New Zealand European Research Articles

Systematic review of disparities in surgical care for Māori in New Zealand.

Health equity for Indigenous peoples in the context of surgery has recently become topical amongst surgeons in Australasia. Health inequities are amongst the most consistent and compelling disparities between Māori and New Zealand Europeans (NZE) in New Zealand (NZ). We aimed to investigate where ethnic disparities in surgical care may occur and highlight some of the potential contributing factors, over all surgical specialties, between Māori and NZE adults in NZ. A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A series of electronic searches were performed in Medline, Embase, PubMed and CINAHL. Ten studies met the inclusion criteria. All studies employed a range of indicators for surgical care including receipt of surgery following diagnosis, delays to treatment and post-operative morbidity and mortality. Disparities in the receipt of surgical treatment for several cancers were observed for Māori and remained after adjustment for socioeconomic variables and extent of disease. Māori were more likely to experience delays in treatment and referral to other medical specialties involved in their care. Despite the significant variation in the types of diseases, procedures and indicators of surgical care of the included studies, consistent findings are that disparities in different aspects of surgical care exist between Māori and NZE in NZ. This review highlights the need to better quantify the important issue of health equity for Māori in surgery given the lack of studies over the majority of surgical specialties.

Paediatric food-induced anaphylaxis hospital presentations in New Zealand.

Globally, rates of paediatric food-induced anaphylaxis (FIA) are increasing. Little data is available regarding the epidemiology of FIA among New Zealand (NZ) children. This study investigated the incidence of paediatric (0-14 years) FIA hospital presentations in NZ over a 10-year period. Ministry of Health public hospital discharge data from 2006 to 2015 were analysed using FIA-related International Classification of Diseases codes (T78.0 - anaphylactic shock due to adverse food reaction and T78.2 - anaphylactic shock unspecified and free text qualifier) to identify acute hospital presentations. The overall annualised FIA hospital presentation rate was 16.2 per 100 000 children. Subgroup analysis indicated a significantly higher rate in males (19.1/100 000) than in females (13.1/100 000), and among children aged less than 2 years of age (50.5/100 000) compared with older children. Rates among Asian and Pacific children were higher than Māori and NZ European children. In 67.7% of cases, a single specific allergen was suggested by the information provided; among these cases, nuts (48%), specifically peanuts (26%), were the most commonly reported allergen, followed by cow's milk (21%). Time trend analysis showed a 2.8-fold increase in the overall annualised rate for the 10-year period. These findings are consistent with other international studies indicating increasing rates of FIA in children. These data will provide information for a review of NZ paediatric allergy services to ensure current international standards with regard to the equitable delivery of timely, appropriate and accessible care are being met. Reasons for differences by gender, age and ethnicity require further investigation.

Social and built-environment factors related to children's independent mobility: The importance of neighbourhood cohesion and connectedness

This study examines aspects of neighbourhood social environments (namely, neighbourhood safety, cohesion and connection) and child-specific built environment attributes in relation to children's independent mobility. The results suggest that children aged 8–13 years with parents who perceive their neighbourhood as more cohesive and more connected, and are located closer to school, engaged in higher levels of independently mobile trips. The qualitative component of this research revealed that for NZ European, Māori, Samoan and other Pacific parents, ‘people danger’ was the most common concern for letting their children go out alone, whereas for Asian and Indian parents, ‘traffic danger’ was the most common reason for their concern.

