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Maclennan B, Wyeth E, Derrett S. Health-related quality of life following trauma: Prevalence of problems and factors associated with six-month outcomes in a New Zealand cohort. Injury 2024; 55:111468. [PMID: 38452699 DOI: 10.1016/j.injury.2024.111468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/01/2024] [Accepted: 02/25/2024] [Indexed: 03/09/2024]
Abstract
Injury is a leading cause of health loss in Aotearoa me Te Waipounamu (New Zealand; NZ). The NZ Trauma Registry was established in 2015 to monitor outcomes in those experiencing severe injury and to identify ways of improving the quality of care for these patients. Few NZ studies have assessed outcomes in trauma patients using patient-reported outcome measures (PROMs) despite increasing recognition that the impacts of injury are better understood through PROMs. Our aim was to estimate the prevalence of self-reported problems with health-related quality of life (HRQoL) outcomes six months post-injury, and identify factors associated with these, in a cohort of Māori (the Indigenous population of NZ) and non-Māori individuals who had experienced major trauma. HRQoL outcomes were measured according to the five dimensions of the EQ-5D-5L. This information, along with sociodemographic data, was collected via structured telephone interviews. Participants (n = 870), aged 16 years or more, were recruited following admission to a trauma hospital in one of three (of NZ's four) trauma regions. Multivariable models were developed using modified Poisson Regression to identify factors associated with outcomes for both Māori and non-Māori patients. The prevalence and severity of problems across each of the five EQ-5D-5L dimensions was similar for Māori and non-Māori except for Anxiety/Depression. The prevalence and severity of problems with Anxiety/Depression was greater for Māori. Factors associated with HRQoL problems at six-months were also largely similar for each cohort. Those commonly associated with outcomes were age, hospital length of stay, adequacy of household income, and participants' expectations regarding recovery from injury. Further research examining recovery expectations in trauma patients to determine which factors contribute to formulating recovery expectations, and the potential impact of recovery expectations on treatment and rehabilitation, would be of value. Should expectations, at least in part, influence HRQoL outcomes, then routinely collecting data on patients' recovery expectations, adequacy of household income and potential barriers to treatment and rehabilitation, could help inform post-hospital treatment plans, and identify those who may require additional support following discharge from hospital.
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Affiliation(s)
- Brett Maclennan
- Te Roopū Rakahau Hauora Māori a Kāi Tahu (Ngāi Tahu Māori Health Research Unit), Division of Health Sciences, University of Otago, New Zealand
| | - Emma Wyeth
- Te Roopū Rakahau Hauora Māori a Kāi Tahu (Ngāi Tahu Māori Health Research Unit), Division of Health Sciences, University of Otago, New Zealand.
| | - Sarah Derrett
- Te Roopū Rakahau Hauora Māori a Kāi Tahu (Ngāi Tahu Māori Health Research Unit), Division of Health Sciences, University of Otago, New Zealand
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Derrett S, Owen HE, Barson D, Maclennan B, Samaranayaka A, Harcombe H, Wyeth EH. New Zealand's Prospective Outcomes of Injury Study-10 years on (POIS-10): descriptive outcomes to 12 years post-injury. Inj Prev 2024:ip-2023-045058. [PMID: 38195656 DOI: 10.1136/ip-2023-045058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND The 'Prospective Outcomes of Injury Study-10 years on' (POIS-10) aims to contribute to improving long-term disability, health and well-being outcomes for injured New Zealanders. This brief report describes recruitment, characteristics and key outcomes to 12 years post-injury. METHODS Between 2007 and 2009, the study recruited 2856 people, including 566 Māori, from New Zealand's Accident Compensation Corporation's entitlement claims register. People experienced a range of injury types, causes and settings; 25% had been hospitalised for their injury. POIS-10 data were primarily collected via interviewer-administered structured questionnaires. RESULTS Of the original participants, 2068 (92%) were eligible for follow-up in POIS-10. Of these, 1543 (75%) people participated between March 2020 and July 2021, including 240 Māori. Half of the participants (n=757; 50%) reported ongoing problems attributed to their injury 12 years earlier. Most reported difficulties with items assessing disability (WHO Disability Assessment Schedule II). For health-related quality of life (HRQoL), measured using the EQ-5D-5L, the prevalence of problems was higher 12 years post-injury compared with 12 months post-injury for four of five dimensions. Importantly, the prevalence of problems did not reduce to pre-injury levels for any HRQoL dimension. DISCUSSION POIS-10 highlights the importance of early post-injury interventions to improve health, disability and well-being outcomes of injured New Zealanders.
