Association between experience of racial discrimination and hazardous alcohol use among Māori in Aotearoa New Zealand

Ethnic disparities in mental health problems in New Caledonia and French Polynesia

OBJECTIVES

Indigenous people experience poorer mental health compared to the general population. Socioeconomic gaps partly explain these disparities. However, there is variability between populations and French overseas territories are understudied. This study examines the prevalence of mental health problems among Indigenous people in New Caledonia and French Polynesia, describing and comparing it with that of their counterparts while considering associated factors.

METHODS

We used the data from the cross-sectional Mental Health in the General Population survey in the only 3 sites for which information on indigenous status was available: Noumea (2006) and the 'Bush' (2008) in New Caledonia, and French Polynesia (2015-2017). Current mental health issues were screened using the Mini-International Neuropsychiatric Interview. In multivariable analyses, we considered the following factors: gender, age, education level, marital status, occupational activity and monthly income.

RESULTS

Overall, 2294 participants were analysed. Among the 1379 indigenous participants, 52.3% had at least one mental health issue. The prevalence of depressive disorder (18.0% vs 11.7%), alcohol use disorder (16.7% vs 11.7%) and suicide risk (22.3% vs 16.7%) were higher among indigenous participants compared to non-indigenous participants. After adjustment, the association between indigenous status and these mental health issues did not persist, except for alcohol use disorder.

CONCLUSION

We found higher prevalence of depressive disorder, alcohol use disorder and suicide risk among indigenous people of French Polynesia and New Caledonia compared to their counterparts. These differences seemed largely explained by socioeconomic disparities. Future studies could explore the use of and access to healthcare by indigenous populations.

Population-Level Impacts of Alcohol Use on Mental and Physical Health Outcomes

This study explores patterns of alcohol drinking within a representative New Zealand sample (2887 participants (1464 female, 1423 male)). Alcohol use and drinking patterns across the population are described. Multivariable logistic regressions document associations between alcohol use and drinking patterns and the likelihood of experiencing different health outcomes. Alcohol use, early drinking initiation, frequent drinking, and heavy episodic drinking (HED) are prevalent in New Zealand and vary in relation to gender, age, and socioeconomic characteristics. Those who reported alcohol-related problems were more likely to report poor mental health (AOR: 2.21; 95% CI: 1.42-3.46) and disability (AOR: 1.79, 95% CI: 1.06-3.00), and less likely to experience positive mental health (AOR: 0.28, 95% CI: 0.18-0.42). Those who reported HED were also less likely to experience good general health (AOR: 0.61, 95% CI: 0.47-0.81) and positive mental health (AOR: 0.67, 95% CI: 0.53-0.84). Younger age cohorts were more likely to engage in early drinking, and those who initiated regular drinking before age 18 were more likely to report HED and alcohol-related problems. Findings indicate that problem drinking and HED are not only associated with poor physical health, but also reduce the likelihood of individuals experiencing positive mental health. This provides information to enable public health practitioners to target alcohol prevention strategies at the entire population of drinkers.

The New Zealand drug harms ranking study: A multi-criteria decision analysis

AIMS

The harms arising from psychoactive drug use are complex, and harm reduction strategies should be informed by a detailed understanding of the extent and nature of that harm. Drug harm is also context specific, and so any comprehensive assessment of drug harm should be relevant to the characteristics of the population in question. This study aimed to evaluate and rank drug harms within Aotearoa New Zealand using a multi-criteria decision analysis (MCDA) framework, and to separately consider harm within the total population, and among youth.

METHODS

Two facilitated workshops involved the separate ranking of harm for the total population, and then for youth aged 12-17, by two expert panels. In the total population workshop, 23 drugs were scored against 17 harm criteria, and those criteria were then evaluated using a swing weighting process. Scoring and weighting were subsequently updated during the youth-specific workshop. All results were recorded and analysed using specialised MCDA software.

RESULTS

When considering overall harm, the MCDA modelling results indicated that alcohol, methamphetamine and synthetic cannabinoids were the most harmful to both the overall population and the youth, followed by tobacco in the total population. Alcohol remained the most harmful drug for the total population when separately considering harm to those who use it, and harm to others.