Abstract P4-21-28: Trastuzumab improves outcomes of New Zealand women with HER2+ stage I-III breast cancer

Abstract Introduction HER2 status has been routinely ascertained for stage I-III breast cancer since late 2005. Trastuzumab was first funded in New Zealand for use in HER2+ breast cancer in July 2007. This observational study aims to compare the difference in outcome between women with HER2+ stage I-III breast cancer who received trastuzumab as adjuvant therapy versus those who did not. Differences in presentation, treatment and outcomes between Māori and NZ European were studied. Methods The combined Waikato and Auckland Breast Cancer Registries have clinical details of 12377 women diagnosed with breast cancer between June 2000 and May 2013. 9506 women with breast cancer were tested for HER2 receptor status. Proportion of women with HER2+ (FISH amplified or IHC 3+), stage I-III breast cancer were examined by age, ethnicity and stage. Differences in use of trastuzumab for women with stage I-III breast cancer with a tumour size equal or larger than 1 cm and aged less than 75 years were assessed by ethnicity and year of diagnosis. Patients who had inflammatory breast cancer or developed metastatic disease or local recurrence within 3 months after diagnosis were excluded. Kaplan-Meier method and Cox proportional hazards model were used to examine the breast cancer-specific survival between women treated with trastuzumab and chemotherapy and those treated with chemotherapy without trastuzumab. Results 1454 patients with early invasive breast cancer were HER2+. The proportion of cases with HER2+, stage I-III breast cancer increased with stage (stage I-III: 11.5%-26.9%), but decreased with age (<40 years to 80+ years: 28.8%-9.7%). Māori women were more likely to have HER2+ cancers than NZ European (17.8% versus 14.9%; p=0.02). Among the eligible patients, 605 women received trastuzumab and chemotherapy within 12 months for stage I-III breast cancer, and 275 had chemotherapy without trastuzumab. A small proportion (10.2%, 34/333) of women diagnosed in 2000-2005 received trastuzumab as part of a clinical trial. The proportion of women who received trastuzumab increased to 60.3% in 2006-2009 and to 87.1% in 2010-2013. 46.2% of Māori women were treated with trastuzumab compared to 55.9% of NZ European (p=0.040). The cancer-specific survival estimated with Kaplan-Meier method is shown in Table 1. Women treated with chemotherapy without trastuzumab were 2.7 times (95% CI: 1.9-3.9) more likely to die of breast cancer compared to those treated with trastuzumab and chemotherapy, after adjustment for stage, tumour size and hormone therapy. Table 1. Breast cancer-specific survival between women with HER2+ stage I-III breast cancer who received trastuzumab as adjuvant therapy versus those who did notTreatmentNumber of patientsMedian follow-up time (months)5-year survival10-year survivalTrastuzumab+chemotherapy6055389.6%84.3%Chemotherapy without trastuzumab27510775.6%69.1% Conclusions Trastuzumab improved the breast cancer-specific survival of women with HER2+ stage I-III breast cancer. Māori women were more likely to have HER2+ cancer and less likely to be treated with trastuzumab. Rates of treatment with trastuzumab and the adjusted survival between Māori women and NZ European women were not significantly different. Citation Format: Lawrenson R, Lao C, Harvey V, Campbell I, Brown C, Seneviratne S, Edwards M, Scott N, Elwood M, Sarfati D, Kuper-Hommel M. Trastuzumab improves outcomes of New Zealand women with HER2+ stage I-III breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-21-28.

A cohort study of ethnic differences in use of adjuvant chemotherapy and radiation therapy for breast cancer in New Zealand

BackgroundEthnic and socioeconomic inequities in use of breast cancer adjuvant therapy are well documented in many countries including the USA, and are known to contribute to lower breast cancer survival among minority ethnic and socioeconomically deprived women. We investigated ethnic and socioeconomic inequities in use of adjuvant radiotherapy and chemotherapy in a cohort of women with invasive breast cancer in New Zealand.MethodsAll women with newly diagnosed invasive breast cancer during 1999-2012 were identified from the Waikato Breast Cancer Register. Rates of chemotherapy use and radiotherapy use were assessed in women who were deemed to be eligible for chemotherapy (n = 1212) and radiotherapy (n = 1708) based on guidelines. Factors associated with use of chemotherapy and radiation therapy were analysed in univariate and multivariate regression models, adjusting for covariates.ResultsOverall, rates of chemotherapy and radiotherapy use were 69% (n = 836) and 87.3% (n = 1491), respectively. In the multivariate model, significantly lower rates of radiotherapy use were associated with Māori compared with NZ European (Odds Ratio [OR] = 0.63, 0.40-0.98), presence of comorbidity (OR = 0.49, 0.34-0.72), distance from hospital of over 100km (OR = 0.47, 0.23-0.96), mastectomy compared with breast conserving surgery (OR = 0.32, 0.17-0.56) and non-screen compared with screen detection (OR = 0.53, 0.35-0.79). No significant associations were observed between chemotherapy use and ethnic or socio-demographic factors.ConclusionsImproving access for radiotherapy, especially for women who are at a higher risk of not receiving optimum cancer therapy due to ethnicity, geography or socioeconomic status need to be recognized as a priority to reduce inequities in breast cancer care in New Zealand.

