Zealand Health Survey Research Articles

Racism and Health Among Aotearoa New Zealand Young People Aged 15–24 years: Analysis of Multiple National Surveys

PurposeThis Aotearoa New Zealand–based study addresses a gap in literature focusing on individual experiences of racism among adolescents and young adults and its links to health. MethodsThis cross-sectional study uses data from multiple instances of the New Zealand Health Survey (2002/03, 2006/07, 2011/12, 2016/17) and General Social Survey (2008–2016) restricted to participants aged 15–24 years. Prevalence of reported experiences of racism are estimated. Meta-analytic techniques to pool data and multiple regression analyses are used to examine associations between experiences of racism and outcomes measures (mental and physical health, general health and well-being, life satisfaction, inability to access health care, and identity). The study used an ethical co-design process between university researchers and a rangatahi Māori (Māori young people) partnership group. ResultsRacism was higher among Māori, Pacific, and Asian young people compared to European young people. Racism was associated with all negative health and well-being measures examined for young people, including negative mental and physical health measures (12-Item Short Form Survey, Kessler Psychological Distress Scale), lower self-rated health, negative life satisfaction, higher unmet need for primary care, and identity measures (feelings of not belonging in New Zealand, less able to express their identity). DiscussionThe results of this study are concerning. Non-European young people disproportionately bear the burden of racism in Aotearoa New Zealand with a potentially substantial impact on their health and well-being. This is a breach of Indigenous (for Māori) and other international human rights and should be motivation to act to eliminate racism in all its forms.

Prevalence of urinary incontinence in New Zealand women from the cross-sectional Sexual and Reproductive Health module of the New Zealand Health Survey 2014/2015.

To describe urinary incontinence prevalence for New Zealand women. The New Zealand Health Survey Adult Sexual and Reproductive Health module 2014/2015 was used to estimate urinary incontinence prevalence. Associations between urinary incontinence and age, body mass index (BMI), parity and ethnicity were estimated by logistic regression adjusted for sampling weights. There were 2,472/5,685 (43.5%) of women aged between and 16 and 74 who responded to the urinary incontinence question and reported at least some incontinence. The sample survey weight-adjusted prevalence (95% confidence interval) was 41.7% (40.0-43.4). An increased prevalence of incontinence was seen with older age, increased BMI and greater parity. The association between BMI and parity was complex, with the lower prevalence with lower BMI attenuated with increasing parity. After adjustment for these variables there was no association with incontinence prevalence for Māori versus non-Māori or European versus non-European. Urinary incontinence is highly prevalent in New Zealand women. There was no association with ethnicity after adjusting for older age, increased BMI and parity. The prevalence identified in the New Zealand Health Survey is higher than that reported in older surveys based on the electoral roll.

Understanding ethnic inequities associated with tobacco use in Aotearoa New Zealand: a quantitative analysis.

Despite the inclusion of both individual interventions and population-based measures in the Aotearoa New Zealand (Aotearoa NZ) Tobacco Control Programme, the gap between Māori, Pacific peoples and European/Asian/Other (EAO) populations in tobacco use has not decreased significantly. Tobacco control interventions that focus on individual behaviour change have produced little impact towards reducing tobacco smoking inequities for Māori and Pacific peoples in Aotearoa NZ. Using data from the New Zealand Health Survey (NZHS), this research investigates the impact of the wider determinants of health and individual-level factors on inequities in tobacco use between Māori, Pacific peoples and EAO. A conceptual framework was developed to support the theoretical positioning of this research and to inform data categorization, framing, discourse, analyses and interpretation. We conducted hierarchical regression to examine the effect of factors from each domain on ethnic inequities in tobacco use. We found that socioeconomic factors accounted for a significant amount of the disparity in adults currently smoking between Māori and Pacific peoples and EAO. Our results suggest that socioeconomic factors may be a more effective target of intervention than individual behaviours for reducing tobacco-related inequities. Addressing the broader determinants of health through comprehensive cross-agency cooperation to reduce ethnic inequities in tobacco use in Aotearoa NZ is likely to be more effective than individual behaviour change approaches.

Consequences of cost barriers to prescriptions: cohort study in Aotearoa New Zealand.