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Affiliation(s)
- Sarah Derrett
- Ngāi Tahu Māori Health Research Unit, University of Otago, Dunedin, Otago, New Zealand
| | - Helen E Owen
- Ngāi Tahu Māori Health Research Unit, University of Otago, Dunedin, Otago, New Zealand
| | - David Barson
- Preventive and Social Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Brett Maclennan
- Ngāi Tahu Māori Health Research Unit, University of Otago, Dunedin, Otago, New Zealand
| | | | - Helen Harcombe
- Preventive and Social Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Emma H Wyeth
- Ngāi Tahu Māori Health Research Unit, University of Otago, Dunedin, Otago, New Zealand
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Penno E, Atmore C, Maclennan B, Richard L, Wyeth E, Richards R, Doolan-Noble F, Gray AR, Sullivan T, Gauld R, Stokes T. How did New Zealand's regional District Health Board groupings work to improve service integration and health outcomes: a realist evaluation. BMJ Open 2023; 13:e079268. [PMID: 38081663 PMCID: PMC10729044 DOI: 10.1136/bmjopen-2023-079268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES In Aotearoa New Zealand (NZ), integration across the healthcare continuum has been a key approach to strengthening the health system and improving health outcomes. A key example has been four regional District Health Board (DHB) groupings, which, from 2011 to 2022, required the country's 20 DHBs to work together regionally. This research explores how this initiative functioned, examining how, for whom and in what circumstances regional DHB groupings worked to deliver improvements in system integration and health outcomes and equity. DESIGN We used a realist-informed evaluation study design. We used documentary analysis to develop programme logic models to describe the context, structure, capabilities, implementation activities and impact of each of the four regional groupings and then conducted interviews with stakeholders. We developed a generalised context-mechanisms-outcomes model, identifying key commonalities explaining how regional work 'worked' across NZ while noting important regional differences. SETTING NZ's four regional DHB groupings. PARTICIPANTS Forty-nine stakeholders from across the four regional groupings. These included regional DHB governance groups and coordinating regional agencies, DHB senior leadership, Māori and Pasifika leadership and lead clinicians for regional work streams. RESULTS Regional DHB working was layered on top of an already complex DHB environment. Organisational heterogeneity and tensions between local and regional priorities were key contextual factors. In response, regional DHB groupings leveraged a combination of 'hard' policy and planning processes, as well as 'soft', relationship-based mechanisms, aiming to improve system integration, population health outcomes and health equity. CONCLUSION The complexity of DHB regional working meant that success hinged on building relationships, leadership and trust, alongside robust planning and process mechanisms. As NZ reorients its health system towards a more centralised model underpinned by collaborations between local providers, our findings point to a need to align policy expectations and foster environments that support connection and collegiality across the health system.
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Affiliation(s)
- Erin Penno
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Carol Atmore
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Brett Maclennan
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Lauralie Richard
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Emma Wyeth
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Rosalina Richards
- Centre for Pacific Health, Va'a o Tautai, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Fiona Doolan-Noble
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Andrew R Gray
- Biostatistics Centre, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Trudy Sullivan
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Robin Gauld
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Otago Business School, University of Otago, Dunedin, New Zealand
| | - Tim Stokes
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Owen HE, Wyeth EH, Maclennan B, Barson D, McBride P, Gabbe BJ, Civil I, Derrett S. Cohort profile: The Trauma Outcomes Project, a prospective study of New Zealanders experiencing major trauma. BMJ Open 2023; 13:e075480. [PMID: 38011969 PMCID: PMC10685924 DOI: 10.1136/bmjopen-2023-075480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE Patient-reported outcome measures (PROMs) are useful for trauma registries interested in monitoring patient outcomes and trauma care quality. PROMs had not previously been collected by the New Zealand Trauma Registry (NZTR). More than 2500 New Zealanders are admitted to hospital for major trauma annually. The Trauma Outcomes Project (TOP) collected PROMs postinjury from three of New Zealand's (NZ's) major trauma regions. This cohort profile paper aims to provide a thorough description of preinjury and 6 month postinjury characteristics of the TOP cohort, including specifically for Māori (Indigenous population in Aotearoa me Te Waipounamu/NZ). PARTICIPANTS Between July 2019 and June 2020, 2533 NZ trauma patients were admitted to one of 22 hospitals nationwide for major trauma and included on the NZTR. TOP invited trauma patients (aged ≥16 years) to be interviewed from three regions; one region (Midlands) declined to participate. Interviews included questions about health-related quality of life, disability, injury recovery, healthcare access and household income adequacy. FINDINGS TO DATE TOP recruited 870 participants, including 119 Māori. At 6 months postinjury, most (85%) reported that the injury still affected them, 88% reported problems with≥1 of five EQ-5D-5L dimensions (eg, 75% reported problems with pain or discomfort, 71% reported problems with usual activities and 52% reported problems with mobility). Considerable disability (World Health Organization Disability Assessment Schedule, WHODAS II, score ≥10) was reported by 45% of participants. The prevalence of disability among Māori participants was 53%; for non-Māori it was 44%. Over a quarter of participants (28%) reported trouble accessing healthcare services for their injury. Participation in paid work decreased from 63% preinjury to 45% 6 months postinjury. FUTURE PLANS The 12 and 24 month postinjury data collection has recently been completed; analyses of 12 month outcomes are underway. There is potential for longer-term follow-up interviews with the existing cohort in future. TOP findings are intended to inform the National Trauma Network's quality improvement processes. TOP will identify key aspects that aid in improving postinjury outcomes for people experiencing serious injury, including importantly for Māori.
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Affiliation(s)
- Helen E Owen
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Emma H Wyeth
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Brett Maclennan
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - David Barson
- Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Paul McBride
- New Zealand Health Quality and Safety Commission, Wellington, New Zealand
| | - Belinda J Gabbe
- Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ian Civil
- New Zealand National Trauma Network, Wellington, New Zealand
| | - Sarah Derrett
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
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Maclennan B, Derrett S, Wyeth E. Health-related quality of life 12 years after injury: prevalence and predictors of outcomes in a cohort of injured Māori. Qual Life Res 2023:10.1007/s11136-023-03419-9. [PMID: 37055711 PMCID: PMC10393854 DOI: 10.1007/s11136-023-03419-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 04/15/2023]
Abstract
PURPOSE Studies have found that many people who sustain an injury can experience adverse outcomes for a considerable time thereafter. Māori, the Indigenous peoples of Aotearoa me Te Waipounamu (New Zealand; NZ), are no exception. The Prospective Outcomes of Injury Study (POIS) found that almost three-quarters of Māori participants were experiencing at least one of a range of poor outcomes at two years post-injury. The aim of this paper was to estimate the prevalence, and identify predictors, of adverse health-related quality of life (HRQoL) outcomes in the POIS-10 Māori cohort, 12 years after participants sustained an injury. METHODS Interviewers reached 354 individuals who were eligible to participate in a POIS-10 Māori interview, to be conducted a decade after the last phase of POIS interviews (held 24 months post-injury). The outcomes of interest were responses to each of the five EQ-5D-5L dimensions at 12 years post-injury. Potential predictors (i.e., pre-injury sociodemographic and health measures; injury-related factors) were collected from earlier POIS interviews. Additional injury-related information was collected from administrative datasets proximate to the injury event 12 years prior. RESULTS Predictors of 12-year HRQoL outcomes varied by EQ-5D-5L dimension. The most common predictors across dimensions were pre-injury chronic conditions and pre-injury living arrangements. CONCLUSION An approach to rehabilitation where health services proactively enquire about, and consider the broader aspects of, patient health and wellbeing throughout the injury recovery process, and effectively coordinate their patients' care with other health and social services where necessary, may help improve long-term HRQoL outcomes for injured Māori.