Selenium and thyroid health in NZ European women

Selenium and thyroid health in NZ European women

Prevalence of comorbidities in obese New Zealand children and adolescents at enrolment in a community-based obesity programme.

The aim of this study was to describe the characteristics at enrolment of children and adolescents referred to an obesity programme and to determine how the prevalence of comorbidities differed in Indigenous versus non-Indigenous children. Participants were residents of a semi-rural region of New Zealand (NZ). Eligibility was defined by a body mass index (BMI) of ≥98th percentile or >91st centile with weight-related comorbidities. Fasting blood, medical and physical assessments were obtained. During the recruitment period from January 2012 to August 2014, 239 participants, aged 4.8-16.8 years, undertook assessment. Average BMI standard deviation score was 3.09 (standard deviation (SD) = 0.60, range 1.52-5.34 SD). The majority of participants were of either Maori (NZ's indigenous people (45%)) or NZ European (45%) ethnicity; 29% of participants were from the most deprived quintile of household deprivation. Maori participants were more likely than NZ Europeans to have a mother who smoked during pregnancy (52% vs. 28%, P = 0.001), a family history of type 2 diabetes (66% vs. 53%, P = 0.04), acanthosis nigricans on examination (58% vs. 20%, P < 0.0001), a low serum high-density lipoprotein cholesterol (27% vs. 14%, P = 0.03) or high serum triglyceride (38% vs. 24%, P = 0.03) concentration. The unique aspect of this study was the ability to recruit high levels of Maori participants and those from most deprived areas, indicating a high level of acceptability for these target groups. Comorbidities were prevalent in this cohort of overweight/obese school-aged children. While there were some differences in comorbidity prevalence between Maori and NZ Europeans, the overall clinical picture in our cohort, irrespective of ethnicity, was of concern.

Exploring the Dietary Patterns of Young New Zealand Women and Associations with BMI and Body Fat.

Examining dietary patterns provides an alternative approach to investigating dietary behaviors related to excess adiposity. The study aim was to investigate dietary patterns and body composition profiles of New Zealand European (NZE) women, participating in the women’s EXPLORE (Examining the Predictors Linking Obesity Related Elements) study. Post-menarche, pre-menopausal NZE women (16–45 years) (n = 231) completed a validated 220-item, self-administrated, semi-quantitative food frequency questionnaire. Body mass index (BMI) was calculated using measured height (cm) and weight (kg); body fat percentage (BF%) was measured using air displacement plethysmography (BodPod). Dietary patterns were identified using principal component factor analysis. Associations between dietary patterns, age, BMI and BF% were investigated. Four dietary patterns were identified: snacking; energy-dense meat; fruit and vegetable; healthy, which explained 6.9%, 6.8%, 5.6% and 4.8% of food intake variation, respectively. Age (p = 0.012) and BMI (p = 0.016) were positively associated with the “energy-dense meat” pattern. BF% (p = 0.016) was positively associated with the “energy-dense meat” pattern after adjusting for energy intake. The women following the identified dietary patterns had carbohydrate intakes below and saturated fat intakes above recommended guidelines. Dietary patterns in NZE women explain only some variations in body composition. Further research should examine other potential factors including physical activity and socioeconomic status.