CONCLUSIONS

The results provide detailed and context-specific insight into the harm associated with psychoactive drugs use within Aotearoa New Zealand. The findings also demonstrate the value of separately considering harm for different countries, and for different population subgroups.

Lung Cancer Attracts Greater Stigma than Other Cancer Types in Aotearoa New Zealand

Background

Lung cancer is the leading cause of cancer death in Aotearoa New Zealand, killing over 1,700 people each year. Despite the burden of lung cancer in Aotearoa New Zealand, the popular press has referred to it as the cancer type that no one talks about. Here, we investigate one factor that may contribute to this state of affairs: lung cancer stigma.

Methods

Participants were university students and members of the general public. University students were recruited via an online experiment participation system in 2021. Members of the public were recruited via social media. All participants completed the Cancer Stigma Scale (CSS) for one of five cancer types (lung, cervical, breast, skin, or bowel). The CSS is a 25-item scale with six subscales: awkwardness, avoidance, severity, policy opposition, personal responsibility, and financial discrimination.

Results

The mean age of participants was 24.3 (Standard Deviation = 10.4). Data from each subscale were submitted to an analysis of covariance (ANCOVA), with cancer type as a between-participant factor (5: lung, cervical, breast, skin, or bowel) and stigma as the dependent variable. Relative to most other cancer types, people were more likely to avoid someone with lung cancer, view interacting with someone with lung cancer as more awkward, and view people with lung cancer as being responsible for their condition.

Conclusion

The Health Research Council of New Zealand recently funded the very first trial of lung cancer screening in Aotearoa New Zealand. The current study suggests that addressing stigma will be essential for the success of such programs, with stigma likely influencing those who engage in such trials.

Diversifying Indigenous Vulnerability and Adaptation: An Intersectional Reading of Māori Women’s Experiences of Health, Wellbeing, and Climate Change

Despite evidence that Indigenous peoples’ multiple subjectivities engender diverse lived experiences both between and within Indigenous groups, the influence of multiple subjectivities on Indigenous peoples’ vulnerability and adaptation to climate change is largely un-explored. Drawing on ethnographic research with Indigenous Māori women in Aotearoa New Zealand, this paper provides empirical evidence that subjectivity-mediated power dynamics operating within Indigenous societies (at the individual and household scale) are important determinants of vulnerability and adaptation which should be considered in both scholarship and policy. Using an intersectional framework, I demonstrate how different Māori women and their whānau (families) live, cope with, and adapt to the embodied physical and emotional health effects of climate change in radically different ways because of their subject positionings, even though they belong to the same community, hapū (sub-tribe), or iwi (tribe). In underlining these heterogenous experiences, I provide an avenue for reconsidering how climate adaptation scholarship, policies, and practices might better engage with the complex, amorphous realities within Māori and other Indigenous communities. I argue it is possible to develop more inclusive, tailored, and sustainable adaptation that considers divergent vulnerabilities and adaptive capacities within Indigenous communities, groups, and societies and supports customised vulnerability-reduction strategies.

The intersection race/skin color and gender, smoking and excessive alcohol consumption: cross sectional analysis of the Brazilian National Health Survey, 2013

This study aims to investigate whether the intersectional identities defined by race/skin color and gender are associated with smoking and excessive consumption of alcohol in a representative sample of Brazilian adults. This is a cross-sectional study with 48,234 participants in the Brazilian National Health Survey (PNS) - 2013. Crude and adjusted odds ratios (OR) and respective 95% confidence intervals (95%CI) were used to estimate the associations of intersectional categories of race/skin color and gender (white woman, brown woman, black woman, white man, brown man, black man) with smoking and excessive consumption of alcohol, based on the combination of weekly "days" and "servings". The prevalence of smoking varied from 10.6% for white women to 23.1% for black men, while the prevalence of elevated consumption of alcohol ranged from 3.3% to 14%, respectively. In comparison to white women, only white, brown, and black men presented greater chances of smoking, reaching the OR of 2.04 (95%CI: 1.66-2.51) in black men. As to excessive consumption of alcohol, all intersectional categories showed greater chances of consumption than white women, with the greatest magnitude in black men (OR = 4.78; 95%CI: 3.66-6.23). These associations maintained statistical significance after adjustments made for sociodemographic, behavioral, and health characteristics. Results demonstrated differences in smoking habit and excessive consumption of alcohol when the intersectional categories were compared to traditional analyses. These findings reinforce the significance of including intersectionality of race/skin color and gender in epidemiological studies.