A NZ$5 co-payment prescription charge was removed in July 2023 but may be reinstated. Here we quantify the health impact and cost of not being able to afford this charge. We linked New Zealand Health Surveys (2013/2014-2018/2019) to hospitalisation data using data available in Integrated Data Infrastructure (IDI). Cox proportional-hazards models compared time to hospitalisation between those who had faced a cost barrier to collecting a prescription and those who had not. Of the 81,626 total survey respondents, 72,243 were available for analysis in IDI. A further 516 were excluded to give an analysis dataset of 71,502. Of these, 5,889 (8.2%) reported not collecting a prescription due to cost in the previous year. Among people who faced a cost barrier, 60.0% (95% confidence interval [CI] 58.7-61.2%) were admitted to hospital during the study period, compared to 43.9% (95% CI 43.6-44.3%) of those who did not. Having adjusted for socio-demographic variables, people who faced a cost barrier were 34% (hazard ratio 1.34; 95% CI 1.29-1.39) more likely to be admitted to hospital than those who did not. Annual avoidable hospitalisation costs-were prescription co-payments to remain free-are estimated at $32.4 million per year based on the assumption of a causal relationship between unmet need for prescription medicines and subsequent hospitalisation. The revenue to the health system from co-payments may be offset by the costs associated with avoidable hospitalisations.

An overview of labelling and environmental claims on fish and seafood products in New Zealand supermarkets

Fish and other seafood are a major component of New Zealanders’ diet; the 2018/2019 and 2019/2020 New Zealand Health Survey found that nearly three quarters of New Zealanders eat seafood at least once a week(1). Environmental and ethical factors influence New Zealand consumers’ purchase of seafood and consumers prefer to get their information about seafood at the point of purchase(2). However, environmental claims are not regulated under the Australia New Zealand Food Standards Code, unlike health and nutrition claims. Some seafood products are certified by programmes (e.g. Best Aquaculture Practice (BAP)), ensuring the seafood was sourced according to specific criteria related to environmental management, but other products carry self-declared environmental claims that have not been independently verified. This study aimed to describe labelling practices, including environmental claims, on fish and seafood packaged products sold in major New Zealand supermarkets and available in the 2022 Nutritrack database. Nutritrack is an annual survey conducted by trained fieldworkers who take photographs of all packaged food and beverage products displaying a nutrition information panel (NIP) from 4 major supermarkets in New Zealand. Information from the photographs, including the NIP and the ingredients list is entered into the Nutritrack database. For this study, data (including fish species, harvest location, processing country, fishing method, environmental certifications and self-declared environmental claims) were extracted from the archived photographs of all sides of the packaged fish and seafood products in the 2022 Nutritrack database. Self-declared environmental claims were assessed against the ISO 14021 standard for “Environmental labels and declarations — Self-declared environmental claims (Type II environmental labelling)” on specific criteria that were relevant for seafood products, including if the self-declared claim mentioned the word “sustainable” (as this term is difficult to substantiate and should be avoided); was vague and non-specific; or overstated the benefits (to imply multiple benefits from a single environmental change). There were 369 fish and seafood products included in this study. Eighty-eight products (23.8%) displayed a certification; the Marine Stewardship Council’s certification (MSC) for wild fish was the most common and was featured by 72 products (19.5%). One hundred and fifty-two products (41.2%) displayed at least one self-declared claim. Thirty-three distinct self-declared environmental claims were identified, 16 (48.5%) of which breached the ISO 14021 standard for environmental declarations because they used the term “sustainable” and 26 (78.8%) of which breached the ISO 14021 standard because they were vague. This analysis suggests that stricter regulation is needed for self-declared environmental claims on fish and other seafood products available for purchase in New Zealand, to prevent greenwashing and to provide consumers transparent, accurate and substantiated information.

New migrants' access to primary healthcare services in Aotearoa New Zealand.

To explore new migrants' access to primary healthcare services in the first 10 years after arrival in Aotearoa New Zealand. Data come from three New Zealand Health Surveys (2014/2015, 2015/2016 and 2016/2017), which each sampled around 13,500 people, aged 15+ years, who were usual residents of Aotearoa New Zealand. Respondents who said they were born overseas were asked the first year they had come to Aotearoa New Zealand. Those who had arrived in the 10 years before their survey was completed were considered new migrants. The survey data were pooled and around 3,700 respondents were estimated to fit this category. Log-linear models, with adjustments for age, sex, ethnicity and New Zealand Deprivation Index, were used to look at last year use of primary healthcare. Overall, new migrants used primary healthcare similarly to other New Zealanders. They were more likely to have comprehensive health insurance and paid more for GP visits upon arrival but acted similarly to other New Zealanders after 4 years. Generally, new migrants-after adjusting for covariates-appear to be accessing primary healthcare services in a similar manner to other New Zealanders, on average, soon after arrival.

