Search

Objectives: The Pasifika Prediabetes Youth Empowerment Programme (PPYEP) was a community‐based research project that aimed to investigate empowerment and co‐design modules to build the capacity of Pasifika youth to develop community interventions for preventing prediabetes. Methods: This paper reports findings from a formative evaluation process of the programme using thematic analysis. It emphasises the adoption, perceptions and application of empowerment and co‐design based on the youth and community providers’ experiences. Results: We found that the programme fostered a safe space, increased youth's knowledge about health and healthy lifestyles, developed their leadership and social change capacities, and provided a tool to develop and refine culturally centred prediabetes‐prevention programmes. These themes emerged non‐linearly and synergistically throughout the programme. Conclusions: Our research emphasises that empowerment and co‐design are complementary in building youth capacity in community‐based partnerships in health promotion. Implications for public health: Empowerment and co‐design are effective tools to develop and implement culturally tailored health promotion programmes for Pasifika peoples. Future research is needed to explore the programme within different Pasifika contexts, health issues and Indigenous groups.

This paper provides insights from a community-centre intervention study that was co-designed by youth, health providers and researchers. The aims of the paper were to highlight the effectiveness of...

Inequities in the provision of accessible primary health care contribute to poor health outcomes and health inequity. This study evaluated inequities in the prevalence and consequences of barriers that children face in seeing a general practitioner (GP) in Aotearoa New Zealand. We analysed data on 5,947 children from the Growing Up in New Zealand longitudinal study cohort on barriers to seeing a GP in the previous year, reported by mothers when their children were aged 24 months and 54 months (in 2011/12 and 2013/14 respectively); and maternal-reported hospitalisations in the year prior to age 54 months. We used logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CIs) for consequences of these barriers.Overall, 4.7% (n = 279) of children experienced barriers to seeing a GP in the year to 24 months and 5.5% (n = 325) in the year to 54 months. At each age, and for each specific barrier studied, barriers were more prevalent among Māori (the indigenous people of Aotearoa New Zealand), and among Pacific, compared to New Zealand European, children. Children facing barriers in the year to age 24 months were twice as likely to be hospitalised in the year to 54 months (OR 2.18, 95%CI: 1.38 to 3.44). When this relationship was analysed by ethnicity, the association was strongest for Māori (OR: 2.92, 95%CI: 1.60 to 5.30), less strong for Pacific (OR 2.01, 95%CI: 0.92 to 4.37) and not present for New Zealand European (OR 1.27, 95%CI 0.39 to 4.12) families.Barriers that children face to seeing a GP have social and cost implications for families and the health system. Changes to the health system, and future health policy, must align with the New Zealand government’s obligations under Te Tiriti o [The Treaty of] Waitangi, to ensure that health equity becomes a reality for Māori.

Issue Empowerment is a concept over‐used in health promotion, yet it is an important process that can used in developing the capacity and capability of young people for creating social change to improve healthier lives. Methods The Youth Empowerment Program (YEP), a pilot study aimed at empowering 15 youth (18‐24 years) to lead healthier lives. We present secondary outcomes of the original YEP study, using focus groups and mobile‐mentary approaches to capture the impact of the YEP through the youths’ understanding of the program. Thematic analyses to examine the pragmatic usefulness of the empowerment program. Results We identified three major themes: (aa) Knowledge: education and awareness of healthy living and understanding of the wider social health issues, compound the health complexities of obesity; (b) Youth as catalysts for change: the youth viewed themselves as agents of social change; and (c) Transformation: the youth recognised themselves as catalysts for change that can positively transform communities into action. Conclusion This study contributes new insights and depth of understanding about how the empowerment program can strengthen the process of individual capacity in an effort to mobilise social change for the betterment of the whole community, particularly among indigenous Pasifika population groups. So what? Developing empowerment principles will enable others to consider “how apply” empowerment more practically when working with young people and not use it flippantly with no real action‐oriented outcome.

Hospitals have a pivotal role in reducing health inequities for indigenous people and other marginalised groups, argue Anna Matheson and colleagues

Background/Introduction Occupation is a poorly characterised risk factor for cardiovascular disease (CVD), with females and minority populations particularly under-represented in research. There is also a lack of longitudinal studies using detailed health data that does not rely on self-reports. Purpose This study aimed to address these gaps by assessing the association between a range of occupational groups and ischaemic heart disease (IHD) in New Zealand (NZ), through linkage of population-based occupational surveys to routinely collected health data. Half of the study population were females and 40% were indigenous Māori (who comprise 15% of the total 4.8 million NZ population), which enabled sex and ethnicity-specific aspects of the relationship between occupation and IHD to be assessed. Methods Two probability-based sample surveys of the NZ adult population (New Zealand Workforce Survey (NZWS); 2004–2006; n=3003) and of the Māori population (NZWS Māori; 2009–2010; n=2107), for which detailed occupational histories and lifestyle factors were collected, were linked with routinely collected health data available through Statistics NZ. Cox regression was used to calculate hazard ratios (HR) for “ever-worked” in any one of nine major occupational groups, with “never worked” in that occupational group defined as the reference group. Analyses were controlled for age, deprivation and smoking, and stratified by sex and ethnicity. Results The strongest associations were found for “plant/machine operators and assemblers” and “elementary workers”, particularly among female Māori (HR 2.19, 95% CI 1.16–4.13 and HR 2.03, 1.07–3.82 respectively). In contrast, inverse associations with IHD across all groups were observed for “technicians and associate professionals”, which was significant for NZWS males (HR 0.52, 0.32–0.84). There were some sex and ethnic differences, particularly for “clerks”, where a positive association was found for NZWS males (HR 1.81, 1.19–2.74), whilst an inverse association was observed for Māori females (HR 0.42, 0.22–0.82). Duration analyses (≤2 years, 2–10 years and 10+ years) showed significant dose-response trends for “clerks” in NZWS males, and “plant/machine operators and assemblers” and “elementary workers” in Māori females. Further adjustments for other potential confounders such diabetes mellitus, hypertension and high cholesterol did not affect the results. Conclusion Associations between occupation and IHD differed significantly across occupational groups and between sexes and ethnicities, even within the same occupational groups. This suggests that results may not be generalised across these groups and occupational interventions to reduce IHD risk may therefore need different approaches depending on the population and specific groups of interest. Funding Acknowledgement Type of funding source: Other. Main funding source(s): Health Research Council (HRC) of New Zealand

Primary Health Care in Aotearoa New Zealand is mainly funded through capitation-based funding to general practices, supplemented by a user co-payment. Funding is designed in part to keep the costs of care low for key groups in the population who have higher health needs. We investigated changes in the socio-demographic determinants of no-cost and low-cost access to Primary Health Care using data from sequential waves of the New Zealand Health Survey (1996/97–2016/17). Fees paid were self-reported and inflated using CPI-adjustment to the value of the 2018NZD. Over the 20-year study period, there was an increase in the population accessing low-cost care. Access to low-cost care was particularly high for Pacific people, but also higher for Māori and Asian people compared to Other/New Zealand European ethnicities. Area-level deprivation was a stronger predictor of access to low-cost care for non-Māori than for Māori. Although Māori were more likely than non-Māori to access low-cost care at all levels of deprivation, this was less evident in more deprived compared to more affluent areas. Given ongoing reported inequity for Māori being less able to afford primary health care, we suggest that future policies to improve access should be fully aligned with the articles of Te Tiriti o Waitangi and should focus on equity.

