990s, and to calculate corrected ethnic mortality and life expectancy trends. We calculated adjustment ratios for undercounting of Mäori and Pacific deaths (and over-counting of non-Mäori non-Pacific (nMnP) deaths) using the linked census-mortality data. These ratios were then used to calculate corrected mortality rates and life expectancies. Mäori deaths were underestimated by a quarter, and Pacific deaths by a third, during the 1980s and early 1990s. Undercounting was minor in the late 1990s following alignment of ethnicity collection on mortality data to approximate the census. Corrected mortality rates demonstrated 30% (males) and 26% (females) decreases among nMnP from 1980–84 to 1996–99, smaller decreases among Mäori (8% and 7%) and no clear change among Pacific people (9% decrease for males, 4% increase for females). The gap in life expectancy increased from an average of 7.7 years in 1980–84 to 10.8 years in 1996–99 for Mäori, and from 3.3 to 7.7 years for Pacific people, in comparison to nMnP people. Deaths among 45–64 and 65 plus year olds, and cardiovascular disease and cancer deaths, were the main contributors to these disparities. The economic reforms in New Zealand during the 1980s and early 1990s impacted harder upon Mäori and Pacific people in terms of unemployment and income, and are a likely explanation for the diverging mortality trends in this period. Both behavioural factors and health services probably also play a role, but in the absence of trend data by ethnicity, their contribution to diverging mortality trends is unknown. Internationally, our study demonstrates marked undercounting of Mäori and Pacific deaths. We strongly encourage researchers and custodians of vital statistics in other countries to investigate the possibility of undercounting of deaths by ethnicity. [Copyright &y& Elsevier]

Examines the association between metropolitan area income inequality and self-rated health in the United States. Calculation of income inequality and average income from the census data using Gini coefficients; Use of multi-level logistic regression models; Limitations of the Panel Study of Income Dynamics for testing the income inequality hypothesis.

Objectives To assess the cost-effectiveness of a cancer care coordinator (CCC) in helping women with estrogen receptor positive (ER+) early breast cancer persist with tamoxifen for 5 years. Methods We investigated the cost-effectiveness of a CCC across eight breast cancer subtypes, defined by progesterone receptor (PR) status, human epidermal growth factor receptor 2 (HER2) status, and local/regional spread. These subtypes range from excellent to poorer prognoses. The CCC helped in improving tamoxifen persistence by providing information, checking-in by phone, and “troubleshooting” concerns. We constructed a Markov macrosimulation model to estimate health gain (in quality-adjusted life-years or QALYs) and health system costs in New Zealand, compared with no CCC. Participants were modeled until death or till the age of 110 years. Some input parameters (e.g., the impact of a CCC on tamoxifen persistence) had sparse evidence. Therefore, we used estimates with generous uncertainty and conducted sensitivity analyses. Results The cost-effectiveness of a CCC for regional ER+/PR−/HER2+ breast cancer (worst prognosis) was NZ $23,400 (US $15,800) per QALY gained, compared with NZ $368,500 (US $248,800) for local ER+/PR+/HER2− breast cancer (best prognosis). Using a cost-effectiveness threshold of NZ $45,000 (US $30,400) per QALY, a CCC would be cost-effective only in the four subtypes with the worst prognoses. Conclusions There is value in investigating cost-effectiveness by different subtypes within a disease. In this example of breast cancer, the poorer the prognosis, the greater the health gains from a CCC and the better the cost-effectiveness. Incorporating heterogeneity in a cost-utility analysis is important and can inform resource allocation decisions. It is also feasible to undertake in practice. [ABSTRACT FROM AUTHOR]

Immunity to SARS-CoV-2 following vaccination wanes over time in a non-linear fashion, making modelling of likely population impacts of COVID-19 policy options challenging. We observed that it was possible to mathematize non-linear waning of vaccine effectiveness (VE) on the percentage scale as linear waning on the log-odds scale, and developed a random effects logistic regression equation based on UK Health Security Agency data to model VE against Omicron following two and three doses of a COVID-19 vaccine. VE on the odds scale reduced by 47% per month for symptomatic infection after two vaccine doses, lessening to 35% per month for hospitalisation. Waning on the odds scale after triple dose vaccines was 35% per month for symptomatic disease and 19% for hospitalisation. This log-odds system for estimating waning and boosting of COVID-19 VE provides a simple solution that may be used to parametrize SARS-CoV-2 immunity over time parsimoniously in epidemiological models. [ABSTRACT FROM AUTHOR]