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Affiliation(s)
- Brett Maclennan
- Division of Health Sciences, Te Roopū Rakahau Hauora Māori a Kāi Tahu (Ngāi Tahu Māori Health Research Unit), University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - Sarah Derrett
- Division of Health Sciences, Te Roopū Rakahau Hauora Māori a Kāi Tahu (Ngāi Tahu Māori Health Research Unit), University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - Emma Wyeth
- Division of Health Sciences, Te Roopū Rakahau Hauora Māori a Kāi Tahu (Ngāi Tahu Māori Health Research Unit), University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
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Wyeth EH, Davie G, Maclennan B, Lambert M, Harcombe H, Sullivan T, Derrett S. Does support received for subsequent injuries differ between Māori and non-Māori? Findings from a cohort study of injured New Zealanders. N Z Med J 2022; 135:12-22. [PMID: 36356265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
AIMS To examine if differences exist between injured Māori and non-Māori in accessing and receiving support from the Accident Compensation Corporation (ACC) for treatment and rehabilitation of subsequent injuries. METHODS This cohort study utilised participants' self-reported data from the Prospective Outcomes of Injury Study, and ACC claims data. RESULTS Approximately one-third of Māori (32%) and non-Māori (35%) who self-reported a subsequent injury had no associated ACC claim. Statistically significant differences in this outcome (i.e., self-reported subsequent injury but no ACC claim) were found between Māori and non-Māori when comparing across occupation type and severity of participants' sentinel injuries. Few differences were observed between Māori and non-Māori in the percentages of ACC claims accepted that compensated various treatments and supports; this was similar for average compensation amounts provided. CONCLUSIONS Māori and non-Māori who received support from ACC for a sentinel injury prior to sustaining another injury appear to have received equitable ACC compensation for the treatment and rehabilitation of the subsequent injury with two potential exceptions. Further research is needed to determine how generalisable these findings are. Establishing routine systems for collecting data about the support needed, treatment pathways and outcomes once accessing ACC support is vital to ensure positive and equitable injury outcomes for Māori.
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Affiliation(s)
- Emma H Wyeth
- Associate Professor, Te Roopū Rakahau Hauora Māori a Kāi Tahu (Ngāi Tahu Māori Health Research Unit), University of Otago, Dunedin, New Zealand
| | - Gabrielle Davie
- Associate Professor, Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Brett Maclennan
- Senior Research Fellow, Te Roopū Rakahau Hauora Māori a Kāi Tahu (Ngāi Tahu Māori Health Research Unit), University of Otago, Dunedin, New Zealand
| | - Michelle Lambert
- Research Fellow, Te Roopū Rakahau Hauora Māori a Kāi Tahu (Ngāi Tahu Māori Health Research Unit), University of Otago, Dunedin, New Zealand
| | - Helen Harcombe
- Senior Lecturer, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Trudy Sullivan
- Associate Professor, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Sarah Derrett
- Professor, Te Roopū Rakahau Hauora Māori a Kāi Tahu (Ngāi Tahu Māori Health Research Unit), University of Otago, Dunedin, New Zealand
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Wyeth EH, Wilson S, Nelson V, Harcombe H, Davie G, Maclennan B, Derrett S. Participation in paid and unpaid work one year after injury and the impact of subsequent injuries for Māori: Results from a longitudinal cohort study in New Zealand. Injury 2022; 53:1927-1934. [PMID: 35303997 DOI: 10.1016/j.injury.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 02/20/2022] [Accepted: 03/05/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Indigenous populations experience greater injury burdens than non-indigenous groups. This paper investigated, for injured Māori (New Zealand's indigenous population): 1) participation in paid and unpaid work 12 months after injury, 2) whether subsequent injuries are predictive of reduced participation, and 3) if particular characteristics of subsequent injuries predict reduced participation. METHODS The Subsequent Injury Study utilised data from the earlier Prospective Outcomes of Injury Study, a study of 2856 injured New Zealanders (including 566 Māori; 20%) who had an Accident Compensation Corporation (ACC; New Zealand's no-fault injury insurer) entitlement claim (sentinel injury). Data about subsequent injuries reported to ACC and hospital discharge data for injuries resulting in hospitalisation were also utilised. Multivariable models were used to examine if certain aspects of subsequent injury predicted either of two outcomes - reduced participation in paid, and unpaid work 12 months after a sentinel injury. RESULTS Eligible participants were identified from the 405 Māori participants interviewed at 12 months. Thirty-two percent sustained at least one ACC subsequent injury, and 16% reported reduced participation in unpaid work. Of the eligible participants working for pay at the time of their sentinel injury, 35% reported reduced participation in paid work. Although the relationship between sustaining a subsequent injury (or not) and reduced participation in paid work was unclear (aRR 1.4, 95%CI 0.9,2.3), particular subsequent injury characteristics were identified as being independently predictive: subsequent injury resulting from an assault (aRR 2.4, 95%CI 1.2,4.9), a subsequent injury involving an entitlement claim (aRR 2.0, 95%CI 1.1,3.4), sustaining more than one subsequent injury (aRR 2.0, 95%CI 1.1,3.6), and only non-work-related subsequent injuries (aRR 1.6, 95%CI 1.0,2.7). CONCLUSIONS Reduced participation in paid work is prevalent for Māori after an ACC entitlement claim injury. Particular characteristics of subsequent injuries after such an event impacts on participation in paid work 12 months after the sentinel injury, but the picture is less clear for unpaid work. Understanding the changes in paid and unpaid work, and the predictive characteristics of subsequent injuries for injured Māori, is important for future injury prevention strategies and supporting return to work rehabilitation programmes, specifically for Māori.