BackgroundHealth inequities between indigenous and non-indigenous people are well documented. However, the contribution of differential exposure to risk factors in the occupational environment remains unclear. This study assessed differences in the prevalence of self-reported exposure to disease risk factors, including dust and chemicals, physical factors and organisational factors, between Māori and non-Māori workers in New Zealand.MethodsPotential participants were sampled from the New Zealand electoral rolls and invited to take part in a telephone interview, which included questions about current workplace exposures. Logistic regression, accounting for differences in age, socioeconomic status and occupational distribution between Māori and non-Māori, was used to assess differences in exposures.ResultsIn total, 2344 Māori and 2710 non-Māori participants were included in the analyses. Māori had greater exposure to occupational risk factors than non-Māori. For dust and chemical exposures, the main differences related to Māori working in occupations where these exposures are more common. However, even within the same job, Māori were more likely to be exposed to physical factors such as heavy lifting and loud noise, and organisational factors such as carrying out repetitive tasks and working to tight deadlines compared with non-Māori.ConclusionsThis is one of the first studies internationally to compare occupational risk factors between indigenous and non-indigenous people. These findings suggest that the contribution of the occupational environment to health inequities between Māori and non-Māori has been underestimated and that work tasks may be unequally distributed according to ethnicity.

In New Zealand, the burden of obesity is greatest among Pacific people. However, targeted prevention strategies among Pacific communities are needed to learn about how to partner with indigenous groups to successfully apply such strategies. The aim of this study was to pilot the Pasifika Youth Empowerment Programme (YEP), which consisted of five interactive learning modules, among 15 Pasifika youth (18–24 years) from Wellington, New Zealand. This article describes the YEP methodology, to understand how to address obesity-related issues for Pasifika youth. At the completion of the YEP, the participants identified three causes of obesity relevant to Pasifika youth and developed preventative action plans targeting these causes: (a) poor diet, (b) lack of education, and (c) lack of physical activity. This study highlights that capacity and capability development of young people in understanding the key issues related to obesity is important to champion culturally acceptable strategies.

ObjectivesObesity among Pasifika people living in New Zealand is a serious health problem with prevalence rates more than twice those of the general population (67% vs 33%, respectively). Due to the high risk of developing obesity for this population, we investigated diet quality of Pacific youth and their parents and grandparents. Therefore, we examined the dietary diversity of 30 youth and their parents and grandparents (n=34) to identify whether there are generational differences in dietary patterns and investigate the relationship between acculturation and dietary patterns.MethodsThe study design of the overarching study was cross-sectional. Face-to-face interviews were conducted with Pasifika youth, parents and grandparents to investigate dietary diversity, that included both nutritious and discretionary food items and food groups over a 7 day period. Study setting was located in 2 large urban cities, New Zealand. Exploratory factor analyses were used to calculate food scores (means) from individual food items based on proportions consumed over the week, and weights were applied to calculate a standardised food score. The relationship between the level of acculturation and deprivation with dietary patterns was also assessed.ResultsThree distinctive dietary patterns across all participants were identified from our analyses. Healthy diet, processed diet and mixed diet. Mean food scores indicated statistically significant differences between the dietary patterns for older and younger generations. Older generations showed greater diversity in food items consumed, as well as eating primarily a ‘healthy diet’. The younger generation was more likely to consume a ‘processed diet’. There was significant association between acculturation and deprivation with the distinctive dietary patterns.ConclusionOur investigation highlighted generational differences in consuming a limited range of food items. Identified dietary components may, in part, be explained by specific acculturation modes (assimilation and marginalised) and high socioeconomic deprivation among this particular study population.

New Zealand Māori have a considerably higher incidence of gastric cancer compared to non-Māori, and are one of the few populations worldwide with a higher prevalence of diffuse-type disease. Pathogenic germline CDH1 mutations are causative of hereditary diffuse gastric cancer, a cancer predisposition syndrome primarily characterised by an extreme lifetime risk of developing diffuse gastric cancer. Pathogenic CDH1 mutations are well described in Māori families in New Zealand. However, the contribution of these mutations to the high incidence of gastric cancer is unknown. We have used next-generation sequencing, Sanger sequencing, and Multiplex Ligation-dependent Probe Amplification to examine germline CDH1 in an unselected series of 94 Māori gastric cancer patients and 200 healthy matched controls. Overall, 18% of all cases, 34% of cases diagnosed with diffuse-type gastric cancer, and 67% of cases diagnosed aged less than 45 years carried pathogenic CDH1 mutations. After adjusting for the effect of screening known HDGC families, we estimate that 6% of all advanced gastric cancers and 13% of all advanced diffuse-type gastric cancers would carry germline CDH1 mutations. Our results demonstrate that germline CDH1 mutations are a significant contributor to the high frequency of diffuse gastric cancer in New Zealand Māori. Electronic supplementary material The online version of this article (10.1007/s10689-018-0080-8) contains supplementary material, which is available to authorized users.