Abstract: There is increasing evidence of a direct association between unaffordable housing and poor mental health, over and above the effects of general financial hardship. Type of housing tenure may be an important factor in determining how individuals experience and respond to housing affordability problems. This study investigated whether a relationship exists between unaffordable housing and mental health that differs for home purchasers and private renters among low-income households. Data from 2001 to 2010 of the longitudinal Household, Income and Labour Dynamics in Australia (HILDA) survey were analysed using fixed-effects linear regression to examine change in the SF-36 Mental Component Summary (MCS) score of individuals aged 25–64 years, associated with changes in housing affordability, testing for an interaction with housing tenure type. After adjusting for age, survey year and household income, among individuals living in households in the lower 40% of the national income distribution, private renters in unaffordable housing experienced somewhat poorer in mental health than when their housing was affordable (difference in MCS = −1.18 or about 20% of one S.D. of the MCS score; 95% CI: -1.95,-0.41; p = 0.003) while home purchasers experienced no difference on average. The statistical evidence for housing tenure modifying the association between unaffordable housing and mental health was moderate (p = 0.058). When alternatives to 40% were considered as income cut-offs for inclusion in the sample, evidence of a difference between renters and home purchasers was stronger amongst households in the lowest 50% of the income distribution (p = 0.020), and between the 30th and 50th percentile (p = 0.045), with renters consistently experiencing a decline in mental health while mean MCS scores of home purchasers did not change. In this study, private renters appeared to be more vulnerable than home purchasers to mental health effects of unaffordable housing. Such a modified effect suggests that tenure-differentiated policy responses to poor housing affordability may be appropriate. [Copyright &y& Elsevier]

Abstract: Self-rated health (SRH) is commonly used in longitudinal analyses as a repeated outcome measure. This assumes that computed changes in SRH over time truly represent within-individual changes in underlying health. The longitudinal validity of SRH, however, is threatened by ceiling effects (where people reporting the highest level of SRH cannot report subsequent improved health), insensitivity to small changes within SRH categories, reference group effects (where individuals assess their health changes relative to their peers) and stability in SRH even when change in underlying health is occurring. We assessed the longitudinal validity of SRH by comparing computed changes in SRH with a measure of self-assessed change in health (SACH). We used two waves of data (2003–2005) from the New Zealand longitudinal Survey of Family, Income and Employment (SoFIE). Computed change in SRH and SACH were compared directly and also in regression models using an objective measure of health outcome change (hospitalisations within the past year). Computed change in SRH and SACH were not well correlated, consistent with ceiling and/or categorisation effects in SRH. In regression models, SACH was more strongly predictive of hospitalisation than computed change in SRH (worse SACH was associated with an increased odds of hospitalisation of 3.7 compared to 1.8 for decreased computed change in SRH). SACH may be affected by recall bias, but if SRH is used as a repeated outcome measure in longitudinal analyses, results may also be biased, if change in SRH does not occur in response to significant health events. [Copyright &y& Elsevier]

Abstract: Studies investigating relationships between mental health and residential areas suggest that certain characteristics of neighbourhood environments matter. After developing a conceptual model of neighbourhood social fragmentation and health we examine this relationship (using the New Zealand Index of Neighbourhood Social Fragmentation (NeighFrag)) with self-reported mental health (using SF-36). We used the nationally representative 2002/3 New Zealand Health Survey dataset of urban adults, employing multilevel methods. Results suggest that increasing neighbourhood-level social fragmentation is associated with poorer mental health, when simultaneously accounting for individual-level confounding factors and neighbourhood-level deprivation. The association was modified by sex (stronger association seen for women) and labour force status (unemployed women more sensitive to NeighFrag than those employed or not in labour force). There was limited evidence of any association of fragmentation with non-mental health outcomes, suggesting specificity for mental health. Social fragmentation as a property of neighbourhoods appears to have a specific association with mental health among women, and particularly unemployed women, in our study. [Copyright &y& Elsevier]