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Affiliation(s)
- E H Wyeth
- Te Roopū Rakahau Hauora Māori o Kāi Tahu (Ngāi Tahu Māori Health Research Unit), Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand.
| | - S Wilson
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - V Nelson
- Te Roopū Rakahau Hauora Māori o Kāi Tahu (Ngāi Tahu Māori Health Research Unit), Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - H Harcombe
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - G Davie
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - B Maclennan
- Te Roopū Rakahau Hauora Māori o Kāi Tahu (Ngāi Tahu Māori Health Research Unit), Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - S Derrett
- Te Roopū Rakahau Hauora Māori o Kāi Tahu (Ngāi Tahu Māori Health Research Unit), Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
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Maclennan B, Wyeth E, Samaranayaka A, Derrett S. Predictors of EQ-5D-3L outcomes amongst injured Māori: 1-year post-injury findings from a New Zealand cohort study. Qual Life Res 2022; 31:1689-1701. [PMID: 35076826 PMCID: PMC8787030 DOI: 10.1007/s11136-022-03085-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Māori, the Indigenous population of New Zealand (NZ), are at higher risk of problems with health-related quality of life (HRQoL) 12 months following injury. This paper examines pre-injury sociodemographic and health characteristics and injury-related factors, including healthcare access, and their association with HRQoL outcomes 12 months after injury. METHODS The Prospective Outcomes of Injury Study recruited 2856 injured New Zealanders aged 18-64 years from the entitlement claims register of the country's no-fault injury insurance agency. One-fifth (n = 566) of the cohort were Māori. Information on predictors and outcomes, with the exception of injury and hospitalisation, was obtained directly from participants at approximately 3 and 12 months post-injury. The outcomes of interest were responses to the five dimensions of the EQ-5D-3L and a dichotomous measure obtained by summing scored responses to each question. Modified Poisson regression was used to identify predictors of each outcome at 12 months post-injury. RESULTS Predictors differed by outcome. Being female, experiencing EQ-5D-3L problems pre-injury, having ≥ 2 chronic conditions pre-injury, perceiving one's injury to be a threat of long-term disability, and having trouble accessing health services for injury were common predictors of EQ-5D-3L problems at 12 months post-injury for Māori. CONCLUSION Opportunities exist to improve HRQoL outcomes by identifying individuals in the early stages of injury recovery who may benefit from further treatment and support.
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Affiliation(s)
- Brett Maclennan
- Department of Preventive and Social Medicine, Dunedin School of Medicine, Te Roopū Rakahau Hauora Māori a Kāi Tahu (Ngāi Tahu Māori Health Research Unit), University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - Emma Wyeth
- Department of Preventive and Social Medicine, Dunedin School of Medicine, Te Roopū Rakahau Hauora Māori a Kāi Tahu (Ngāi Tahu Māori Health Research Unit), University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - Ari Samaranayaka
- Biostatistics Centre, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Sarah Derrett
- Department of Preventive and Social Medicine, Dunedin School of Medicine, Te Roopū Rakahau Hauora Māori a Kāi Tahu (Ngāi Tahu Māori Health Research Unit), University of Otago, PO Box 56, Dunedin, 9054, New Zealand
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Wyeth E, Mccarty G, Maclennan B, Davie G, Harcombe H, Derrett S. Predictors of subsequent injury for Māori in New Zealand. Injury 2021; 52:2630-2637. [PMID: 34083025 DOI: 10.1016/j.injury.2021.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/20/2021] [Accepted: 05/07/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION This paper identifies predictors of subsequent injury (SI) in a cohort of injured Māori. Interventions to reduce SI among indigenous populations would help overcome the disproportionate burden of subsequent injury experienced, thereby reducing inequities in injury outcomes and the overall burden of injury. METHODS Interview data from the Prospective Outcomes of Injury Study (POIS) were combined with Accident Compensation Corporation (ACC; New Zealand's universal no-fault injury insurer) and hospital discharge datasets. Any injury event resulting in an ACC claim and occurring within 24 months of the injury for which participants were recruited to POIS was considered an SI. This was regardless of whether it was the same type, region or cause as the original injury or not. Predictors of SI were identified using modified Poisson regression. RESULTS Of 566 participants, 62% (n=349) experienced ≥1 SI in the 24 months following their sentinel injury. Māori whose sentinel injury was an intracranial injury were more likely to sustain an SI compared to those whose sentinel injury was another type. SI was less likely to occur for participants whose sentinel injury was a lower extremity fracture or classified as "Other" (e.g. crush, burn, poisoning). SI were more common among those aged 18-29 years compared to those aged 30-49 years, and less common among those living with family compared to those who were living alone. CONCLUSIONS More research into the circumstances of intracranial injury and SI among Māori is warranted. This would help inform the nature of interventions to prevent SI and the points at which these should be implemented.