Summary Introduction Indigenous people have disproportionally worse health and lower life expectancy than their non-indigenous counterparts in high-income countries. Cancer data for indigenous people are scarce and incidence has not previously been collectively reported in Australia, New Zealand, Canada, and the USA. We aimed to investigate and compare, for the first time, the cancer burden in indigenous populations in these countries. Methods We derived incidence data from population-based cancer registries in three states of Australia (Queensland, Western Australia, and the Northern Territory), New Zealand, the province of Alberta in Canada, and the Contract Health Service Delivery Areas of the USA. Summary rates for First Nations and Inuit in Alberta, Canada, were provided directly by Alberta Health Services. We compared age-standardised rates by registry, sex, cancer site, and ethnicity for all incident cancer cases, excluding non-melanoma skin cancers, diagnosed between 2002 and 2006. Standardised rate ratios (SRRs) and 95% CIs were computed to compare the indigenous and non-indigenous populations of each jurisdiction, except for the Alaska Native population, which was compared with the white population from the USA. Findings We included 24 815 cases of cancer in indigenous people and 5 685 264 in non-indigenous people from all jurisdictions, not including Alberta, Canada. The overall cancer burden in indigenous populations was substantially lower in the USA except in Alaska, similar or slightly lower in Australia and Canada, and higher in New Zealand compared with their non-indigenous counterparts. Among the most commonly occurring cancers in indigenous men were lung, prostate, and colorectal cancer. In most jurisdictions, breast cancer was the most common cancer in women followed by lung and colorectal cancer. The incidence of lung cancer was higher in indigenous men in all Australian regions, in Alberta, and in US Alaska Natives than in their non-indigenous counterparts. For breast cancer, rates in women were lower in all indigenous populations except in New Zealand (SRR 1·23, CI 95% 1·16–1·32) and Alaska (1·14, 1·01–1·30). Incidence of cervical cancer was higher in indigenous women than in non-indigenous women in most jurisdictions, although the difference was not always statistically significant. Interpretation There are clear differences in the scale and profile of cancer in indigenous and non-indigenous populations in Australia, New Zealand, Canada, and the USA. Our findings highlight the need for much-improved, targeted programmes of screening, vaccination, and smoking cessation, among other prevention strategies. Governments and researchers need to work in partnership with indigenous communities to improve cancer surveillance in all jurisdictions and facilitate access to cancer data. Funding International Agency for Research on Cancer–Australia Fellowship.

Background: Despite poor cancer survival statistics, Māori do not readily access hospice services. This study aims to explore how hospice services respond to Māori by investigating the different influences and interactions between three perspectives of hospice care. Method: The authors conducted a Māori-centred, cross-sectional qualitative study by undertaking semi-structured interviews with hospice patients and whānau (families) (n=8), hospice representatives (n=4), and representatives from three Māori health provider organisations (n=5). Conclusions: The study found that negative perceptions of hospice are being changed by hospices' relationships with other organisations and positive stories from whānau. Involvement from whānau, continuity of care and after-hours care with a greater Māori workforce and a further emphasis on culturally safe care are critical for this work to gain momentum. Findings can be of use to further develop quality of care indicators that reflect the perspectives of patients and whānau, and those who provide their care.

Background In New Zealand, the burden of childhood obesity is greatest in Māori and Pacific children. Methods In 687 infants from an internet-based birth cohort in New Zealand, we investigated ethnic differences in early life risk factors for later obesity, the degree to which these were explained by sociodemographic factors, and the extent to which ethnic differences in weight at age 3 months were explained by measured risk factors. Results The risk of having an obese mother was double in Māori and Pacific infants compared with NZ European infants (prevalence 24% and 14%, respectively; OR 2.23, 95% CI 1.23 to 4.04). Māori and Pacific infants had higher weights in the first week of life and at 3 months (mean difference 0.19 kg, 95% CI 0.01 to 0.38), and their mothers had higher scores on a ‘snacks’ dietary pattern and lower scores on ‘healthy’ and ‘sweet’ dietary patterns. These inequalities were not explained by maternal education, maternal age or area-based deprivation. No ethnic differences were observed for maternal pre-pregnancy physical activity, hypertension or diabetes in pregnancy, exclusive breastfeeding or early introduction of solid foods. Ethnic inequalities in infant weight at 3 months were not explained by sociodemographic variables, maternal pre-pregnancy body mass index or dietary pattern scores or by other measured risk factors. Conclusions This study shows excess prevalence of early life risk factors for obesity in Māori and Pacific infants in New Zealand and suggests an urgent need for early interventions for these groups.

Māori, the indigenous people of New Zealand, experience disproportionate rates of stomach cancer, compared to non-Māori. The overall aim of the study was to better understand the reasons for the considerable excess of stomach cancer in Māori and to identify priorities for prevention. Māori stomach cancer cases from the New Zealand Cancer Registry between 1 February 2009 and 31 October 2013 and Māori controls, randomly selected from the New Zealand electoral roll were matched by 5-year age bands to cases. Logistic regression was used to estimate odd ratios (OR) and 95% confidence intervals (CI) between exposures and stomach cancer risk. Post-stratification weighting of controls was used to account for differential non-response by deprivation category. The study comprised 165 cases and 480 controls. Nearly half (47.9%) of cases were of the diffuse subtype. There were differences in the distribution of risk factors between cases and controls. Of interest were the strong relationships seen with increased stomach risk and having >2 people sharing a bedroom in childhood (OR 3.30, 95%CI 1.95-5.59), testing for H pylori (OR 12.17, 95%CI 6.15-24.08), being an ex-smoker (OR 2.26, 95%CI 1.44-3.54) and exposure to environmental tobacco smoke in adulthood (OR 3.29, 95%CI 1.94-5.59). Some results were attenuated following post-stratification weighting. This is the first national study of stomach cancer in any indigenous population and the first Māori-only population-based study of stomach cancer undertaken in New Zealand. We emphasize caution in interpreting the findings given the possibility of selection bias. Population-level strategies to reduce the incidence of stomach cancer in Māori include expanding measures to screen and treat those infected with H pylori and a continued policy focus on reducing tobacco consumption and uptake.

Exposure to workplace hazards, such as dust, solvents, and fumes, has the potential to adversely affect the health of people. However, the effects of workplace hazards on health may differ when exposure occurs at different times in the circadian cycle, and among people who work longer hours or who do not obtain adequate sleep. The aim of the present study was to document exposures to workplace hazards across a national sample of New Zealanders, comparing people who work a standard 08:00 -17:00 h Monday-to-Friday working week (Std hours) and those who do not (N-Std hours). New Zealanders (n = 10 000) aged 20-64 yrs were randomly selected from the Electoral Roll to take part in a nationwide survey of workplace exposures. Telephone interviews were conducted between 2004 and 2006, using a six-part questionnaire addressing demographics, detailed information on the current or most recent job (including exposures to a range of workplace hazards), sleep, sleepiness, and health status. N-Std hours were categorised on the basis of: being required to start work prior to 07:00 h or finish work after 21:00 h and/or; having a regular on-call commitment (at least once per week) and/or; working rotating shifts and/or; working night shift(s) in the last month. The response rate was 37% (n = 3003), with 22.2% of participants (n = 656) categorised as working N-Std hours. Industry sectors with the highest numbers of participants working N-Std hours were manufacturing, health and community services, and agriculture, fishing, and forestry. Response rate was 37% (n = 3003) with 22.2% (n = 656) categorised as working N-Std hours. Participants working N-Std hours were more likely to be exposed to all identified hazards, including multiple hazards (OR = 2.45, 95% CI = 2.01-3.0) compared to those working Std hours. Participants working N-Std hours were also more likely to report 'never/rarely' getting enough sleep (OR = 1.38, 95% CI = 1.15-1.65), 'never/rarely' waking refreshed (OR = 1.23, 95% CI = 1.04-1.47), and excessive sleepiness (OR = 1.77, 95% CI = 1.29-2.42). New Zealanders working N-Std hours are more likely to be exposed to hazards in the workplace, to be exposed to multiple hazards, and to report inadequate sleep and excessive sleepiness than their colleagues working a standard 08:00-17:00 h Monday-to-Friday working week. More research is needed on the effects of exposure to hazardous substances outside the usual waking day, on the effects of exposure to multiple hazards, and on the combination of hazard exposure and sleep restriction as a result of shift work.