Abstract: Food security (access to safe, nutritious, affordable food) is intrinsically linked to feelings of stress or distress and it is strongly associated with socioeconomic factors. However, the impact of food insecurity on mental health, independent of confounding socioeconomic factors, is not clear. We investigated the association of food insecurity with psychological distress in New Zealand, controlling for socioeconomic factors. Secondarily, we examined the association in males and females. We used data from the Survey of Families, Income and Employment (SoFIE) (N = 18,955). Respondents were classified as food insecure if, in the last 12 months, they: used special food grants/banks, had to buy cheaper food to pay for other things, or went without fresh fruit and vegetables often. Psychological distress was measured using the Kessler-10 scale dichotomised at low (10–15) and moderate to high (16+). Logistic regression analyses were used to investigate the association of food insecurity with psychological distress using a staged modelling approach. Interaction models included an interaction between food security and gender, as well as interactions between gender and all other covariates (significant at p-value < 0.1). Models were repeated, stratified by gender. A strong relationship between food insecurity and psychological distress was found (crude odds ratio OR 3.4). Whilst substantially reduced, the association remained after adjusting for confounding demographic and socioeconomic variables (adjusted OR 1.8). In stratified models, food insecure females had slightly higher odds for psychological distress (fully adjusted OR 2.0) than males (fully adjusted OR 1.5). As such, an independent association of food insecurity with psychological distress was found in both males and females – slightly more so in females. However, we cannot rule out residual confounding as an explanation for the independent association and any apparent gender interaction. [Copyright &y& Elsevier]

Abstract: It is generally assumed that income is strongly and positively associated with health. However, much of the evidence supporting this assumption comes from cross-sectional data or analyses that have not fully accounted for biases from confounding and health selection (the reverse pathway from health to income). This paper reports results of a systematic review of panel and longitudinal studies investigating whether changes in income led to changes in self-rated health (SRH) in adults. A variety of electronic databases were searched, up until January 2010, and thirteen studies were included, using data from five different panel or longitudinal studies. The majority of studies found a small, positive and statistically significant association of income with SRH, which was much reduced after controlling for unmeasured confounders and/or health selection. Residual bias, particularly from measurement error, probably reduced this association to the null. Most studies investigated short-term associations between income and SRH or the effect of temporary (usually one year) income changes or shocks, so did not rule out possibly stronger associations between health and longer-term average income or income lagged over longer time periods. Nevertheless, the true causal short-term relationship between income and health, estimated by longitudinal studies of income change and SRH that control for confounding, may be much smaller than that suggested by previous, mostly cross-sectional, research. [Copyright &y& Elsevier]

Abstract: Differential locational access to fast-food retailing between neighbourhoods of varying socioeconomic status has been suggested as a contextual explanation for the social distribution of diet-related mortality and morbidity. This New Zealand study examines whether neighbourhood access to fast-food outlets is associated with individual diet-related health outcomes. Travel distances to the closest fast-food outlet (multinational and locally operated) were calculated for all neighbourhoods and appended to a national health survey. Residents in neighbourhoods with the furthest access to a multinational fast-food outlet were more likely to eat the recommended intake of vegetables but also be overweight. There was no association with fruit consumption. Access to locally operated fast-food outlets was not associated with the consumption of the recommended fruit and vegetables or being overweight. Better neighbourhood access to fast-food retailing is unlikely to be a key contextual driver for inequalities in diet-related health outcomes in New Zealand. [Copyright &y& Elsevier]