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Affiliation(s)
- Emma Wyeth
- Te Roopū Rakahau Hauora Māori o Kāi Tahu (Ngāi Tahu Māori Health Research Unit), Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand.
| | - Georgia Mccarty
- Te Roopū Rakahau Hauora Māori o Kāi Tahu (Ngāi Tahu Māori Health Research Unit), Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - Brett Maclennan
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - Gabrielle Davie
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - Helen Harcombe
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - Sarah Derrett
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
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Connor J, Maclennan B, Huckle T, Romeo J, Davie G, Kypri K. Changes in the incidence of assault after restrictions on late-night alcohol sales in New Zealand: evaluation of a natural experiment using hospitalization and police data. Addiction 2021; 116:788-798. [PMID: 33480462 DOI: 10.1111/add.15206] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/24/2020] [Accepted: 07/22/2020] [Indexed: 01/03/2023]
Abstract
AIMS To estimate the effect of national restrictions on late-night availability of alcohol on alcohol-related assault at a population level as indicated by (1) change in hospitalizations for weekend assaults and (2) change in the proportion of assaults documented by police that occur at night. DESIGN Evaluation of a natural experiment, involving: (1) pre-post comparisons of age-specific incidence rates, adjusted for seasonality and background trend using Poisson regression; and (2) interrupted time-series analyses, using seasonal autoregressive integrated moving average (SARIMA) models of national data with no control site. SETTING New Zealand. PARTICIPANTS (1) Inpatients discharged from NZ hospitals following assault during the weekend (Friday-Sunday) from 2004 to 2016 (n = 14 996) and (2) cases of assault recorded by NZ Police from 2012 to 2018. INTERVENTION introduction of national maximum trading hours for all on-licence (8 a.m.-4 a.m.) and off-licence premises (7 a.m.-11 p.m.), abolishing existing 24-hour licences, on 18 December 2013. MEASUREMENTS (1) Age-specific incidence of hospitalization for assault on Friday, Saturday or Sunday from the national hospital discharge data set, excluding short-stay emergency department admissions and (2) proportion of weekly police-documented assaults occurring between 9 p.m. and 5.59 a.m., from NZ Police Demand and Activity data set. FINDINGS Following the restrictions, weekend hospitalized assaults declined by 11% [incidence rate ratio (IRR) = 0.89; 95% confidence interval (CI) = 0.84, 0.94], with the greatest reduction among 15-29-year-olds (IRR = 0.82; 95% CI = 0.76, 0.89). There was an absolute reduction (step change) of 1.8% (95% CI = 0.2, 3.5%) in the proportion of police-documented assaults occurring at night, equivalent to 9.70 (95% CI = 0.10, 19.30) fewer night-time assaults per week, out of 207.4. CONCLUSIONS The 2013 implementation of national maximum trading hours for alcohol in NZ was followed by reductions in two complementary indicators of alcohol-related assault, consistent with beneficial effects of modest nation-wide restrictions on the late-night availability of alcohol.
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Affiliation(s)
- Jennie Connor
- Department of Preventive and Social Medicine, University of Otago Medical School, Dunedin, New Zealand
| | - Brett Maclennan
- Department of Preventive and Social Medicine, University of Otago Medical School, Dunedin, New Zealand
| | - Taisia Huckle
- SHORE and Whariki Research Centre, College of Health, Massey University, New Zealand
| | - Jose Romeo
- SHORE and Whariki Research Centre, College of Health, Massey University, New Zealand
| | - Gabrielle Davie
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of Otago, New Zealand
| | - Kypros Kypri
- Department of Preventive and Social Medicine, University of Otago Medical School, Dunedin, New Zealand.,School of Medicine and Public Health, University of Newcastle, Australia
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Lilley R, Maclennan B, Davie G, McNoe BM, Horsburgh S, Driscoll TR. Decade of variable progress: trends in fatal injury in workers in New Zealand from a national observational study. Occup Environ Med 2020; 78:oemed-2020-106812. [PMID: 33106350 DOI: 10.1136/oemed-2020-106812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/19/2020] [Accepted: 09/22/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Analyses of secular trends in work-related fatal injury in New Zealand have previously only considered the total working population, potentially hiding trends for important subgroups of workers. This paper examines trends in work-related fatalities in worker subgroups between 2005 and 2014 to indicate where workplace safety action should be prioritised. METHODS A dataset of fatally injured workers was created; all persons aged 15-84 years, fatally injured in the period 2005-2014, were identified from mortality records, linked to coronial records which were then reviewed for work relatedness. Poisson regression modelling was used to estimate annual percentage change in rates by age, sex, ethnicity, employment status, industry and occupation. RESULTS Overall, worker fatalities decreased by 2.4% (95% CI 0.0% to 4.6%) annually; an average reduction of 18 deaths per year from baseline (2005). Significant declines in annual rates were observed for younger workers (15-29 and 30-49 years), indigenous Māori, those in the public administration and service sector, and those in community and personal service occupations. Increases in annual rates occurred for workers in agriculture and forestry and fisheries sectors and for labourers. Rates of worker deaths in work-traffic settings declined faster than in workplace settings. DISCUSSION Although overall age-standardised rates of work-related fatal injury have been declining, these trends were variable. Sources of injury risk in identifiable subgroups with increases in annual rates need to be urgently addressed. This study demonstrates the need for regular, detailed examination of the secular trends to identify those subgroups of workers requiring further workplace safety attention.
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Affiliation(s)
- Rebbecca Lilley
- Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Brett Maclennan
- Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Gabrielle Davie
- Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Bronwen M McNoe
- Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Simon Horsburgh
- Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Tim R Driscoll
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Lilley R, Maclennan B, McNoe BM, Davie G, Horsburgh S, Driscoll T. Decade of fatal injuries in workers in New Zealand: insights from a comprehensive national observational study. Inj Prev 2020; 27:124-130. [PMID: 32209586 PMCID: PMC8005803 DOI: 10.1136/injuryprev-2020-043643] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 11/27/2022]
Abstract
Introduction Current priorities and strategies to prevent work-related fatal injury (WRFI) in New Zealand (NZ) are based on incomplete data capture. This paper provides an overview of key results from a comprehensive 10-year NZ study of worker fatalities using coronial records. Methods A data set of workers, aged 15–84 years at the time of death who died in the period 2005–2014, was created using coronial records. Data collection involved: (1) identifying possible cases from mortality records using selected external cause of injury codes; (2) linking these to coronial records; (3) retrieving and reviewing records for work-relatedness; and (4) coding work-related cases. Frequencies, percentages and rates were calculated. Analyses were stratified into workplace and work-traffic settings. Results Over the decade, 955 workers were fatally injured, giving a rate of 4.8 (95% CI 5.6 to 6.3) per 100 000 worker-years. High rates of worker fatalities were observed for workers aged 70–84 years, indigenous Māori and for males. Workers employed in mining had the highest rate in workplace settings while transport, postal and warehousing employees had the highest rate in work-traffic settings. Vehicle-related mechanisms dominated the mechanism and vehicles and environmental agents dominated the breakdown agencies contributing to worker fatalities. Discussion This study shows the rates of worker fatalities vary widely by age, sex, ethnicity, occupation and industry and are a very serious problem for particular groups. Future efforts to address NZ’s high rates of WRFI should use these findings to aid understanding where preventive actions should be prioritised.