Neonatal encephalopathy in New Zealand: Demographics and clinical outcome.

To establish the incidence of moderate to severe neonatal encephalopathy (NE) in term infants from New Zealand and to document demographic characteristics and neonatal outcomes. Cases were reported monthly via the New Zealand Paediatric Surveillance Unit (NZPSU). Data were collected from paediatricians for neonatal items and lead maternity carers for pregnancy and birth details. Term neonatal deaths in the Perinatal and Maternal Mortality Review Committee dataset that were because of hypoxia and/or neonatal deaths from hypoxic ischaemic encephalopathy were added to the cases identified via the NZPSU, if they had not previously been ascertained. For the period January 2010 to December 2012, there were 227 cases, equivalent to a rate of 1.30/1000 term births (95% CI 1.14-1.48). Rates of NE were high in babies of Pacific and Indian mothers but only reached statistical significance for the comparison between Pacific and NZ European. There was also a significant increase in NE rates with increasing deprivation. Resuscitation at birth was initiated for 209 (92.1%) infants with NE. Mechanical ventilation was required, following neonatal unit admission, in 171 (75.3%) infants. Anticonvulsants were used in 157 (69.2%) infants with phenobarbitone (65.6%), phenytoin (14.5%) and benzodiazapines (21.1%), the most common. Cooling was induced in 168 infants (74%) with 145 (86.3%) reported as commenced within a 6-h window. The rate of NE in New Zealand is consistent with reported international rates. Establishing antecedent factors for NE is an important part of improving care, which may inform strategic efforts to decrease rates of NE.

Australian and New Zealand Society for Geriatric Medicine Position Statement Abstract: Ageing and indigenous health in Aotearoa New Zealand.

Australasian Journal on AgeingVolume 36, Issue 2 p. 134-134 Indigenous Ageing Research FeatureFree Access Australian and New Zealand Society for Geriatric Medicine Position Statement Abstract: Ageing and indigenous health in Aotearoa New Zealand First published: 07 April 2016 https://doi.org/10.1111/ajag.12217Citations: 1 This Position Statement represents the views of the Australian and New Zealand Society for Geriatric Medicine. The preparation of this paper was coordinated by Dr Oliver Menzies, Professor Ngaire Kerse and Dr Mere Kēpa and was approved by the Federal Council of the ANZSGM on 16 June 2013. Te Ohu Rata O Aotearoa (Te ORA) – The Māori Medical Practitioners Association – has also reviewed this Statement. [Correction added on 21 October 2016, after first online publication: The Position Statement Ageing and indigenous health in Aotearoa New Zealand has been replaced by its summary. The version originally published can be found as the supporting information of this article on Wiley Online Library.] AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Communication between different cultures are common in New Zealand (NZ), and common in healthcare situations. A doctor's culture and belief systems influence his or her interactions with patients and this may impact on the doctor–patient relationship. Older Māori in NZ share a particular health background and understanding this may help to appreciate where current health or ill health may have stemmed. The process of colonisation has had a marked effect on the health of Māori in NZ. The Treaty of Waitangi is NZ's founding nationhood document and has important significance for health. The NZ Government has recognised that there are disparities in health in NZ, and also the governmental responsibility to improve health outcomes for Māori. Socioeconomic disadvantage explains a considerable proportion of the disparity in health between Māori and non-Māori. There have been a number of different models developed for understanding Māori Health; common themes however are spirituality, mental health, physical health, family, language and cultural heritage. The assessment and treatment of Māori can vary compared with non-Māori, and health practitioners should take note of this to allow best care for their patient. Particular examples of this are contained within this Position Statement. It is important, with the patient's consent, to involve family and whānau (wider family) in both assessment and treatment. Management for older Māori should include consideration of Rongoā/Māori Medicine and healing, which may incorporate particular medicinal formulations and massage. The ANZSGM supports further research into Māori Health and government initiatives to improve the deficit in health of Māori populations compared with the NZ European population. Introduction He aha te mea nui o te ao What is the most important thing in the world? He tangata, he tangata, he tangata It is the people, it is the people, it is the people (Māori proverb) Māori is the name given to the Tangata Whenua/people of the land (Indigenous people) of Aotearoa, NZ [1]. This Statement addresses the health of older Māori in NZ. The background and epidemiology of Māori Health in NZ is discussed, followed by practical application in assessment of the older Māori patient. The full document of this Position Statement can be found at http://www.anzsgm.org/posstate.asp Supporting Information Filename Description ajag12217-sup-0001-ArticleS1.pdfPDF document, 163 KB Article S1. Ageing and indigenous health in Aotearoa New Zealand (full document). Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article. Reference Barlow, CB. Tikango Whakaaro, Key Concepts in Māori Culture. Auckland: Oxford University Press, 1991. Google Scholar Citing Literature Volume36, Issue2June 2017Pages 134-134 ReferencesRelatedInformation