The impact of racism on subsequent healthcare use and experiences for adult New Zealanders: a prospective cohort study

BackgroundRacism is an important determinant of health and driver of racial/ethnic health inequities. Experience of racism has been linked to negative healthcare use and experiences although most studies have been cross-sectional. This study examines the relationship between reported experience of racism and subsequent use and experience of health services.MethodsThis is a prospective cohort study design. The 2016/2017 adult New Zealand Health Survey (NZHS) provided the sampling frame and baseline data on exposures, health status and confounders. This stand-alone study invited all exposed individuals to participate when sampled based on their reported experience of racism (ever), stratified by broad ethnic groupings (Māori, Pacific, Asian, European/Other). Equal numbers of unexposed participants were selected for invitation using propensity score matching (propensity to experience racism, based on key available predictive factors). Follow-up was one to two years after NZHS interview. Outcome variables (last 12 months) were: unmet healthcare need (overall, for mental health, for a general practitioner); satisfaction with usual medical centre; and experiences with general practitioners (explaining care, involvement in decision-making, treated with respect/dignity, confidence and trust). Logistic regression models examining the association between experience of racism (at baseline) and health service use and experience (at follow-up) used doubly-robust estimation to weight for propensity scores used in the sampling with additional adjustment for confounders.ResultsThe study had 2010 participants. Experience of racism (ever) at baseline was associated with higher overall unmet need at follow-up (adjusted OR (aOR) = 1.71, 95% CI 1.31, 2.23), with similar patterns for other unmet need measures. Experience of racism was associated with higher dissatisfaction with a usual medical centre (aOR = 1.41, 95% CI 1.10, 1.81) and with higher reporting of negative patient experiences.ConclusionIn line with how racism structures oppression, exposure to racism is largely felt by non-European groups in Aotearoa New Zealand. Experiences of racism potentially lead to poorer healthcare and healthcare inequities through higher unmet need, lower satisfaction and more negative experiences of healthcare. The health system has a critical role to play in addressing racism within healthcare and supporting societal efforts to eliminate racism and ethnic inequities.

Inequalities in Mortality in the Asia-Pacific: A Cross-National Comparison of Socioeconomic Gradients.

Social inequalities in mortality are poorly studied in much of the Asia-Pacific. Using data from harmonized nationally representative longitudinal health and aging surveys our study systematically assesses mortality disparities across 3 standardized measures of socioeconomic status in 7 Asia-Pacific countries. We used data from multiple waves of 7 representative sample surveys: the Health, Income and Labour Dynamics in Australia survey, China Health and Retirement Longitudinal Study, the Indonesian Family Life Survey, the New Zealand Health, Work and Retirement survey, the Korean Longitudinal Study on Ageing and the Health, Aging and Retirement in Thailand survey, and the Japanese Study of Aging and Retirement. We use Cox proportional hazards modeling to examine how the hazard of mortality differs across domains of social stratification including educational attainment, wealth, and occupational status across countries. We found consistent and pervasive gradients in mortality risk in the high-income countries by all available measures of social stratification. In contrast, patterns of inequality in adult mortality in middle-income and recently transitioned high-income countries investigated varied depending on the measure of social stratification, with strong gradients by wealth but mixed gradients by education. Analyzing social gradients in mortality in the Asia-Pacific shows that inequalities, especially wealth-based inequalities, in later-life health are present across the region, and that the magnitude of social gradients in mortality is overall larger in high-income countries as compared to middle-income countries.

Unmet need for primary health care and subsequent inpatient hospitalisation in Aotearoa New Zealand. A cohort study.