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Affiliation(s)
- Rebbecca Lilley
- Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Brett Maclennan
- Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Bronwen M McNoe
- Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Gabrielle Davie
- Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Simon Horsburgh
- Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Tim Driscoll
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Kypri K, Maclennan B, Connor J. Alcohol Harms over a Period of Alcohol Policy Reform: Surveys of New Zealand College Residents in 2004 and 2014. Int J Environ Res Public Health 2020; 17:ijerph17030836. [PMID: 32013107 PMCID: PMC7037796 DOI: 10.3390/ijerph17030836] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/24/2020] [Indexed: 11/16/2022]
Abstract
Background: We estimated the change in the prevalence of harms attributed by students to their drinking and to others’ drinking, over a decade of concerted effort by university authorities to reduce antisocial behaviour and improve student safety. Interventions included a security and liaison service, a stricter code of conduct, challenges to liquor license applications near campus, and a ban on alcohol advertising. Methods: We used a pre-post design adjusting for population changes. We invited all students residing in colleges of a New Zealand University to complete web surveys in 2004 and 2014, using identical methods. We estimated change in the 4-week prevalence of 15 problems and harms among drinkers, and nine harms from others’ drinking among all respondents. We adjusted for differences in sample sociodemographic characteristics between surveys. Results: Among drinkers there were reductions in several harms, the largest being in acts of vandalism (7.1% to 2.7%), theft (11% to 4.5%), and physical aggression (10% to 5.3%). Among all respondents (including non-drinkers), there were reductions in unwanted sexual advances (14% to 8.9%) and being the victim of sexual assault (1.0% to 0.4%). Conclusion: Alcohol-related harm, including the most serious outcomes, decreased substantially among college residents in this period of alcohol policy reform. In conjunction with evidence of reduced drinking to intoxication in this population, the findings suggest that strategies to reduce the availability and promotion of alcohol on and near campus can substantially reduce the incidence of health and social harms.
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Affiliation(s)
- Kypros Kypri
- Department of Preventive and Social Medicine, University of Otago, Dunedia 9016, New Zealand; (B.M.); (J.C.)
- School of Medicine and Public Health, University of Newcastle, Callaghan NSW 2308, Australia
- Correspondence: ; Tel.: +61-448-898-814
| | - Brett Maclennan
- Department of Preventive and Social Medicine, University of Otago, Dunedia 9016, New Zealand; (B.M.); (J.C.)
| | - Jennie Connor
- Department of Preventive and Social Medicine, University of Otago, Dunedia 9016, New Zealand; (B.M.); (J.C.)
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14
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Lilley R, McNoe B, Davie G, Horsburgh S, Maclennan B, Driscoll T. Identifying opportunities to prevent work-related fatal injury in New Zealand using 40 years of coronial records: protocol for a retrospective case review study. Inj Epidemiol 2019; 6:16. [PMID: 31245265 PMCID: PMC6582675 DOI: 10.1186/s40621-019-0193-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 03/21/2019] [Indexed: 11/10/2022] Open
Abstract
Background Improving New Zealand's poor workplace safety record has become a high priority following high profile workplace fatal incidents in 2010 and 2014. Existing routine official data are unable to reliably inform occupational safety policy and action in New Zealand. This case review study will examine work-related fatal injury (WRFI) to: i) determine their burden, rates and distribution; ii) identify high-risk groups, causes and circumstances; iii) analyse secular trends, and iv) examine the impact of historic occupational safety legislative reform. Design and methods A comprehensive New Zealand WRFI dataset from 1975 to 2014 will be established using existing data for 1975-1994 combined with new data for 1995-2014 extracted from reviewed coronial case files. Data collection involves: 1) identifying likely cases of WRFI from national mortality records using selected injury external cause codes; 2) linking these to coronial case files, which will be retrieved and reviewed to determine work-relatedness; and 3) coding work-related cases. Annual WRFI frequencies and rates will be calculated and disaggregated by age, sex, employment status, occupation and industry to identify high-risk groups and compared across the time series. The circumstances of the WRFIs will be analysed in-depth. The impact of New Zealand's Health and Safety in Employment 1992 Act, which resulted in deregulation of the previous legislative frameworks for occupational health and safety during a period of rapid labour market restructuring, will be examined by comparing rates before and after implementation of the Act. Discussion The resulting evidence will serve as the basis for policy development and practical interventions to reduce WRFI, targeting groups of high-risk workers, and for bench-marking of workplace safety performance in New Zealand.