• CT lung cancer screening is unlikely to be cost-effective in NZ for the target group. • The overall incremental cost effectiveness ratio was US$44,000 per QALY gained. • Screening maybe cost-effective for Māori, who have a high lung cancer disease burden. The cost-effectiveness of low-dose computed tomography (LDCT) screening for lung cancer is uncertain. This study estimated the health gains, costs (net health system, and including 'unrelated') and cost-effectiveness of biennial LDCT screening among 55−74 years olds with a smoking history of at least 30 pack years, and (if a former smoker) having quit within last 15 years, in New Zealand. We used a macrosimulation stage shift model with New Zealand-specific lung cancer incidence rates and intervention parameters from the National Lung Screening Trial, a health system perspective, and a lifetime horizon for quality-adjusted life-years (QALYs) and costs discounted at 3% per annum. We also examined heterogeneity by gender, ethnicity (Māori (indigenous population) versus non-Māori), age and smoking status. We estimated 0.067 QALYs gained (95 % uncertainty interval (UI) 0.044 to 0.095) per eligible participant, at a cost of US$2843 ($2067−3797; 2011 $US). The overall incremental cost effectiveness ratio (ICER) was US$44,000 per QALY gained (95 % UI US$27,000 to US$70,000). The ICER was substantially lower for Māori, at US$26,000 per QALY gained (95 % UI US$17,000 to US$39,000). The cost-effectiveness varied by socio-demographics, from US$21,000 for 70−74 year old Māori females to US$60,000 for 55−59 year old non-Māori males. The two scenarios that lowered the ICER the most were halving the screening costs (ICER = US$33,000 per QALY), and improving the sensitivity (from 93.8% to 98%) and specificity (from 73.4% to 95%) of the screening test (ICER = US$23,000 per QALY). Based on a threshold of GDP per capita per QALY gained (i.e. US$30,000), LDCT screening for lung cancer is unlikely to be cost-effective in New Zealand for the proposed target population under our modelling assumptions. However, it is likely to be cost-effective for Māori, a population group which carries a disproportionately high disease burden from lung cancer. [ABSTRACT FROM AUTHOR]

Highlights • Quantified the number of lung cancer deaths averted in Australia through tobacco control. • Almost 2 million lung cancer deaths have already been prevented over the period 1956–2100. • Lung cancer will continue to be a significant public health concern in Australia. • Achieving zero smoking by 2025 would result in 360,000 more lung cancer deaths being averted by 2100. • Highlighted the urgent need for more effective and targeted tobacco control strategies to be implemented. Abstract Objectives To estimate the number of past and future lung cancer deaths that have already been averted by tobacco control initiatives in Australia, and to estimate the number of additional deaths averted under various smoking scenarios. Methods We predicted lung cancer mortality rates and case numbers to 2100 using a previously validated generalized linear model based on age, birth cohort and population cigarette smoking exposure. We estimated the impact of various tobacco control scenarios: 'actual tobacco control' (incorporating the aggregate effect of past and current taxation, plain packaging, mass media campaigns and other initiatives) and scenarios where 10%, 5% and 0% smoking prevalence was achieved by 2025, all of which were compared to a counterfactual scenario with the highest historical smoking consumption level continuing into the future as if no tobacco control initiatives had been implemented. Results Without tobacco control, there would have been an estimated 392,116 lung cancer deaths over the period 1956–2015; of these 20% (78,925 deaths; 75,839 males, 3086 females) have been averted due to tobacco control. However, if past and current measures continue to have the expected effect, an estimated 1.9 million deaths (1,579,515 males, 320,856 females; 67% of future lung cancer deaths) will be averted in 2016–2100. If smoking prevalence is reduced to 10%, 5% or 0% by 2025, an additional 97,432, 208,714 or 360,557 deaths could be averted from 2016 to 2100, respectively. Conclusion Tobacco control in Australia has had a dramatic impact on the number of people dying from lung cancer. Several hundred thousand more lung cancer deaths could be averted over the course of the century if close-to-zero smoking prevalence could be achieved in the next decade. [ABSTRACT FROM AUTHOR]