Impact of racism and discrimination on physical and mental health among Aboriginal and Torres Strait islander peoples living in Australia: a systematic scoping review

BACKGROUND

Racism is increasingly recognised as a significant health determinant that contributes to health inequalities. In Australia efforts have been made to bridge the recognised health gap between Aboriginal and Torres Strait Islander people and other Australians. This systematic scoping review aimed to assess, synthesise, and analyse the evidence in Australia about the impacts of racism on the mental and physical health of Aboriginal and Torrens Strait Islander peoples.

METHODS

A systematic search was conducted to locate Australian studies in English published between 2000 and 2020. Five electronic databases were used: PubMed, CINAHL, Embase, Web of Science and the Australia's National Institute for Aboriginal and Torres Strait Islander Health Research. The search strategy included a combination of key words related with racism, mental health, physical health and Indigenous people. Data were extracted based on review questions and findings were synthesized in a narrative summary.

RESULTS

Of total 338 searched studies from five databases, 12 studies met the inclusion criteria for narrative synthesis where eight were cross-sectional studies and four prospective cohorts. General mental health and general health perception were the most frequently studied outcomes followed by child behaviour, smoking and substance consumption and specific health conditions. The prevalence of racism varied between 6.9 and 97%. The most common health outcomes associated with racism were general poor mental health and poor general health perception. More specific health outcomes such as anxiety, depression, child behaviour, asthma, increased BMI and smoking were also associated with racism but were analysed by a limited number of studies. Three studies analysed psychological distress, negative mental health, sleeping difficulties and negative perceived mental health according to severity of exposition to racism.

CONCLUSION

Racism is associated with negative overall mental and negative general health outcomes among Aboriginal and Torres Strait Islander peoples. Strategies to prevent all forms and sources of racism are necessary to move forward to bridging the health gap between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians. Further research is needed to understand in more detail the impact of racism from an Aboriginal and Torres Strait Islander definition of health and wellbeing.

Alcohol consumption and dependence is linked to the extent that people experience need satisfaction while drinking alcohol in two Aboriginal and Torres Strait Islander communities

BACKGROUND

Unhealthy alcohol use is a key concern for Aboriginal and Torres Strait Islander ('Indigenous Australian') communities. Due to systematic disadvantage and inter-generational trauma, Indigenous Australians may be less likely to have satisfied basic psychological needs (autonomy, competence, and relatedness). When people are need-thwarted, they may engage in compensatory behaviours to feel better in the short-term. We explore the relationship between perceived basic psychological needs satisfaction and alcohol consumption use among Indigenous Australians. Better understanding the functions that alcohol may play for some Indigenous Australian drinkers may aid communities, clinicians, and policy makers in improving programs for reducing drinking-related harms.

METHODS

We performed a cross-sectional survey of Indigenous Australians (aged 16 years or older) living in two South Australian communities. Participants were eligible if they had consumed any alcohol in the past 12 months. Spearman correlations and linear regressions were used to determine if feeling more autonomous, competent, and related to others (need satisfied) while drinking, was linked to alcohol consumption and dependence.

RESULTS

Controlling for participant demographics, reporting feeling need satisfied while drinking was linked to drinking more alcohol per day, reporting more frequent symptoms of alcohol dependence, spending more money on alcohol, and scoring higher on the AUDIT-C.

CONCLUSIONS

Unhealthy drinking may partly stem from attempts to satisfy basic psychological needs. Programs which support Indigenous Australians to meet basic psychological needs could reduce attempts to meet psychological needs through alcohol consumption.