© The Author(s) 2014. Little research has been undertaken on the actual decision-making processes in cancer care multidisciplinary meetings (MDMs). This article was based on a qualitative observational study of two regional cancer treatment centers in New Zealand. We audiorecorded 10 meetings in which 106 patient cases were discussed. Members of the meetings categorized cases in varying ways, drew on a range of sources of authority, expressed different value positions, and utilized a variety of strategies to justify their actions. An important dimension of authority was encountered authority - the authority a clinician has because of meeting the patient. The MDM chairperson can play an important role in making explicit the sources of authority being drawn on and the value positions of members to provide more clarity to the decision-making process. Attending to issues of process, authority, and values in MDMs has the potential to improve cancer care decision making and ultimately, health outcomes.

Objective Stomach cancer is a leading cause of cancer death, especially in developing countries. Incidence has been associated with poverty and is also reported to disproportionately affect indigenous peoples, many of whom live in poor socioeconomic circumstances and experience lower standards of health. In this comprehensive assessment, we explore the burden of stomach cancer among indigenous peoples globally. Design The literature was searched systematically for studies on stomach cancer incidence, mortality and survival in indigenous populations, including Indigenous Australians, Maori in New Zealand, indigenous peoples from the circumpolar region, native Americans and Alaska natives in the USA, and the Mapuche peoples in Chile. Data from the New Zealand Health Information Service and the Surveillance Epidemiology and End Results (SEER) Program were used to estimate trends in incidence. Results Elevated rates of stomach cancer incidence and mortality were found in almost all indigenous peoples relative to corresponding non-indigenous populations in the same regions or countries. This was particularly evident among Inuit residing in the circumpolar region (standardised incidence ratios (SIR) males: 3.9, females: 3.6) and in Maori (SIR males: 2.2, females: 3.2). Increasing trends in incidence were found for some groups. Conclusions We found a higher burden of stomach cancer in indigenous populations globally, and rising incidence in some indigenous groups, in stark contrast to the decreasing global trends. This is of major public health concern requiring close surveillance and further research of potential risk factors. Given evidence that improving nutrition and housing sanitation, and Helicobacter pylori eradication programmes could reduce stomach cancer rates, policies which address these initiatives could reduce inequalities in stomach cancer burden for indigenous peoples.

BackgroundAssociations between ischaemic heart disease (IHD) and occupation are poorly understood. We linked two previously conducted New Zealand workforce surveys with routinely collected health data to assess occupational risk factors of IHD in New Zealand.MethodsTwo probability-based sample surveys of the general New Zealand adult population (2004–2006; n=3003) and of the New Zealand indigenous peoples (M&_x0101;ori; 2009–2010; n=2107), for which occupational history was collected, were linked with health data up to the end of 2017 using Statistics New Zealand individual-level microdata. Incident IHD events were identified using hospitalisations, prescriptions and deaths. The odds ratios associated with ever being employed in occupational groups were estimated by logistic regression adjusting for age, smoking and socio-economic status separately for males and females in each cohort.ResultsA total of 282 IHD cases were identified in both surveys. Statistically significant elevated IHD risks were observed for male clerks in the general survey (OR=1.60, 95%CI=1.02–2.49) and agriculture and fishery male workers in the M&_x0101;ori survey (OR=1.70, 95%CI=1.02–2.82). Among females, the odds ratios for agriculture and fishery workers were 1.69 (95%CI=0.81–3.51) and 1.49 (95%CI=0.81–2.75) in the general survey and the M&_x0101;ori survey, respectively. A statistically significant increased risk was observed for female plant and machine operators and assemblers in the M&_x0101;ori survey (OR=1.87, 95%CI=1.05–3.31). In the general survey, male plant and machine operators and assemblers had an odds ratio of 1.26 (95%CI=0.81–1.95). We also identified borderline increased odds ratios for trades workers among males in the general survey (OR=1.39, 95%CI=0.92–2.12, p-value=0.12) and among females in the M&_x0101;ori survey (OR=2.26, 95%CI=0.98–5.21, p-value=0.06).ConclusionThis study identified associations between several occupational groups and IHD in the New Zealand population. Further analyses will be conducted to assess specific occupational exposures associated with IHD risk.

BackgroundDifferences in cardiovascular disease (CVD) risk between occupations have been observed, but what specific risk factors underlie these patterns remains unclear. This study assessed how established CVD risk factors differ across occupational groups in New Zealand, and whether patterns differ by gender and ethnicity.MethodsTwo probability-based sample surveys of the general New Zealand adult population (2004–2006; n=3003) and of the indigenous peoples of New Zealand (M&_x0101;ori; 2009–2010; n=2107), for which occupational histories and lifestyle factors were collected, were linked with routinely collected health data. For males and females in each cohort, smoking, body mass index, diabetes, hypertension and high cholesterol were dichotomised and compared between occupational groups using age-adjusted logistic regression. In addition, two way tables and chi-squared tests were used to compare the distribution of risk factors between white and blue-collar workers.ResultsThe prevalence of ever smoking was greater in blue-collar compared to white-collar workers of both cohorts, i.e. general population male (56%; 47%), general population female (62%; 47%), M&_x0101;ori male (68%; 55%) and M&_x0101;ori female (84%; 64%). For diabetes and high cholesterol, differences were statistically significant only for general population females (11%; 6% and 26%; 16% respectively). Hypertension prevalence was higher in blue versus white-collar workers for general population females (36%; 29%), M&_x0101;ori males (43%; 36%) and M&_x0101;ori females (44%; 37%), but not for general population males (35%; 34%). Results by occupational group revealed the same patterns with some noteworthy exceptions. In both cohorts, clerks had an increased risk of hypertension, particularly among males. Male agricultural workers in the general population cohort had a reduced risk of hypertension, diabetes and high cholesterol, but this pattern was not observed for females or among M&_x0101;ori.ConclusionThis study showed differences in profiles of known CVD risk factors across occupations, with some notable ethnic and gender differences.

