ISSN ISSN 1178-6191

Maori Health Review

Making Education Easy Issue 63 - 2016

Maori Health Review

Smoking prevalence in New Zealand from 1996– 2015: a critical review of national data sources to inform progress toward the Smokefree 2025 goal

Authors: Ball J et al.

Summary: This analysis of findings from the Census, the New Zealand Health Survey (NZHS) and the Health and Lifestyles Survey (HLS) evaluated progress towards New Zealand’s goal of becoming a smokefree nation by 2025. Data from the Census and the NZHS showing a decline in adult (age ≥15 years) daily smoking from 23–25% in 1996/97 to ~15% in 2014/15 are broadly consistent with findings from the HLS, which dates back to 2008. However, recent NZHS findings do not suggest substantive reductions in daily smoking prevalence, particularly for Māori and Pacific populations, with 2014/15 rates of 35.5% and 22.4% in these populations respectively, and no statistically significant change since 2006/07.

Comment: I saw a presentation earlier this year showing that ‘political activity’ to reduce smoking had significantly reduced since Dame Turia and Hone Harawira left parliament. I can’t help thinking that this is associated with the results presented in this paper. I’m personally trying to find out more about what’s working elsewhere – including the pros and cons of e-cigarettes – as we can’t let the goal get away on us.

Reference: N Z Med J. 2016;129(1439):11-22


Changes in the sexual health behaviours of New Zealand secondary school students, 2001–2012: findings from a national survey series

Authors: Clark TC et al.

Summary: This analysis examined trends in self-reported sexual and reproductive health behaviours among New Zealand secondary school students, using findings from nationally representative health and wellbeing surveys conducted in 2001 (n=9699), 2007 (n=9107) and 2012 (n=8500). Logistic regression analyses revealed significant reductions over time in certain sexual outcomes: ‘Ever had sex’ (−6.9%; p<0.001); ‘currently sexually active’ (− 2.3%; p<0.001); ‘always use condoms’ (−3.3%; p=0.006); ‘condoms at last sex’ (−7.0; p=0.002); ‘contraception at last sex’ (−5.8%; p<0.001) and sexually transmitted infections (−0.3%; p=0.001). However, there was no significant change over time in ‘Always use contraception’ (−1.4%, p=0.514). In 2012, Māori (OR 0.7), Pacific (OR 0.5) and socioeconomically deprived students (OR 0.7) were less likely to use condoms than students in 2001. Moreover, Māori (OR 0.6), Pacific (OR 0.4), Asian (OR 0.5), younger (OR 0.6), and socioeconomically deprived (OR 0.6) students were less likely to use contraception, compared to students in 2001.

Comment: Māori youth are less likely to use contraception/condom when they are depressed, are feeling low or are regular users of marijuana or other drugs. As a GP I’m comfortable to talk to young people about starting contraception, or provide free condoms; but I’m probably not addressing those other factors that support young people to use these adequately, as well as I should.

Reference: Aust N Z J Public Health. 2016;40(4):329-36


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Disclaimer: This publication is not intended as a replacement for regular medical education but to assist in the process. The reviews are a summarised interpretation of the published study and reflect the opinion of the writer rather than those of the research group or scientific journal. It is suggested readers review the full trial data before forming a final conclusion on its merits.

Research Review publications are intended for New Zealand health professionals.

The association between socioeconomic deprivation and secondary school students’ health: findings from a latent class analysis of a national adolescent health survey

Authors: Denny S et al.

Summary: This Auckland University research group used data from a nationally representative youth health survey to examine indicators of socioeconomic deprivation and how these indicators vary by demographic characteristics of adolescents. The 2012 survey included 8500 secondary school students. Latent class analysis grouped students by household poverty based on 9 indicators of household socioeconomic deprivation: no car; no phone; no computer; their parent/s worry about not having enough money for food; more than 2 people sharing a bedroom; no holidays with their families; moving home more than twice that year; garages or living rooms used as bedrooms; and, no parent at home with employment. Three groups of students were identified: 80% of students had low levels of household poverty across all indicators; 15% experienced moderate poverty; and 5% experienced high levels of poverty. Depressive symptoms and cigarette smoking were 2–3 times higher in the poverty groups compared to students not experiencing poverty. The relationship was less clear between overweight/obesity and household socioeconomic deprivation after adjusting for covariates. Students experiencing household poverty reported higher levels of depressive symptoms and higher rates of cigarette smoking if they lived in more affluent neighbourhoods than if they lived in low (quintile 1) socioeconomic neighbourhoods.