Introduction The inability to afford a consultation with a general practitioner may lead to delays in accessing care pathways. Aim This study aimed to explore the characteristics of people by their unmet need for a general practitioner consultation because of cost, and the characteristics of subsequent inpatient hospitalisations. Methods From the New Zealand Health Surveys (2013/14-2018/19), two groups were formed based on their unmet need for a general practitioner consultation due to cost. These groups were compared by socio-demographic factors and subsequent inpatient hospitalisation characteristics during follow-up. Time to an inpatient hospitalisation was the outcome in a proportional hazards regression model with need status as the key variable. The model was expanded to include confounding variables: sex, age group, ethnicity, the New Zealand Deprivation Index and self-rated health. Results The need group, characterised by having a higher proportion of females, younger adults, Māori, increased socioeconomic deprivation and poorer self-rated health experienced a greater chance of hospitalisation, a similar number of visits during follow-up, shorter stays and a quicker time to hospitalisation compared to the no-need group. Proportional hazards survival models gave a 28% higher hazard rate for the time to an inpatient hospitalisation for the need group compared to the no-need group. The inclusion of all the confounders in the model gave a similar hazard ratio. Discussion Although consultation fees vary across general practices, it is evident that this may not eliminate the cost barriers to accessing care for some groups. Needing multiple consultations may contribute to persistent unmet needs.

How is enrolment with a general practice associated with subsequent use of the emergency department in Aotearoa New Zealand? A cohort study

Introduction Around 5% of the people in Aotearoa New Zealand (NZ) are not enrolled with a general practice. Aim This study aimed to explore the utilisation of general practice by enrolment status and subsequent use of an emergency department. Methods We compared a cohort of respondents from New Zealand Health Surveys (2013/14–2018/19) on self-reported general practice utilisation and their substitutes, according to their enrolment status (enrolled and not enrolled). They were then followed up to examine their subsequent use of an emergency department. Time to an emergency department presentation was modelled with proportional hazards regression models with enrolment status as the explanatory variable. Confounding variables used were sex, age group, prioritised ethnicity, the New Zealand Deprivation Index and self-rated health. Results Those not enrolled were more likely to be young, male, Asian, more socioeconomically deprived and with better health status than those enrolled. Generally, those not enrolled utilised general practice services less. Those not enrolled who had used an emergency department were more likely to have used it as a substitute for general practice (40% vs 26%). Modelling showed that those not enrolled took longer to access an emergency department. Adjusting for confounding variables did not change that interpretation. Discussion Those not enrolled were younger and healthier and may have a perception that enrolment isn’t necessary. As a group, they were more likely to be socioeconomically deprived and to use an emergency department, which is free at a public hospital in NZ, as a substitute for primary care which suggests that cost may influence their choices.

The prevalence of vegetarians, vegans and other dietary patterns that exclude some animal-source foods in a representative sample of New Zealand adults.

This study aimed to estimate the prevalence of vegetarians, vegans and other dietary patterns that exclude some animal-source foods in New Zealand adults. We also examined socio-demographic and lifestyle correlates of these dietary patterns. The New Zealand Health Survey is a representative rolling cross-sectional survey of New Zealanders; data from the 2018/19 and 2019/20 waves were used for this analysis. Participants were asked if they completely excluded red meat, poultry, fish/shellfish, eggs or dairy products from their diet. New Zealand. Adults, aged ≥ 15 years (n 23 292). The prevalence of red-meat excluders (2·89 %), pescatarians (1·40 %), vegetarians (2·04 %) and vegans (0·74 %) was low. After adjustment for socio-demographic and lifestyle factors, women (OR = 1·54, 95 % CI: 1·22, 1·95), Asian people (OR = 2·56, 95 % CI: 1·96, 4·45), people with tertiary education (OR = 1·71, 95 % CI: 1·18, 2·48) and physically active people (OR = 1·36, 95 % CI: 1·04, 1·76) were more likely to be vegetarian/vegan. Those aged ≥ 75 years (OR = 0·28, 95 % CI: 0·14, 0·53) and current smokers (OR = 0·42, 95 % CI: 0·23, 0·76) were less likely to be vegetarian/vegan. Similar associations were seen between socio-demographic and lifestyle factors and the odds of being a red-meat excluder/pescatarian. Approximately 93 % of New Zealand adults eat red meat and a very small number exclude all animal products from their diets. The Eating and Activity Guidelines for New Zealand adults recommend a plant-based diet with moderate amounts of animal-source foods. A comprehensive national nutrition survey would provide detailed information on the amount of red meat and other animal-source foods that the New Zealand population currently consumes.

Financial barriers to primary health care in Aotearoa New Zealand.