Background Internationally, a typical model of maternity care is a medically led system with varying levels of midwifery input. New Zealand has a midwife-led model of care, and there are movements in other countries to adopt such a system. There is a paucity of systemic evaluation that formally investigates safety-related outcomes in relationship to midwife-led care within an entire maternity service. The main objective of this study was to compare major adverse perinatal outcomes between midwife-led and medical-led maternity care in New Zealand. Methods and Findings This was a population-based retrospective cohort study. Participants were mother/baby pairs for all 244,047 singleton, term deliveries occurring between 1 January 2008 and 31 December 2012 in New Zealand in which no major fetal, neonatal, chromosomal or metabolic abnormality was identified and the mother was first registered with a midwife, obstetrician, or general practitioner as lead maternity carer. Main outcome measures were low Apgar score at five min, intrauterine hypoxia, birth-related asphyxia, neonatal encephalopathy, small for gestational age (as a negative control), and mortality outcomes (perinatal related mortality, stillbirth, and neonatal mortality). Logistic regression models were fitted, with crude and adjusted odds ratios (ORs) generated for each outcome for midwife-led versus medical-led care (based on lead maternity carer at first registration) with 95% confidence intervals. Fully adjusted models included age, ethnicity, deprivation, trimester of registration, parity, smoking, body mass index (BMI), and pre-existing diabetes and/or hypertension in the model. Of the 244,047 pregnancies included in the study, 223,385 (91.5%) were first registered with a midwife lead maternity carer, and 20,662 (8.5%) with a medical lead maternity carer. Adjusted ORs showed that medical-led births were associated with lower odds of an Apgar score of less than seven at 5 min (OR 0.52; 95% confidence interval 0.43–0.64), intrauterine hypoxia (OR 0.79; 0.62–1.02), birth-related asphyxia (OR 0.45; 0.32–0.62), and neonatal encephalopathy (OR 0.61; 0.38–0.97). No association was found between lead carer at first registration and being small for gestational age (SGA), which was included as a negative control (OR 1.00; 0.95–1.05). It was not possible to definitively determine whether one model of care was associated with fewer infant deaths, with ORs for the medical-led model compared with the midwife-led model being 0.80 (0.54–1.19) for perinatal related mortality, 0.86 (0.55–1.34) for stillbirth, and 0.62 (0.25–1.53) for neonatal mortality. Major limitations were related to the use of routine data in which some variables lacked detail; for example, we were unable to differentiate the midwife-led group into those who had received medical input during pregnancy and those who had not. Conclusions There is an unexplained excess of adverse events in midwife-led deliveries in New Zealand where midwives practice autonomously. The findings are of concern and demonstrate a need for further research that specifically investigates the reasons for the apparent excess of adverse outcomes in mothers with midwife-led care. These findings should be interpreted in the context of New Zealand’s internationally comparable birth outcomes and in the context of research that supports the many benefits of midwife-led care, such as greater patient satisfaction and lower intervention rates., In a retrospective study of routinely collected medical data, Ellie Wernham and colleagues compare adverse fetal and neonatal outcomes associated with midwife-led and medical-led models of care., Author Summary Why Was This Study Done? New Zealand adopted an autonomous midwife-led model of maternity care in 1990. There has never been a detailed review examining what effect, if any, midwife-led care has on adverse outcomes for unborn and newly born infants in the New Zealand setting. A review of the safety of New Zealand’s midwife-led maternity system is of relevance to other countries that are considering adopting this model of care. What Did the Researchers Do and Find? We examined data on all full-term births in which no serious abnormalities were detected in the baby that occurred in New Zealand over a 5-y period (total sample size 244,047). We compared rates of adverse outcomes for unborn and newly born infants among women who were in midwife-led versus medical-led care at first registration during antenatal care. Overall rates of adverse outcomes in the New Zealand setting were low and comparable to international rates. We found that, among mothers with medical-led care compared with midwife-led care, there were lower odds of some adverse outcomes for infants. These included oxygen deprivation during the delivery (birth-related asphyxia) (55% lower odds), neonatal encephalopathy—a condition that can result in brain injury (39% lower odds), and low Apgar score, which is a measure of infant well-being immediately postdelivery, with a low score being indicative of an unwell baby (48% lower odds). What Do These Findings Mean? Despite New Zealand having overall internationally comparable maternity outcomes, the findings of this study suggest that avoidable adverse outcomes may still be occurring. Further research that examines the potential reasons for an apparent excess in adverse outcomes in midwife-led care is required.

In New Zealand, the burden of obesity is greatest among Pacific people, especially in children and adolescents. We investigated the factors of the obesogenic environment that were indigenous to Pasifika youths' social-cultural context, their food purchasing behaviours, and associated anthropometric measures.An exploratory study of 30 Pasifika youth aged 16-24 years in Wellington and Auckland, New Zealand.A large proportion of the participants were obese (mean body mass index: 31.0kg/m2; waistto-hip ratio: 0.84; waist-to-height ratio: 0.6), suggesting that the future health and wellbeing trajectory of the studied Pasifika youth is poor. Purchasing behaviours of food and snacks over a 7-day period provided meaningful insights that could be a useful future research tool to examine the role of their physical environment on food access and availability.From this exploratory study, we highlight the following: (i) the future health trajectory of Pasifika youth is poor. Developing the youths' healthy lifestyle knowledge may lend itself to developing culturally relevant intervention programmes; (ii) identifying the enablers and barriers within the Pasifika ontext of an obesogenic environment can provide very useful information; (iii) use of spatial analysis using purchased food receipts adds to the current knowledge base of obesity-related research, although this was an exploratory investigation. We need to address these highlights if we are to reverse the trend of obesity for this population.

To investigate the contribution to cancer care and prevention by Māori health provider organisations (MHPs) in Aotearoa/New Zealand.A nationwide postal survey of all MHPs (n=253) was undertaken in 2011. The response rate was 55%.We found that MHPs are delivering a wide range of programmes including cancer prevention services focussed on health promotion, advocacy, information and support. MHPs identified financial hardship, transport difficulties, and lack of information as the greatest barriers to cancer care. Culturally safe care by mainstream providers would improve cancer service provision overall. The importance of trust and long-term relationships, with a focus on families rather than individual-based care, was highlighted.These findings could lead to substantial improvements in quality of life for Māori cancer patients. This is the first study to show how indigenous health providers contribute to cancer care and prevention in Aotearoa/New Zealand.