Comment: The standout result for me was the finding (which was statistically significant) that students experiencing household poverty but living in affluent neighbourhoods report higher rates of health risk and poor health outcomes. I wondered if these were related to bullying at school.

Reference: Int J Equity Health. 2016;15:109


Maori Health Review

To move or not to move? Exploring the relationship between residential mobility, risk of cardiovascular disease and ethnicity in New Zealand

Authors: Darlington-Pollock F et al.

Summary: These researchers investigated associations between residential mobility, risk of cardiovascular disease (CVD) and ethnicity in a cohort of 2,077,470 New Zealand residents aged ≥30 years. Encrypted National Health Index numbers were linked to individual level routinely recorded data. Binary logistic regression modelled the risk of CVD for the population stratified by ethnic group according to mover status, baseline deprivation and transitions between deprivation statuses. The analysis revealed variation between ethnic groups for the relationship between residential mobility and CVD. Furthermore, this ethnic variation was found to be strongly influenced by the inter-relationship between residential mobility and deprivation mobility.

Comment: The authors recognise the context for these results, i.e. colonisation and more recent urbanisation policies that contribute to the spatial distribution of Māori residency in Auckland. These findings also raise questions about why ‘moving’ in itself is strongly associated with increased CVD risk for Māori and Pacific people. They are more likely to report unfair treatment, based on their ethnicity, when looking for housing compared with NZ Europeans. Furthermore, reported experiences of racial discrimination when looking for housing is associated with negative mental and physical health outcomes, including self-reported CVD.

Reference: Soc Sci Med. 2016;165:128-40


Incidence of transient ischemic attack in Auckland, New Zealand, in 2011 to 2012

Authors: Barber PA et al.

Summary: The fourth Auckland Regional Community Stroke study (ARCOS IV) identified all hospitalised and nonhospitalised cases of transient ischaemic attack (TIA) that occurred over a 12-month period from 1 March 2011 in people aged ≥16 years usually resident in Auckland. During the study period, 785 people presented with TIA (402 [51.2%] women, mean age 71.5 years); 614 (78%) of European origin, 84 (11%) Māori/Pacific, and 75 (10%) Asian/Other. The annual incidence of TIA was 40, and attack rate was 63, in age-standardised rates per 100,000 population, standardised to the World Health Organization (WHO) world standard population. Approximately twothirds of people were known to be hypertensive or were being treated with blood pressure-lowering agents, half were taking antiplatelet agents and just under half were taking lipid-lowering therapy before the index TIA. Of 210 people were known to have atrial fibrillation at the time of the TIA, only 61 (29%) were taking anticoagulant therapy, suggesting a failure to identify or treat atrial fibrillation.

Comment: An appropriate paper, given the recent ‘Stroke Awareness’ campaign fronted by Miriama Kamo. As the authors suggest, we don’t diagnose, let alone treat, atrial fibrillation adequately in NZ. My impression is that Māori and Pacific people may be at increased risk for atrial fibrillation, given higher rates for rheumatic heart disease and heart failure.

Reference: Stroke. 2016;47(9):2183-8


Emergency department length of stay for Māori and European patients in New Zealand

Authors: Prisk D et al.

Summary: A demographic audit of a provincial New Zealand emergency department (ED) revealed a significantly shorter ED length of stay (LOS) among Māori versus European patients (mean LOS, 266.8 mins vs 315.9 mins, respectively), despite Māori having poorer health outcomes overall. The study researchers therefore sought to determine drivers of LOS in this ED. They reviewed 80,714 electronic medical records of ED patients from 1 December 2012 to 1 December 2014. In a stepwise regression procedure that accounted for patient factors of age, gender and deprivation score, ethnicity had no statistically significant effect on LOS. Māori were, on average, younger, less likely to receive bloodwork and radiographs, less likely to go to the ED observation area, less likely to have a GP, and more likely to be discharged and to self-discharge; all of these factors decreased their length of stay.