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Affiliation(s)
- Rebbecca Lilley
- 1Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054 New Zealand
| | - Bronwen McNoe
- 1Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054 New Zealand
| | - Gabrielle Davie
- 1Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054 New Zealand
| | - Simon Horsburgh
- 1Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054 New Zealand
| | - Brett Maclennan
- 1Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054 New Zealand
| | - Tim Driscoll
- 2Public Health, School of Public Health, University of Sydney, Sydney, NSW Australia
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15
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Kypri K, Maclennan B, Brausch S, Wyeth E, Connor J. Did New Zealand’s new alcohol legislation achieve its object of facilitating public input? Qualitative study of Māori communities. Drug Alcohol Rev 2019; 38:331-338. [DOI: 10.1111/dar.12886] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Kypros Kypri
- Department of Preventive and Social MedicineUniversity of Otago Dunedin New Zealand
- School of Medicine and Public HealthUniversity of Newcastle Newcastle Australia
| | - Brett Maclennan
- Department of Preventive and Social MedicineUniversity of Otago Dunedin New Zealand
| | - Shawnee Brausch
- Department of Preventive and Social MedicineUniversity of Otago Dunedin New Zealand
| | - Emma Wyeth
- Ngāi Tahu Māori Health Research Unit, Department of Preventive and Social MedicineUniversity of Otago Dunedin New Zealand
| | - Jennie Connor
- Department of Preventive and Social MedicineUniversity of Otago Dunedin New Zealand
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16
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Kypri K, Maclennan B, Cousins K, Connor J. Hazardous Drinking among Students over a Decade of University Policy Change: Controlled Before-and-After Evaluation. Int J Environ Res Public Health 2018; 15:ijerph15102137. [PMID: 30274175 PMCID: PMC6210920 DOI: 10.3390/ijerph15102137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/26/2018] [Accepted: 09/27/2018] [Indexed: 11/19/2022]
Abstract
Background: Responding to high levels of alcohol-related harm among students, a New Zealand university deployed a security and liaison service, strengthened the Student Code of Conduct, increased its input on the operation of alcohol outlets near campus, and banned alcohol advertising on campus. We estimated the change in the prevalence of alcohol consumption patterns among students at the university compared with other universities. Methods: We conducted a controlled before-and-after study with surveys in residential colleges at the target university in 2004 and 2014, and in random samples of students at the target university and three control universities in 2005 and 2013. The primary outcome was the prevalence of recent intoxication, while we analysed drinking per se and drinking in selected locations to investigate mechanisms of change. Results: The 7-day prevalence of intoxication decreased from 45% in 2004 to 33% in 2014 (absolute difference: 12%; 95% CI: 7% to 17%) among students living in residential colleges, and from 40% in 2005 to 26% in 2013 (absolute difference: 14%; 95% CI: 8% to 20%) in the wider student body of the intervention university. The intervention effect estimate, representing the change at the intervention university adjusted for change at other universities (aOR = 1.30; 95% CI: 0.89 to 1.90), was consistent with a benefit of intervention but was not statistically significant (p = 0.17). Conclusion: In this period of alcohol policy reform, drinking to intoxication decreased substantially in the targeted student population. Policy reforms and coincidental environmental changes may each have contributed to these reductions.
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Affiliation(s)
- Kypros Kypri
- Department of Preventive and Social Medicine, University of Otago, Dunedin 9016, New Zealand.
- School of Medicine and Public Health, University of Newcastle, Newcastle 2308, Australia.
| | - Brett Maclennan
- Department of Preventive and Social Medicine, University of Otago, Dunedin 9016, New Zealand.
| | - Kimberly Cousins
- Department of Preventive and Social Medicine, University of Otago, Dunedin 9016, New Zealand.
| | - Jennie Connor
- Department of Preventive and Social Medicine, University of Otago, Dunedin 9016, New Zealand.
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17
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Richards R, McNoe B, Iosua E, Reeder A, Egan R, Marsh L, Robertson L, Maclennan B, Dawson A, Quigg R, Petersen AC. Cancer Information Seeking Among Adult New Zealanders: a National Cross-Sectional Study. J Cancer Educ 2018; 33:610-614. [PMID: 27853983 DOI: 10.1007/s13187-016-1136-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Organisations seeking to establish themselves as leading cancer information sources for the public need to understand patterns and motivators for information seeking. This study describes cancer information seeking among New Zealanders through a national cross-sectional survey conducted in 2014/15 with a population-based sample of adults (18 years and over). Participants were asked if they had sought information about cancer during the past 12 months, the type of information they sought, what prompted them to look for information and ways of getting information they found helpful. Telephone interviews were completed by 1064 participants (588 females, 476 males, 64% response rate). Of these, 33.8% of females and 23.3% of males (total, 29.2%) had searched for information about cancer over the past year. A search was most frequently prompted by a cancer diagnosis of a family member or friend (43.3%), a desire to educate themselves (17.5%), experience of potential symptoms or a positive screening test (9.4%), family history of cancer (8.9%) or the respondent's own cancer diagnosis (7.7%). Across the cancer control spectrum, the information sought was most commonly about treatment and survival (20.2%), symptoms/early detection (17.2%) or risk factors (14.2%), although many were general or non-specific queries (50.0%). The internet was most commonly identified as a helpful source of information (71.7%), followed by health professionals (35.8%), and reading material (e.g. books, pamphlets) (14.7%).This study provides a snapshot of cancer information seeking in New Zealand, providing valuable knowledge to help shape resource delivery to better meet the diverse needs of information seekers and address potential unmet needs, where information seeking is less prevalent.