This study investigated the role that demographic and tumour factors play in explaining ethnic inequalities in breast cancer survival.Breast cancer cases notified to the New Zealand Cancer Registry (NZCR) from April 2005 to April 2007 were followed up to April 2009. Māori, Pacific and non-Māori/non-Pacific women were categorised according to ethnicity on the NZCR. Deprivation was analysed as quintiles of the New Zealand area-based index of socio-economic position. Relative survival rates were estimated using ethnic-specific life tables. Missing values were imputed and excess mortality modelling was used to estimate the contribution of demographic and tumour factors to ethnic inequalities in survival.There were 2968 breast cancer cases (76.5% non-Māori/non-Pacific, 17% Māori, and 6.5% Pacific) included and 433 recorded deaths. Relative survival rates at 4 years were 91.5% (95% confidence interval (CI) 89.7 to 92.9) for non-Māori/non-Pacific, 86.2% (CI 80.3 to 90.4) for Māori, and 79.6% (CI 68.2 to 87.2) for Pacific women. Using non-Māori/non-Pacific as the reference group, the age-adjusted hazard ratio (HR) dropped for Māori from 1.76 (CI 1.22 to 2.48) to 1.43 (CI 0.97 to 2.10) when further adjusted by deprivation. For Pacific the HR dropped from 2.49 (CI 1.57 to 3.94) to 1.94 (CI 1.20 to 3.13). Inequalities persisted after adjustment for subtype variables (ER/PR/HER2), but adjusting for access to care variables (extent/size) eliminated the ethnic inequalities in excess mortality.Ethnic disparities in breast cancer survival in New Zealand can be attributed to deprivation and differential access to health care rather than differences in breast cancer subtypes.

Although musculoskeletal symptoms (MSS) are common worldwide, little is known about its prevalence amongst the working population in relation to gender, age, and occupational/industrial group. This paper describes the prevalence of MSS in a sample of 3003 men and women aged 20–64 randomly selected from the New Zealand Electoral Roll. MSS experienced during the previous 12 months in 10 body regions was assessed in telephone interviews using a modified version of the Nordic Musculoskeletal Questionnaire (NMQ). MSS prevalence was 92% (for any body region). The highest prevalence was for low back (54%), neck (43%), and shoulders (42%). Females reported a statistically significantly higher prevalence of MSS in the neck, shoulders, wrist/hands, upper back and hips/thighs/buttocks regions compared to males while males reported more symptoms of the elbows, low back and knees. There were no statistically significant differences in prevalence among age groups. In general, participants with heavy physical workloads had significantly higher prevalence of symptoms in most body regions than those with light physical workloads although women with light physical workloads reported more neck symptoms. The study indicates that the New Zealand working population has a high prevalence of MSS and that exposure in the workplace plays a role. Relevance to industry The findings of this study imply that efforts to reduce MSS in the workplace should focus on females and employees with high physical workloads.

Objectives: The authors conducted a population-based\ud survey to examine gender differences in occupational\ud exposure patterns and to investigate whether any\ud observed differences are due to: (a) gender differences\ud in occupational distribution; and/or (b) gender differences\ud in tasks within occupations.\ud Methods: Men and women aged 20e64 years were\ud randomly selected from the Electoral Roll and invited to\ud take part in a telephone interview, which collected\ud information on self-reported occupational exposure to\ud specific dusts and chemicals, physical exposures and\ud organisational factors. The authors used logistic regression\ud to calculate prevalence ORs and 95% CIs comparing the\ud exposure prevalence of males (n¼1431) and females\ud (n¼1572), adjusting for age. To investigate whether men\ud and women in the same occupation were equally exposed,\ud the authors also matched males to females on current\ud occupation using the five-digit code (n¼1208) and\ud conducted conditional logistic regression adjusting for age.\ud Results: Overall, male workers were two to four times\ud more likely to report exposure to dust and chemical\ud substances, loud noise, irregular hours, night shifts and\ud vibrating tools. Women were 30% more likely to report\ud repetitive tasks and working at high speed, and more\ud likely to report exposure to disinfectants, hair dyes and\ud textile dust. When men were compared with women\ud with the same occupation, gender differences were\ud attenuated. However, males remained significantly more\ud likely to report exposure to welding fumes, herbicides,\ud wood dust, solvents, tools that vibrate, irregular hours\ud and night-shift work. Women remained more likely to\ud report repetitive tasks and working at high speed, and in\ud addition were more likely to report awkward or tiring\ud positions compared with men with the same occupation.\ud Conclusion: This population-based study showed\ud substantial differences in occupational exposure patterns\ud between men and women, even within the same\ud occupation. Thus, the influence of gender should not be\ud overlooked in occupational health research.

Objectives To investigate the differences in occupational exposure between Māori (New Zealand's indigenous people) and non-Māori. Methods Participants were randomly selected from the Electoral Roll. Exposure to occupational risk factors was assessed through telephone interviews and exposure prevalences of Māori (n = 273) and non-Māori (n = 2,724) were compared. Subsequently, Māori were matched with non-Māori on current occupation (n = 482) to assess whether ethnic differences also exist within occupations. Results Māori were more likely to report exposure to physical strain (e.g., lifting, standing). Part of these differences remained when Māori were compared with non-Māori in the same job. In addition, Māori women were twice as likely to categorize their job as very or extremely stressful than non-Māori women in the same job, while Māori men were twice as likely to report exposure to dust. Conclusion Marked ethnic differences exist in risk factors for occupational ill-health, due to both occupational distribution and the distribution of tasks within occupations. Am. J. Ind. Med. 54:410–418, 2011. © 2011 Wiley-Liss, Inc.

Background : This study investigated the role that demographic and tumour factors play in explaining socioeconomic inequalities in breast cancer survival. Methods : Breast cancer cases notified to the New Zealand Cancer Registry (NZCR) from April 2005 to April 2007 were followed up to April 2009. The New Zealand area-based deprivation index (NZDep) was used as a measure of socioeconomic position. Relative survival rates were estimated using sex-, deprivation- and ethnic-specific life tables. Multiple imputation was used to impute missing data. Excess mortality modelling was used to estimate the contribution of demographic and tumour factors to inequalities in survival. Results : There were 2968 breast cancer cases included and 433 recorded deaths. Relative survival rates at 4 years varied across deprivation groups. Using NZDep deciles 1–4 (least deprived) as the reference group, the age- and ethnicity-adjusted hazard ratio (HR) for NZDep deciles 7–8 was 2.03 (CI 1.36–3.04) and for NZDep deciles 9–10 was 1.93 (CI 1.28–2.92). In the fully adjusted model there remained 50% excess mortality for the two most deprived groups compared to the most affluent. Variables which measured timely access to care (extent/size) accounted for more of the survival disparity than breast cancer subtype variables (ER/PR/HER2). Conclusion : Women from deprived areas in New Zealand who are diagnosed with breast cancer are less likely to survive as long as those from affluent areas. A substantial proportion of these socioeconomic disparities can be attributed to differential access to health care although other factors, currently unknown, are also likely to play an important role.