Differences in survival between Māori and New Zealand Europeans with prostate cancer.

This study aims to examine the survival disparity between Māori men and New Zealand (NZ) Europeans diagnosed with prostate cancer. We identified men aged 40+ years in the Midland Cancer Network region registered with prostate cancer in 2007-2010 in the Cancer Registry. Data were extracted from patient notes of all Māori men and a sample of NZ Europeans. The survival disparity between Māori men and Europeans was estimated by the Kaplan-Meier method and Cox proportional-hazards regression models after adjusting for other factors. This study included 535 men with prostate cancer (135 Māori men and 400 Europeans). The 5-year cancer-specific survival was 98.6% for men diagnosed with localised cancer, 88.8% for locally advanced disease and 19.1% for metastatic cancer. The all-cause survival and the cancer-specific survival were both significantly poorer for Māori men than for NZ Europeans (log rank test: P=0.004, 0.006 respectively). The hazard ratio of cancer-specific survival for Māori men was 2.01 (95% CI: 1.21-3.36) compared with NZ Europeans. Māori men with prostate cancer had poorer all-cause survival and cancer-specific survival than NZ Europeans. Māori men were at risk of having more advanced disease at diagnosis, which explains most of the survival inequity between Māori men and NZ Europeans.

Stage of breast cancer at diagnosis in New Zealand: impacts of socio-demographic factors, breast cancer screening and biology.

BackgroundExamination of factors associated with late stage diagnosis of breast cancer is useful to identify areas which are amenable to intervention. This study analyses trends in cancer stage at diagnosis and impact of socio-demographic, cancer biological and screening characteristics on cancer stage in a population-based series of women with invasive breast cancer in New Zealand.MethodsAll women diagnosed with invasive breast cancer between 2000 and 2013 were identified from two regional breast cancer registries. Factors associated with advanced (stages III and IV) and metastatic (stage IV) cancer at diagnosis were analysed in univariate and multivariate models adjusting for covariates.ResultsOf the 12390 women included in this study 2448 (19.7 %) were advanced and 575 (4.6 %) were metastatic at diagnosis. Māori (OR = 1.86, 1.39-2.49) and Pacific (OR = 2.81, 2.03-3.87) compared with NZ European ethnicity, other urban (OR = 2.00, 1.37-2.92) compared with main urban residency and non-screen (OR = 6.03, 4.41-8.24) compared with screen detection were significantly associated with metastatic cancer at diagnosis in multivariate analysis. A steady increase in the rate of metastatic cancer was seen which has increased from 3.8 % during 2000-2003 to 5.0 % during 2010-2013 period (p = 0.042).ConclusionsProviding equitable high quality primary care and increasing mammographic screening coverage needs to be looked at as possible avenues to reduce late-stage cancer at diagnosis and to reduce ethnic, socioeconomic and geographical disparities in stage of breast cancer at diagnosis in New Zealand.

Agreement between parental perception of child weight status and actual weight status is similar across different ethnic groups in New Zealand.