Cold indoor temperature (<18 °C) is associated with hypertension-related and respiratory disease, depression, and anxiety. We estimate total health, health expenditure and income impacts of permanently lifting the temperature in living areas of the home to 18 °C in cold homes in South-eastern Australia (N = 17 million). A proportional multistate lifetable model was used to estimate health adjusted life years (HALYs), health expenditure and income earnings, over the remainder of the lifespan of the population alive in 2021 (3% discount rate). Multiple data were integrated including the prevalence of cold housing (5.87%; mean temperature 15 °C), the effect of temperature to hypertension-related, respiratory disease, depression and anxiety. Eradicating cold housing was predicted to lead to 89,600 (95% UI 47,700 to 177,000) lifetime HALYs gained over the population's remaining lifespan, nearly half of which occurred from 2021 to 2040. Respiratory disease (32.4%) and mental illness (60.6%) made large contributions to HALYs gained, but also had large uncertainty (95% UI 30.0%–42.9% and 45.1%–64.6%, respectively) due to uncertain estimates of their magnitude of causal association with cold housing. Health gains per capita were 6.1 times greater (95% UI 4.7 to 8.1) among the most compared to least deprived quintile. From 2021 to 2040, health expenditure decreased by AUD$0.87 billion (0.35–1.98) and income earnings increased by AUD$4.35 billion (1.89–9.81). Eliminating cold housing would lead to substantial health gains, reductions in health inequalities, savings in health expenditure, and productivity gains. Next steps require research to reduce uncertainty about the magnitude of causal associations of cold with mental and respiratory health. • Cold housing significantly impacts cardiovascular, respiratory, and mental health. • Eradicating cold housing leads to health gains across population's lifespan. • Eradicating cold housing leads to health expenditure savings and income gains. • Health gains are higher among the most compared to least deprived quintile. • Further research needed to reduce uncertainty on the magnitude of health impacts. [ABSTRACT FROM AUTHOR]

Highlights • Low-dose CT screening for lung cancer is unlikely to be cost-effective in NZ. • The overall incremental cost effectiveness ratio was US$104,000 per QALY gained. • Even under highly optimistic scenarios the cost-effectiveness was marginal. Abstract Objectives The cost-effectiveness of low-dose computed tomography (LDCT) screening for lung cancer is uncertain. This study estimated the health gains, costs (net health system, and including 'unrelated') and cost-effectiveness of biennial LDCT screening among 55–74 years olds with a smoking history of at least 30 pack years, and (if a former smoker) having quit within last 15 years, in New Zealand. Methods We used a macrosimulation stage shift model with New Zealand-specific lung cancer incidence rates and intervention parameters from the National Lung Screening Trial, a health system perspective, and a lifetime horizon for quality-adjusted life-years (QALYs) and costs discounted at 3% per annum. We also examined heterogeneity by gender, ethnicity (Māori (indigenous population) versus non-Māori), age and current versus ex-smoking status. Results and Conclusion We estimated 0.037 QALYs gained (95% uncertainty interval (UI) 0.024–0.053) per eligible participant, at a cost of US$3606 ($2689–4681). The overall incremental cost effectiveness ratio (ICER) was US$104,000 per QALY gained (95% UI US$59,000–US$175,000). The cost-effectiveness varied moderately by socio-demographics, with the 'best' ICER being US$52,000 for 70–74 year old Māori females and the 'worst' ICER being US$142,000 for 55–59 year old non-Māori females. The ICER varied little by current smoking status, due to higher competing mortality risk limiting QALY gains for current smokers. The two scenarios that lowered the ICER the most were increasing the screening uptake to 100% (ICER = US$50,000 per QALY), and improving the sensitivity (from 93.8%–98%) and specificity (from 73.4%–95%) of the screening test (ICER = US$42,000 per QALY). Based on a threshold of GDP per capita per QALY gained (i.e. US$30,000), LDCT screening for lung cancer is unlikely to be cost-effective in New Zealand for any sociodemographic group. [ABSTRACT FROM AUTHOR]