Comment: I’ve included this paper to highlight the incidental findings – that Māori attending this ED were less likely to receive investigations or have a GP, and more likely to be discharged or self-discharged. It would be interesting to know if guidelines were followed appropriately.

Reference: West J Emerg Med. 2016;17(4):438-48


Maori Health Review

Ngā Hua a Tāne Rore The Benefits of Kapa Haka

Authors: Pihama L et al.

Summary: This report arose out of consultation with kapa haka practitioners and interested government agencies. It not only describes empirical evidence in support of the cultural, social, health, education and economic impacts of kapa haka, but also details how kapa haka is able to facilitate meaningful connections with other cultures.

Comment: A number of students have asked about evidence on the benefits of kapa haka – hence the inclusion of this report for this month’s review.

Reference: Ngā Hua a Tāne Rore The Benefits of Kapa Haka: Scoping the research needs and options for developing a better understanding of the contribution that Kapa Haka makes to Aotearoa New Zealand society. 2014. Wellington: Ministry for Culture and Heritage.


Kaumātua Day: a Māori community-led approach to addressing the health and wellbeing needs of elderly Māori following the Canterbury earthquakes

Authors: Kenney C

Summary: Within the disaster response and research sectors, there is increasing recognition of the value of community-led initiatives that facilitate emergency management, mitigate health risks as well as foster community well-being. In contrast, the value of culture-based approaches to addressing disaster recovery has rarely been acknowledged. Recent kaupapa Māori research conducted in Christchurch suggests that Māori response initiatives were characterised by collaborative accountability, authority, agency, and actions, because within a Māori paradigm, a hierarchically-structured ‘command and control’ approach to facilitating community recovery has proven to be ineffective. Māori-led responses in Canterbury were found to be consistently shaped by kaupapa (cultural values) and highly effective in addressing the needs of local communities. Research findings may be usefully drawn upon to enhance public health and emergency management policies and practices. When the Canterbury earthquakes commenced, Ngāi Tahu, as kaitiaki, had an obligation to ensure the wellbeing of all Christchurch residents. After the February 22nd earthquake in 2011, a national Māori Recovery Network was established, and Te Rūnanga o Ngāi Tahu coordinated community support. The eastern suburbs of Christchurch were most severely impacted by the earthquakes. As these suburbs are home to the majority of urban Māori, many Kaumātua were disproportionately affected with reduced access to basic necessities, sanitation, power, transport and support from frontline responders. Māori elders with significant health and mobility issues were particularly marginalised, due to isolation in unsafe homes. Access to appropriate and culturally acceptable health services was also very limited. Consequently, Māori elderly experienced increased rates of illness and a corresponding deterioration in psychosocial wellbeing. In response, five Māori women with community leadership and service expertise collaborated to develop a community-led initiative, ‘Kaumātua Day’, in order to facilitate psychosocial and material support for elderly Māori living in the eastern suburbs. Seed funding was accessed from both the Todd and Tindall Foundations and the initiative was implemented in March 2012, in accordance with Māori collective values. Specific Kaumātua Day goals included: 1. Reducing social isolation by supporting elderly residents to meet several times a month; and 2. Supporting social connectedness by facilitating group aspirations, entertainment, dinners and opportunities for intergenerational socialisation; and 3. Facilitating access to material, social and health resources/services for those who were mobility impaired, geographically/socially isolated and/or experiencing elder abuse. Since inception, Kaumātua engagement with the initiative has gradually increased. Currently, approximately 170 Māori elders participate on a semi-regular basis. Due to the initiative’s effectiveness, Kaumātua Day has expanded to provide outreach services for the wider elderly community in Eastern Christchurch. Key factors in the initiative’s success include the Māori collectivised approach to leadership as well as the enactment of traditional cultural values and practices, which offer a counterpoint to commonly applied ‘command-and-control’ approaches to managing the health risks of elderly Māori who reside in post-disaster contexts.

Reference: Five Māori women community leaders volunteer to reduce earthquake impact on elderly residents in Eastern Christchurch. In UNISDR (Ed). Women’s Leadership in Risk-Resilient Development (pp. 65-70). Bangkok: United Nations Office for Disaster Risk Reduction.