INTRODUCTION Accurate parental perception of their child's weight is poor. Accuracy may be influenced by differences in ethnicity but this is currently unknown. AIM To determine whether agreement between parental perception of child weight status and actual child weight status differs according to ethnic group (NZ European, Māori, Pacific, Asian), and to investigate whether it is influenced by various demographic and behavioural factors. METHODS A total of 1093 children (4-8 years old) attended a weight screening initiative. Parents completed questionnaires on demographics, beliefs about child weight, parenting style, parental feeding practices and social desirability. Actual measured weight status was compared with parental perception of weight status (underweight, normal weight, overweight). RESULTS Agreement about child weight status was apparent in 85% of NZ European, 84% of Māori, 82% of Pacific and 88% of Asian children. However, adjusting for chance led to kappas of 0.34, 0.38, 0.41 and 0.53, respectively, indicating only fair-to-moderate agreement. Overall, agreement between measured body mass index and parental perception was not related to ethnic group, child sex and age, maternal age and education, and household deprivation (k ranged from 0.16 to 0.47). However, agreement about weight status was higher in parents who reported higher levels of restrictive feeding than in parents who reported less restriction (P < 0.01) but agreement was only fair. CONCLUSION Agreement between parental perception and actual weight status was fair and did not differ between the ethnic groups examined.

The role of self-construal in resisting tobacco smoking

We interpreted depth interviews and personal observations of 29 Tongan and New Zealand European (NZE) women who self-identified as non-smokers to examine the role of self-construal in the creation and maintenance of their smoking-resistant identities. Our research offers substantive contributions to the smoking prevention literature because most prior work has been situated wholly within Western cultural contexts. We contribute methodologically by showing how a multicultural team-based approach can reap the advantages of interviewer–participant congruity whilst overcoming its limitations, thus paving the way for more fruitful qualitative research with minority groups. Our research also contributes theoretically to the self-construal literature by comparing the role of self-construal not just within the two groups but also across them. Our findings show that independent self-construal played a significant role in NZE women's resistance to smoking. However, for Tongan women, both independent and interdependent self-construals played important roles in their smoking resistance. Our findings both confirm and extend the current view that there are marked differences between collectivist and independent societies. We extend this view because our findings contradict the notion that Tongan women are likely to only use an interdependent self-concept when deciding to resist smoking, suggesting instead that Tongan women negotiate their self-construals in ways that allow them to employ the positives from both Tongan values and Western world views. We suggest that future appeals to Pacific women to resist smoking should draw on both traditional Pacific values and modern Western independence.

Ethnic differences in breast cancer survival in New Zealand: contributions of differences in screening, treatment, tumor biology, demographics and comorbidities.

We investigated the breast cancer survival disparity between Indigenous Māori and non-Indigenous European women in New Zealand, and quantified the relative contributions of patient, tumor and healthcare system factors toward this disparity. All women diagnosed with breast cancer in Waikato, New Zealand, during 1999-2012 were identified from the Waikato Breast Cancer Register. Cancer-specific survivals were compared using Kaplan-Meier survival curves, while contributions of different factors toward the survival disparity were quantified with serial Cox proportional hazard modeling. Of the 2,679 women included in this study, 2,260 (84.4%) were NZ European and 419 (15.6%) were Māori. Compared with NZ European women, Māori women had a significantly higher age-adjusted cancer-specific mortality (HR 2.02, 95% CI 1.59-2.58) with significantly lower 5-year (86.8 vs. 76.1%, p < 0.001) and 10-year (79.9 vs. 66.9%, p < 0.001%) crude cancer-specific survivals. Stage at diagnosis made the greatest contribution (approximately 25-40%), while screening, treatment and patient factors (i.e., comorbidity, obesity and smoking) contributed by approximately 15% each toward the survival disparity. The final model accounted for almost all of the cancer survival disparity (HR 1.07, 95% CI 0.80-1.44). Māori women experience an age-adjusted risk of death from breast cancer, which is more than twice that for NZ European women. Equity-focussed improvements in health care, including increasing mammographic screening coverage and providing equitable quality and timely cancer care, may improve the survival disparity between Māori and NZ European women.