In Aotearoa New Zealand, co-payments to see a general practitioner (GP, family doctor) or collect a prescription are payable by virtually all adults. To examine the extent to which these user co-payments are a barrier to accessing health care, focussing on inequities for indigenous Māori. Pooled data from sequential waves (years) of the New Zealand Health Survey, 2011/12 to 2018/19 were analysed. Outcomes were self-reported cost barriers to seeing a GP or collecting a prescription in the previous year. Logistic regression was used to estimate odds ratios (ORs) of barriers to care for Māori compared with non-Māori, sequentially adjusting for additional explanatory variables. Pooled data included 107,231 people, 22,292 (21%) were Māori. Across all years, 22% of Māori (13% non-Māori) experienced a cost barrier to seeing a GP, and 14% of Māori (5% non-Māori) reported a cost barrier to collecting a prescription. The age- and wave-adjusted OR comparing Māori/non-Māori was 1.71 (95% confidence interval [CI]: 1.61, 1.81) for the cost barrier to primary care and 2.97 (95% CI: 2.75, 3.20) for the cost barrier to collecting prescriptions. Sociodemographics accounted for about half the inequity for both outcomes; in a fully adjusted model, age, sex, low income, and poorer underlying health were determinants of both outcomes, and deprivation was additionally associated with the cost barrier to collecting a prescription but not to seeing a GP. Māori experience considerable inequity in access to primary health care; evidence supports an urgent need for change to system funding to eliminate financial barriers to care.

Caregiver experiences of racism and child mental health outcomes: cross-sectional analysis from Aotearoa New Zealand.

This study aimed to estimate the prevalence of vicarious racism experienced by children (0-14 years) in Aotearoa New Zealand and investigate the association between vicarious racism and diagnosed child mental health conditions. Adult and child 2016/2017 New Zealand Health Survey data were merged to create child-caregiver dyads. Multivariable logistic regression models were used to investigate the association between the caregiver experiences of racism (exposure) and diagnosed child mental health conditions (outcome), adjusting for confounders and exploring potential pathway variables. Looking at 2,989 dyads, the prevalence of "any" vicarious racism was higher for Māori (28.1%; 95% CI 24.2-31.9), Pacific (23.2%; 95% CI 17.9-28.5) and Asian (29%; 95% CI 23.6-34.5) children compared to European/Other children (12.5%; 95% CI 10.2-14.8). A statistically significant association was identified between >2 reports of vicarious racism and the outcome (OR= 2.53, 95% 1.18-5.43). Adding caregiver psychological distress reduced this association (OR= 1.92, 95% 0.91-4.08). Children in Māori, Pacific and Asian ethnicity groupings experience higher exposure to vicarious racism than those in the European/Other grouping. Multiple experiences of vicarious racism are associated with increased odds of diagnosed child mental health conditions in a dose-response distribution.

Transgender-related stigma and gender minority stress-related health disparities in Aotearoa New Zealand: hypercholesterolemia, hypertension, myocardial infarction, stroke, diabetes, and general health

Research has found that transgender-related enacted stigma-including discrimination, harassment, violence, cyberbullying, community rejection, and conversion efforts-is associated with negative mental health among transgender people. Transgender people also experience physical health disparities that could be due to chronic gender minority stress caused by stigma and prejudice. We compared a large New Zealand national survey of transgender participants with the New Zealand Health Survey (NZHS) with age and ethnicity weightings on stress-related health conditions and indicators. We conducted multivariate logistic regression to test associations between transgender-related enacted stigma and physical health conditions and indicators, controlling for age, gender, ethnicity, gender affirming hormone use, and alcohol and tobacco use. Transgender participants had a greater likelihood of ever having hypertension (63%, 95% CI 41%-89%), a myocardial infarction (98%, 6%-271%), a stroke (104%, 2%-311%), hypercholesteremia 148% (114%-188%), and current poor or fair general health (128%, 107%-151%). There were no significant differences for diabetes. Compared with those scoring at the 10th percentile on transgender-related enacted stigma, those at the 90th percentile were more likely to have had hypertension (81%, 36%-140%), hypercholesteremia (54%, 20%-98), and poor/fair health (75%, 45%-110%). We found large disparities for stress-related physical health conditions and indicators, and transgender people who experienced higher transgender-related enacted stigma had a significantly increased prevalence of these negative outcomes. Our findings highlight the need for health professionals to consider gender minority stress and for interventions and policy/law reforms to address transgender-related stigma. The Health Research Council of New Zealand and Rule Foundation.