The effect of anti-poverty tax credit interventions on tobacco consumption is unclear. Previous studies have estimated short-term effects, did not isolate the effects of cumulative dose of tax credits, produced conflicting results, and used methods with limited control for some time-varying confounders (e.g., those affected by prior treatment) and treatment regimen (i.e., study participants' tax credit receipt pattern over time). We estimated the longer-term, cumulative effect of New Zealand's Family Tax Credit (FTC) on tobacco consumption, using a natural experiment (administrative errors leading to exogenous variation in FTC receipt) and methods specifically for controlling confounding, reverse causation, and treatment regimen. We extracted seven waves (2002–2009) of the nationally representative Survey of Family, Income and Employment including 4404 working-age (18–65 years) parents in families. The exposure was the total numbers of years of receiving FTC. The outcomes were regular smoking and the average daily number of cigarettes usually smoked at wave 7. We estimated average treatment effects using inverse probability of treatment weighting and marginal structural modelling. Each additional year of receiving FTC affected neither the odds of regular tobacco smoking among all parents (odds ratio 1.02, 95% confidence interval 0.94–1.11), nor the number of cigarettes smoked among parents who smoked regularly (rate ratio 1.01, 95% confidence interval 0.99–1.03). We found no evidence for an association between the cumulative number of years of receiving an anti-poverty tax credit and tobacco smoking or consumption among parents. The assumptions of marginal structural modelling are quite demanding, and we therefore cannot rule out residual confounding. Nonetheless, our results suggest that tax credit programme participation will not increase tobacco consumption among poor parents, at least in this high-income country. [ABSTRACT FROM AUTHOR]

Being physically active has demonstrated health benefits, and more walkable neighbourhoods can potentially increase physical activity. Yet not all neighbourhoods provide opportunities for active lifestyles. This paper examines the social context of being active in local and non-local places. We use a social practice theoretical framework to examine how residents talk about and make sense of physical activity and places, contrasting individual and neighbourhood factors. In 2010, fourteen focus groups were held in four neighbourhoods varying by walkability and area-level deprivation (two Auckland and two Wellington, New Zealand), and with participants grouped by gender, ethnicity, and employment. Focus groups elicited discussion on where local residents go for physical activity, and the opportunities and barriers to physical activity in their local area and beyond. Thematic analyses compared across all groups for contrasts and similarities in the issues discussed. Neighbourhood walkability factors appeared to shape where residents engage with public places, with residents seeking out good places. Individual factors (e.g. employment status) also influenced how residents engage with their local neighbourhoods. All groups referred to being active in places both close by and further afield, but residents in less walkable neighbourhoods with fewer local destinations drew attention to the need to go elsewhere, notably for exercise, being social, and to be in pleasant, restorative environments. Being physically active in public settings was valued for social connection and mental restoration, over and above specifically ‘health’ reasons. Residents talk about being active in local and non-local places revealed agency in how they managed the limitations and opportunities within their immediate residential setting. That is, factors of place and people contributed to the ‘shape’ of everyday residential environments, at least with regard to physical activity. [ABSTRACT FROM AUTHOR]

Abstract: It is hypothesized that unconditional (given without obligation) publicly funded financial credits more effectively improve health than conditional financial credits in high-income countries. We previously reported no discernible short-term impact of an employment-conditional tax credit for families on self-rated health (SRH) in adults in New Zealand. This study estimates the effect of an unconditional tax credit for families, called Family Tax Credit (FTC), on SRH in the same study population and setting. A balanced panel of 6900 adults in families was extracted from seven waves (2002–2009) of the Survey of Family, Income and Employment. The exposures, eligibility for and amount of FTC, were derived by applying government eligibility and entitlement criteria. The outcome, SRH, was collected annually. Fixed effects regression analyses eliminated all time-invariant confounding and adjusted for measured time-varying confounders. Becoming eligible for FTC was associated with a small and statistically insignificant change in SRH over the past year [effect estimate: 0.013; 95% confidence interval (CI) −0.011 to 0.037], as was an increase in the estimated amount of FTC by $1000 (effect estimate: −0.001; 95% CI −0.006 to 0.004). The unconditional tax credit for families had no discernible short-term impact on SRH in adults in New Zealand. It did not more effectively improve health status than an employment-conditional tax credit for families. [Copyright &y& Elsevier]