Background There are ethnic disparities in cervical cancer survival in New Zealand. The objectives of this study were to assess the associations of screening history, ethnicity, socio-economic status (SES) and rural residence with stage at diagnosis in women diagnosed with cervical cancer in New Zealand during 1994-2005. Methods The 2323 cases were categorized as 'ever screened' if they had had at least one smear prior to 6 months before diagnosis, and as 'regular screening' if they had had no more than 36 months between any two smears in the period 6-114 months before diagnosis. Logistic regression was used to estimate the associations of screening history, ethnicity, SES and urban/rural residence with stage at diagnosis. Results The percentages 'ever screened' were 43.3% overall, 24.8% in Pacific, 30.5% in Asian, 40.6% in M (a) over bar ori and 46.1% in 'Other' women. The corresponding estimates for 'regular screening' were 14.0, 5.7, 7.8, 12.5 and 15.3%. Women with 'regular screening' had a lower risk of late stage diagnosis [odds ratio (OR) 0.16, 95% confidence interval (CI) 0.10-0.26], and the effect was greater for squamous cell carcinoma (OR 0.12, 95% CI 0.07-0.23) than for adenocarcinoma (OR 0.32, 95% CI 0.13-0.82). The increased risk of late-stage diagnosis (OR 2.72, 95% CI 1.99-3.72) in M (a) over bar ori (compared with 'Other') women decreased only slightly when adjusted for screening history (OR 2.45, 95% CI 1.77-3.39). Conclusions Over half of cases had not been 'ever screened'. Regular screening substantially lowered the risk of being diagnosed at a late stage. However, screening history does not appear to explain the ethnic differences in stage at diagnosis.

OBJECTIVE: To investigate ethnic, socioeconomic, and urban/rural differences in stage at diagnosis and cervical cancer survival in New Zealand. METHODS: The study involved 1594 cervical cancer cases registered during 1994-2005. Cox regression was used to estimate adjusted cervical cancer mortality hazard ratios (HRs). RESULTS: Māori and Pacific women had higher death rates than Other (predominantly European) women, with age and year of diagnosis adjusted HRs of 2.15 (95% CI 1.68-2.75) and 1.98 (95% CI 1.25-3.13), respectively, whereas Asian women had a lower (nonstatistically significant) risk (0.81, 95% CI 0.47-1.42). Adjustment for stage reduced the HR in Māori to 1.62 (95% CI 1.25-2.09), but there was little change for Pacific or Asian women. These patterns varied over time: for cases diagnosed during 1994-1997, the HR for Māori women was 2.34 (95% CI 1.68-3.27), which reduced to 1.83 (95% CI 1.29-2.60) when adjusted for stage; for cases diagnosed during 2002-2005, the corresponding estimates were 1.54 (95% CI 0.75-3.13) and 0.90 (95% CI 0.43-1.89). Socioeconomic status and urban/rural residence had only marginal effects. CONCLUSIONS: There were major ethnic differences in cervical cancer survival in New Zealand that were only partly explained by stage at diagnosis. These patterns varied over time, with postdiagnostic factors playing an important role in the high Māori mortality rates in the 1990s, but in more recent years, the excess mortality in Māori women appeared to be almost entirely due to stage at diagnosis, indicating that ethnic differences in access to and uptake of screening and treatment of premalignant lesions may have been playing a major role.

Background: Few studies have compared ovarian cancer rates between different ethnic groups in the same country. The aim of this study was to describe ethnic patterns in the incidence and mortality of ovarian cancer in New Zealand, and to investigate ethnic and socioeconomic differences in the grade and stage of ovarian cancer. Methods: Data on all women registered with ovarian cancer on the New Zealand Cancer Registry (1993-2004) were analysed. Population data were taken from the 1996 and 2001 census. Logistic regression was used to estimate associations between ethnicity, deprivation and tumour characteristics. Results: Age-standardised incidence rates were highest in Pacific women, intermediate in Māori women, and lowest in non-Māori, non-Pacific women. Age-standardised mortality rates showed the same pattern. Ovarian cancer subtypes differed by ethnic group. There was no significant association between socioeconomic deprivation and tumour grade or stage. Age-adjusted models showed that Māori women were more likely to have well-differentiated tumours and less likely to present at a later stage compared to non-Māori, non-Pacific women. These patterns were partly explained by socioeconomic deprivation, and were not apparent for Pacific women. Conclusions: Pacific and Māori women experience higher incidence of ovarian cancer and mortality, compared to non-Māori, non-Pacific women. Māori women seemed to have better prognostic factors (local stage and well-differentiated tumours) than non-Māori, non-Pacific women. More work is needed to improve current cancer prevention strategies, particularly in Pacific women.

Background From 1950 to 1990 pentachlorophenol (PCP) was used widely in the New Zealand sawmill industry, and persistent claims of long-term health effects have been made. Methods We surveyed surviving members of a cohort enumerated to study mortality in sawmill workers employed from 1970 to 1990. Estimates of historical exposure were based on job titles held, using the results of a PCP biomonitoring survey conducted in the 1980s. The survey involved interviews and clinical examinations, with interviewers and examiners blinded to exposure status. Results Of the 293 participants 177 had not been exposed, and of the 116 exposed all but 10% had low or short-term PCP exposure. Nevertheless, a number of significant associations between PCP exposure and the prevalence of various symptoms were observed including associations between: (i) exposure levels and self-reported tuberculosis, pleurisy or pneumonia (P

Research Findings: Few rating scales measure social competence in very young Spanish or Catalan children. We aimed to analyze the psychometric characteristics of the California Preschool Social Competence Scale (CPSCS) when applied to a Spanish- and Catalan-speaking population. Children were rated by their respective teachers within 6 months following their 4th birthday in two population-based birth cohorts in Spain (N = 378). A confirmatory factor analysis (CFA) was used to compare the underlying structure of the Spanish–Catalan version with that of the original version. Cronbach's alpha coefficient was used to determine the internal consistency of each of the confirmed factors. Cohen's kappa formula was used to calculate the test–retest reliability in a small subset of children who were rated again one month later. Five correlated factors (Considerateness, Task Orientation, Extraversion, Verbal Facility, and Response to Unfamiliar) were optimally confirmed as a result of CFA. The first three factors had...