Characteristics of Atypical Sleep Durations Among Older Compared to Younger Adults: Evidence from the New Zealand Health Survey.

Understanding and supporting sleep is important across the life span. Disparities in sleep status are well documented in mid-life but under-explored among older populations. Data from 40,659 adults pooled from the New Zealand Health Surveys were used; 24.2% were "older adults" (aged ≥65years), 57% were female, and 20.5% of Māori ethnicity. "Long," "short," or "typical" sleep categories were based on age-related National Sleep Foundation guidelines. Multinomial logistic regression examined predictors of atypical sleep, including sociodemographic characteristics, lifestyle factors, and health status. Prevalence of short and long sleep among older adults was 296 (3.0%) and 723 (7.4%), respectively. Correspondingly, prevalence among younger adults was 2521 (8.2%) and 364 (1.2%). Atypical sleep was more significantly associated with indicators of reduced socioeconomic status and ethnicity among younger rather than older adults. Within both age groups, lower physical activity was associated with long sleep status. Higher physical activity and smoking were related to short sleep status among younger adults only. Within both age groups, atypical sleep was associated with SF-12 scores indicating poorer physical and mental health. Having ≥3 health conditions was related to short sleep among the older adults, while for young adults, it was related to both atypical durations. Indicators of negative lifestyle and health factors remain consistent predictors of atypical sleep with aging. However, demographic disparities are less apparent among older atypical sleepers. This study highlights individual and contextual factors associated with atypical sleep patterns which may be important for age-appropriate recognition and management of sleep problems.

Estimating child maltreatment cases that could be alcohol-attributable in New Zealand.

Children are an important group harmed by others' alcohol consumption. This study (1) compared the risk of occurrence of child maltreatment among children exposed versus not exposed to parents with an alcohol-attributable hospitalization or service use for mental health/addiction and (2) conducted sensitivity analyses to estimate the cases of child maltreatment that could be attributable to alcohol under two different conditions in New Zealand. A cohort study conducted among children 0-17 years and their parents (years 2000-2017) using the Statistics New Zealand Integrated Data Infrastructure. The New Zealand Health Survey 2017 was also used. New Zealand. 58 359 children aged 0-17 years and their parents. Survival analysis based on a Bayesian piecewise exponential model was used to estimate the risk of time to first substantiated child maltreatment event (identified from social service, hospital, mortality and police data) related to exposure to parents with an alcohol-attributable hospitalization or who used a mental health/addiction service (versus no exposure). Potential confounders were included for parents and children. The sensitivity analyses (i) estimated an alcohol-attributable admissions/service use fraction for maltreatment in 2017 and (ii) calculated a population-attributable fraction using the relative risk from the cohort and prevalence of hazardous drinking (AUDIT 8+) among parents in 2017. There was a 65.1% [1.65; 95% confidence interval (CI) = 1.46-1.86] increased risk of child maltreatment if a child was exposed to parents who had an alcohol-attributable hospitalized or mental health/addictions service use. The sensitivity analyses estimated that in 2017 14.6% (CI = 14.0-15.3%) and 11.4% (95% CI = 8.4-14.3%) of the documented cases of child maltreatment in New Zealand could be attributable to parents with severe or hazardous consumption. In New Zealand, exposure to parents with an alcohol-attributable hospitalization or service use is a risk factor for substantiated child maltreatment.

Sleep inequities and associations between poor sleep and mental health for school-aged children: findings from the New Zealand Health Survey

Abstract In Aotearoa/New Zealand, ethnic inequities in sleep health exist for young children and adults and are largely explained by inequities in socioeconomic deprivation. Poor sleep is related to poor mental health for these age groups but whether sleep inequities and associations with mental health exist for school-aged children is unclear. We aimed to (1) determine the prevalence of poor sleep health including sleep problems by ethnicity, (2) examine social determinants of health associated with poor sleep, and (3) investigate relationships between poor sleep and mental health for 5–14-year-olds using cross-sectional New Zealand Health Survey data (n = 8895). Analyses included weighted prevalence estimates and multivariable logistic regression. Short sleep was more prevalent for Indigenous Māori (17.6%), Pacific (24.5%), and Asian (18.4%) children, and snoring/noisy breathing during sleep was more prevalent for Māori (29.4%) and Pacific (28.0%) children, compared to European/Other (short sleep 10.2%, snoring/noisy breathing 17.6%). Ethnicity and neighborhood socioeconomic deprivation were independently associated with short sleep and snoring/noisy breathing during sleep. Short sleep was associated with increased odds of anxiety, attention deficit hyperactivity disorder, and activity-limiting emotional and psychological conditions after adjusting for ethnicity, deprivation, age, and gender. In addition, long sleep was independently associated with increased odds of depression. These findings demonstrate that for school-aged children ethnic inequities in sleep exist, socioeconomic deprivation is associated with poor sleep, and poor sleep is associated with poor mental health. Sociopolitical action is imperative to tackle social inequities to support sleep equity and mental health across the lifecourse.