S12.1 Sexual health of maori adolescents, findings from the youth’12 national youth health and wellbeing survey in secondary schools throughout new zealand

Aim To describe the prevalence and trends of sexual health behaviours for Māori youth in New Zealand. Method The Youth 2000 survey series are anonymous, representative, cross-sectional, self-administered surveys undertaken in 2001, 2007 and 2012 with over 27,000 New Zealand secondary school students aged 12–18 years. Results Data from the surveys highlight that in 2012, 36% of Māori had ever had sex. This was significantly lower than in previous waves of the survey (47.6% in 2001, 55.8% in 2007). Similarly those who report being currently sexually active has declined over time (33.5% in 2001, 41.8% in 2007 and 26.5% in 2012). Despite the trends to fewer Māori youth engaging in sexual behaviour in secondary school, the use of contraception (51.3% in 2001, 52.2% in 2007 and 48.4% in 2012) and condoms (46.4% in 2001, 36.1% in 2007 and 43.8% in 2012) has not improved. Compared to New Zealand European (NZE) students, Māori are significantly more likely to be sexually active (OR 1.50, 95% CI 1.24, 1.83) and less likely to use contraception (OR 0.50, 95% CI 0.38, 0.66). There was no difference in condom use between Māori and NZE. Māori also reported that they were less able to access primary care (GP) they required in the previous 12 months (OR 0.84, 95% CI 0.72, 0.99). Conclusion Māori youth in New Zealand are delaying sexual activity, but those who are sexually active are particularly vulnerable to STIs. Specific strategies are required that improve access to appropriate contraception and condom use for Māori.

Ancestry and BMI Influences on Facial Soft Tissue Depths for A Cohort of Chinese and Caucasoid Women in Dunedin, New Zealand.

This study measured and assessed facial soft tissue depths (FSTDs) in adult female Chinese and New Zealand (NZ) Europeans (Caucasoids). Ultrasound was used to obtain depths at nine landmarks on 108 healthy subjects (51 Chinese, 57 NZ European), erect positioned, of same age group (18-29 years). Height and weight were also recorded. Statistical analysis focused on comparison of tissue depth between the two ancestry groups and the influence of Body Mass Index (BMI) (kg/m2). Results showed mean depth differences at Supra M2 and Infra M2 landmarks significantly greater for Chinese than Caucasoid women for all three BMI Classes (BMI<20, 20≤BMI<25, 25≤BMI<30), even BMI<20. For both groups BMI positively correlated with FSTD values at all landmarks except Labrale superius. This study enabled ancestry and BMI influence on FSTDs to be observed and compared for two distinct groups. Results add to knowledge about facial tissue depth variation.

Attitudes to other ethnicities among New Zealand workers

Purpose– The purpose of this paper is to examine the “other-group orientation” (OGO) of New Zealand (NZ) workers as a way of measuring their attitudes to the growing ethnic diversity in the contemporary workplace.Design/methodology/approach– In all, 500 randomly selected NZ employees were surveyed through computer-assisted telephone interviews. Males, females and ethnic groups were included according to their current proportions in the NZ workforce. Analysis is based on 485 useable cases.Findings– While New Zealanders generally have a high level of OGO, minority ethnic groups and graduates score higher on OGO. Among people under 38 years, males tend to have a higher OGO, while among those over 38, females tend to be higher.Research limitations/implications– The study shows the value of studying the attitudes of workers in relation to diversity and OGO. Workers bring their own orientations into the workplace, affecting the way they relate to their co-workers.Social implications– The pathway to more inclusive workplaces in NZ lies largely in influencing the attitudes and behaviour of NZ Europeans. The study suggests that inclusive educational experiences may be a key part of that process.Originality/value– While the research shows that NZ workers are generally very positive about ethnic diversity, it reveals variations among ethnic and educational groups in terms of their openness to others.

Breast cancer biology and ethnic disparities in breast cancer mortality in new zealand: a cohort study.