Epidemiologic studies have shown an inverse association between atopy and malignant lymphoma, but results are inconsistent. We investigated levels of IgE, before and after commencement of treatment, and evaluated lymphoma risk in relation to total and specific IgE levels. Serum levels of IgM, IgA, and IgG were also measured. We enrolled 467 newly diagnosed lymphoma cases and 544 hospital controls, matched for age, sex, and hospital. Lymphomas were histologically confirmed and categorized according to the WHO classification. Subjects provided blood for analysis of total and specific IgE levels, and total IgM, IgA, and IgG levels. Additional information was collected by interviewer-administered questionnaire. Controlling for age, sex, center, smoking status, and any treated asthma or eczema, we found that the overall risk of lymphoma was significantly lower in the high [odds ratio (OR), 0.39; 95% confidence interval (95% CI), 0.28-0.54] and middle (OR, 0.55; 95% CI, 0.40-0.74) tertiles for total serum IgE compared with the low tertile. Specific IgE to common aeroallergens (defined as ≥0.35 kU/L) was also inversely associated with risk of lymphoma (OR, 0.67; 95% CI, 0.45-1.00). Lymphoma was associated with IgA and IgM but not IgG. Mean levels of all immunoglobulins were decreased with more advanced malignancy, and total serum IgE levels were lower before treatment. The data suggest that the low levels of immunoglobulins seen in a wide range of lymphoma cases is likely to be linked to a lymphogenesis process rather than resulting from a selective protection due to an atopic process. Long-term cohort studies may be fundamental to fully evaluate these associations. (Cancer Epidemiol Biomarkers Prev 2007;16(7):1492–8)

The present study investigated the relationship between socioeconomic status, using measures of occupational class and education level, and the prevalence and incidence of asthma (with and without atopy) and chronic bronchitis using data from the European Community Respiratory Health Survey (ECRHS). Asthma and chronic bronchitis were studied prospectively within the ECRHS (n = 9,023). Incidence analyses comprised subjects with no history of asthma or bronchitis at baseline. Asthma symptoms were also assessed as a continuous score. Bronchitis risk was associated with low educational level (prevalence odds ratio (POR) 1.9; 95% confidence interval (CI) 1.4-2.8) and occupational class (1.8; 1.2-2.7). Incident bronchitis also increased with low educational level (risk ratio (RR) 2.8; 95%CI 1.5-5.4). Prevalent and incident asthma with no atopy were associated with low educational level. Subjects in the low occupational class (incident risk ratio (IRR) 1.4; 95%CI 1.2-1.7) and education group (IRR 1.3; 95% CI 1.1-1.6) had higher mean asthma scores than those in higher socioeconomic groups. Lower educational level was associated with increased risk of prevalent and incident chronic bronchitis and asthma with no atopy. Lower socioeconomic groups tended to have a higher prevalence and incidence of asthma, particularly higher mean asthma scores. Adjustment for variables associated with asthma and bronchitis explained little of the observed health differences by socioeconomic status.

The health status of indigenous peoples worldwide varies according to their unique historical, political, and social circumstances. Disparities in health between Maoris and non-Maoris have been evident for all of the colonial history of New Zealand. Explanations for these differences involve a complex mix of components associated with socioeconomic and lifestyle factors, availability of health care, and discrimination. Improving access to care is critical to addressing health disparities, and increasing evidence suggests that Maoris and non-Maoris differ in terms of access to primary and secondary health care services. We use 2 approaches to health service development to demonstrate how Maori-led initiatives are seeking to improve access to and quality of health care for Maoris.

We explored the contribution of stage at diagnosis to ethnic disparities in cancer survival in New Zealand. We linked 115811 adult patients with invasive cancer registered on the cancer registry (1994 to 2002) to mortality data. Age-standardized, 5-year relative survival rates were lowest for Maori, intermediate for Pacific people (otherwise known as Pacific Islanders), and highest for non-Maori/non-Pacific people for many cancers. Stage at diagnosis accounted for only part of these differences. Possible factors responsible for ethnic inequalities might include access to specialized cancer services and the quality of care received.

BACKGROUND: The reasons for the increasing breast cancer incidence in indigenous Māori compared to non-Māori New Zealand women are unknown. The aim of this study was to assess the association of an index of combined healthy lifestyle behaviours with the risk of breast cancer in Māori and non-Māori women. METHODS: A population-based case-control study was conducted, including breast cancer cases registered in New Zealand from 2005-2007. Controls were matched by ethnicity and 5-year age bands. A healthy lifestyle index score (HLIS) was generated for 1093 cases and 2118 controls, based on public health and cancer prevention recommendations. The HLIS was constructed from eleven factors (limiting red meat, cream, and cheese; consuming more white meat, fish, fruit and vegetables; lower alcohol consumption; not smoking; higher exercise levels; lower body mass index; and longer cumulative duration of breastfeeding). Equal weight was given to each factor. Logistic regression was used to estimate the associations between breast cancer and the HLIS for each ethnic group stratified by menopausal status. RESULTS: Among Māori, the mean HLIS was 5.00 (range 1-9); among non-Māori the mean was 5.43 (range 1.5-10.5). There was little evidence of an association between the HLIS and breast cancer for non-Māori women. Among postmenopausal Māori, those in the top HLIS tertile had a significantly lower odds of breast cancer (Odds Ratio 0.47, 95% confidence interval 0.23-0.94) compared to those in the bottom tertile. CONCLUSION: These findings suggest that healthy lifestyle recommendations could be important for reducing breast cancer risk in postmenopausal Māori women.

Breast cancer incidence differs by ethnicity in New Zealand (NZ) with Māori (the indigenous people) women having the highest rates followed by Pakeha (people primarily of British/European descent), Pacific and Asian women, who experience the lowest rates. The reasons for these differences are unclear. Breast density, an important risk factor for breast cancer, has not previously been studied here. We used an automated system, Volpara™, to measure breast density volume from the medio-lateral oblique view of digital mammograms, by age (≤50 years and >50 years) and ethnicity (Pakeha/Māori/Pacific/Asian) using routine data from the national screening programme: age; x-ray system and mammography details for 3,091 Pakeha, 716 Māori, 170 Pacific and 662 Asian (total n = 4,239) women. Linear regression of the natural logarithm of absolute and percent density values was used, back-transformed and expressed as the ratio of the geometric means. Covariates were age, x-ray system and, for absolute density, the natural log of the volume of non-dense tissue (a proxy for body mass index). Median age for Pakeha women was 55 years; Māori 53 years; and Pacific and Asian women, 52 years. Compared to Pakeha women (reference), Māori had higher absolute volumetric density (1.09; 95% confidence interval [95% CI] 1.03-1.15) which remained following adjustment (1.06; 95% CI 1.01-1.12) and was stronger for older compared to younger Māori women. Asian women had the greatest risk of high percentage breast density (1.35; 95% CI 1.27-1.43) while Pacific women in both the ≤50 and >50 year age groups (0.78; 95% CI 0.66-0.92 and 0.81; 95% CI 0.71-0.93 respectively) had the lowest percentage breast density compared to Pakeha. As well as expected age differences, we found differential patterns of breast density by ethnicity consistent with ethnic differences seen in breast cancer risk. Breast density may be a contributing factor to NZ's well-known, but poorly explained, inequalities in breast cancer incidence.