UNDERSTANDING THE USE OF FLEXIBLE WORK ARRANGEMENTS AMONG OLDER INFORMAL CAREGIVERS

Abstract The increasing provision of informal caregiving and the extension of working lives will result in many older workers combining paid work and informal caregiving responsibilities. Specific flexible work arrangement policies have been enacted in many countries to support working caregivers. Flexibility in the workplace has been suggested to promote prolonged employment among older workers. This study primarily focuses on the question of whether use of flexible work arrangements differs between caregivers and non-caregivers and how potential differences can be explained. Participants were 296 carers and 1611 non-carers (aged 55–70 years) who completed wave 8 of the New Zealand Health, Work and Retirement survey. The use of flexible work arrangements was analyzed based on five categories; Flexibility in number of work hours, flexible schedule, flexible place, options for time off, and other options. Hierarchical regressions were used to investigate caregiving as an independent predictor of use of flexible work arrangements after controlling for demographic and work characteristics. Results indicate that the studied informal caregivers on average used more workplace flexible arrangements than non-caregivers, both in flexible work hours, flexible schedules, and time off. The caregiver status difference in use of the three significant categories of flexible work arrangements can be explained by differences in socio-demographic and work characteristics. This difference in use of FWAs among older caregivers and non-caregivers warrants attention in discussions about prolonged employment and reconciliation of care and paid work.

P045 Profiles of Sleep Status in Older Adults and the Associated Characteristics

Abstract Introduction Sleep problems become more prevalent in older adulthood having implications for healthy ageing. Characteristics of sleep status are under-explored among older populations. Methods Data from 13,309 adults ≥ 15 years was analysed from the 2013/2014 New Zealand Health Survey, 22% (2,932) were older adults (≥ 65 years; 56.51% female, 21.32% Māori). Five sleep profiles were established according to self-reported (a) presence of a sleep disorder; (b) excessive day-time sleepiness and (c) short sleep; (d) long sleep; and (e) typical sleep durations. Sociodemographic and health risk factors and health status were explored and multivariate multinomial models conducted to identify the factors associated with each sleep profile in older adulthood. Results Of the older adults, 27.8% were categorised within profiles that typified poor sleep (compared 19.35% of adults aged 15-64 years). Older adults were more likely to be classified within the ‘sleep disorder’, ‘excessive sleepiness’ or ‘long sleep’ profiles compared to the younger adults. Among the older adults, multimorbidity and polypharmacy were independent predictors of the ‘sleep disorder’ profile, whereas ‘typical sleep’ was significantly associated with better health and socio-economic status. Inadequate nutrition, age and sex were significant predictors of ‘long sleep’. While age, sex, ethnicity, body mass index, and higher quantities of alcohol consumption were independently associated with ‘excessive sleepiness’. Conclusions This research helps establish a picture of the characteristics that coincide with profiles of poor sleep in older adulthood. Early recognition and management of sleep problems could improve physical and mental health status with aging.

Sample Design for Analysis using High-Influence Probability Sampling

AbstractSample designs are typically developed to estimate summary statistics such as means, proportions and prevalences. Analytical outputs may also be a priority but there are fewer methods and results on how to efficiently design samples for the fitting and estimation of statistical models. This paper develops a general approach for determining efficient sampling designs for probability-weighted maximum likelihood estimators and considers application to generalized linear models. We allow for non-ignorable sampling, including outcome-dependent sampling. The new designs have probabilities of selection closely related to influence statistics such as dfbeta and Cook's distance. The new approach is shown to perform well in a simulation based on data from the New Zealand Health Survey.