IntroductionIndigenous Māori women have a 60% higher breast cancer mortality rate compared with European women in New Zealand. We investigated differences in cancer biological characteristics and their impact on breast cancer mortality disparity between Māori and NZ European women.Materials and MethodsData on 2849 women with primary invasive breast cancers diagnosed between 1999 and 2012 were extracted from the Waikato Breast Cancer Register. Differences in distribution of cancer biological characteristics between Māori and NZ European women were explored adjusting for age and socioeconomic deprivation in logistic regression models. Impacts of socioeconomic deprivation, stage and cancer biological characteristics on breast cancer mortality disparity between Māori and NZ European women were explored in Cox regression models.ResultsCompared with NZ European women (n=2304), Māori women (n=429) had significantly higher rates of advanced and higher grade cancers. Māori women also had non-significantly higher rates of ER/PR negative and HER-2 positive breast cancers. Higher odds of advanced stage and higher grade remained significant for Māori after adjusting for age and deprivation. Māori women had almost a 100% higher age and deprivation adjusted breast cancer mortality hazard compared with NZ European women (HR=1.98, 1.55-2.54). Advanced stage and lower proportion of screen detected cancer in Māori explained a greater portion of the excess breast cancer mortality (HR reduction from 1.98 to 1.38), while the additional contribution through biological differences were minimal (HR reduction from 1.38 to 1.35).ConclusionsMore advanced cancer stage at diagnosis has the greatest impact while differences in biological characteristics appear to be a minor contributor for inequities in breast cancer mortality between Māori and NZ European women. Strategies aimed at reducing breast cancer mortality in Māori should focus on earlier diagnosis, which will likely have a greater impact on reducing breast cancer mortality inequity between Māori and NZ European women.

Predictors and risks of body fat profiles in young New Zealand European, Māori and Pacific women: study protocol for the women's EXPLORE study.

BackgroundBody mass index (BMI) (kg/m2) is used internationally to assess body mass or adiposity. However, BMI does not discriminate body fat content or distribution and may vary among ethnicities. Many women with normal BMI are considered healthy, but may have an unidentified “hidden fat” profile associated with higher metabolic disease risk. If only BMI is used to indicate healthy body size, it may fail to predict underlying risks of diseases of lifestyle among population subgroups with normal BMI and different adiposity levels or distributions. Higher body fat levels are often attributed to excessive dietary intake and/or inadequate physical activity. These environmental influences regulate genes and proteins that alter energy expenditure/storage. Micro ribonucleic acid (miRNAs) can influence these genes and proteins, are sensitive to diet and exercise and may influence the varied metabolic responses observed between individuals. The study aims are to investigate associations between different body fat profiles and metabolic disease risk; dietary and physical activity patterns as predictors of body fat profiles; and whether these risk factors are associated with the expression of microRNAs related to energy expenditure or fat storage in young New Zealand women. Given the rising prevalence of obesity globally, this research will address a unique gap of knowledge in obesity research.Methods/DesignA cross-sectional design to investigate 675 NZ European, Māori, and Pacific women aged 16–45 years. Women are classified into three main body fat profiles (n = 225 per ethnicity; n = 75 per body fat profile): 1) normal BMI, normal body fat percentage (BF%); 2) normal BMI, high BF%; 3) high BMI, high BF%. Regional body composition, biomarkers of metabolic disease risk (i.e. fasting insulin, glucose, HbA1c, lipids), inflammation (i.e. IL-6, TNF-alpha, hs-CRP), associations between lifestyle factors (i.e. dietary intake, physical activity, taste perceptions) and microRNA expression will be investigated.DiscussionThis research targets post-menarcheal, premenopausal women, potentially exhibiting lifestyle behaviours resulting in excess body fat affecting metabolic health. These behaviours may be characterised by specific patterns of microRNA expression that will be explored in terms of tailored solutions specific to body fat profile groups and ethnicities.Trial registrationACTRN12613000714785