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Affiliation(s)
- Rosalina Richards
- Cancer Society Social and Behavioural Research Unit, University of Otago, PO Box 56, Dunedin, 9016, New Zealand.
| | - Bronwen McNoe
- Cancer Society Social and Behavioural Research Unit, University of Otago, PO Box 56, Dunedin, 9016, New Zealand
| | - Ella Iosua
- Department of Preventive and Social Medicine Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9016, New Zealand
| | - Anthony Reeder
- Cancer Society Social and Behavioural Research Unit, University of Otago, PO Box 56, Dunedin, 9016, New Zealand
| | - Richard Egan
- Cancer Society Social and Behavioural Research Unit, University of Otago, PO Box 56, Dunedin, 9016, New Zealand
| | - Louise Marsh
- Cancer Society Social and Behavioural Research Unit, University of Otago, PO Box 56, Dunedin, 9016, New Zealand
| | - Lindsay Robertson
- Cancer Society Social and Behavioural Research Unit, University of Otago, PO Box 56, Dunedin, 9016, New Zealand
| | - Brett Maclennan
- Cancer Society Social and Behavioural Research Unit, University of Otago, PO Box 56, Dunedin, 9016, New Zealand
| | - Anna Dawson
- Kōhatu Centre for Hauora Māori, Division of Health Sciences, University of Otago, PO Box 56, Dunedin, 9016, New Zealand
| | - Robin Quigg
- Cancer Society Social and Behavioural Research Unit, University of Otago, PO Box 56, Dunedin, 9016, New Zealand
| | - Anne-Cathrine Petersen
- Cancer Society Social and Behavioural Research Unit, University of Otago, PO Box 56, Dunedin, 9016, New Zealand
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18
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Wyeth EH, Maclennan B, Lambert M, Davie G, Lilley R, Derrett S. Predictors of work participation for Māori 3 months after injury. Arch Environ Occup Health 2018; 73:79-89. [PMID: 28506115 DOI: 10.1080/19338244.2017.1329698] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 05/09/2017] [Indexed: 06/07/2023]
Abstract
An important rehabilitation outcome for injured Māori is a timely sustainable return to work. This article identifies the factors influencing working after injury in an attempt to reduce the individual, social, and economic costs. Māori participants in the Prospective Outcomes of Injury Study were interviewed about preinjury and injury-related factors. Among Māori participants, 521 were working for pay prior to injury; 64% were working 3 months postinjury. Factors identified, using modified Poisson regression, that predicted working include financial security (aRR = 1.34, 95% CI [1.12, 1.61]), an injury of low (aRR = 1.76, 95% CI [1.26, 2.44]) or moderate severity (aRR = 1.86, 95% CI [1.34, 2.59]), professional occupations (aRR = 1.22, 95% CI [1.03, 1.44]), and jobs with less repetitive hand movement (aRR = 1.17, 95% CI [1.01, 1.34]). These factors identified warrant attention when planning interventions to enable rehabilitation back to the workplace.
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Affiliation(s)
- Emma H Wyeth
- a Te Roopū Rakahau Hauora Māori a Kāi Tahu (Ngāi Tahu Māori Health Research Unit), Department of Preventive and Social Medicine , Dunedin School of Medicine, University of Otago , Dunedin , New Zealand
| | - Brett Maclennan
- b Department of Preventive and Social Medicine , Dunedin School of Medicine, University of Otago , Dunedin , New Zealand
| | - Michelle Lambert
- a Te Roopū Rakahau Hauora Māori a Kāi Tahu (Ngāi Tahu Māori Health Research Unit), Department of Preventive and Social Medicine , Dunedin School of Medicine, University of Otago , Dunedin , New Zealand
| | - Gabrielle Davie
- c Injury Prevention Research Unit, Department of Preventive and Social Medicine , Dunedin School of Medicine, University of Otago , Dunedin , New Zealand
| | - Rebbecca Lilley
- c Injury Prevention Research Unit, Department of Preventive and Social Medicine , Dunedin School of Medicine, University of Otago , Dunedin , New Zealand
| | - Sarah Derrett
- b Department of Preventive and Social Medicine , Dunedin School of Medicine, University of Otago , Dunedin , New Zealand
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19
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Richards R, McNoe B, Iosua E, Reeder AI, Egan R, Marsh L, Robertson L, Maclennan B, Latu ATF, Quigg R, Petersen AC. Cancer Mortality, Early Detection and Treatment among Adult New Zealanders: Changes in Perceptions between 2001 and 2014/5. Asian Pac J Cancer Prev 2017; 18:3401-3406. [PMID: 29286610 PMCID: PMC5980901 DOI: 10.22034/apjcp.2017.18.12.3401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Beliefs about cancer risk and experience of early detection and treatment can impact on willingness to engage with these initiatives. This study describes changes in perceptions of cancer mortality, early detection and treatment among adult New Zealanders (NZ) between two cross-sectional studies conducted in 2001 and 2014/5. Methods: Data was collected via telephone interviews conducted by trained interviewers in 2001 (231 females and 207 males, 64% response rate) and 2014/5 (588 females and 476 males, 64% response rate). Participants were asked to identify the most common three causes of cancer mortality among women and then men. They were also asked to note their agreement or otherwise with statements about early detection and treatment of cancer. Results: There was an increase in proportions of men who correctly identified prostate cancer as one of the top three causes of cancer mortality among men, and also an increase among women who correctly identified bowel cancer as one of the top three. Most participants agreed that there were benefits from early detection for cancer outcomes. Over time, there was a significant decline in proportions which felt that most cancer treatment is “so terrible it is worse than death” and that alternative therapy has an “equal or better chance of curing cancer.” Conclusion: Internationally, there is little information available about changes in cancer perceptions over time, these findings suggest some changes in perceptions of treatment and awareness of types of cancer with the highest mortality in NZ, which should support timely engagement with early detection and treatment services.
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Affiliation(s)
- Rosalina Richards
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
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Richards R, McNoe B, Iosua E, Reeder A, Egan R, Marsh L, Robertson L, Maclennan B, Dawson A, Quigg R, Petersen AC. Cancer Awareness in Aotearoa New Zealand (CAANZ), 2001 and 2015: Study Protocols. J Cancer Educ 2017; 32:745-748. [PMID: 27216716 DOI: 10.1007/s13187-016-1050-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Population cancer awareness is of interest worldwide, as efforts are made to reduce cancer incidence via changes in risk and protective behaviours. To date, few studies have described changes in awareness over time, despite significant investment in raising awareness about various cancer types and risk behaviours. This paper describes the Cancer Awareness in Aotearoa New Zealand (CAANZ) survey, a cross-sectional telephone survey of adult New Zealanders conducted in 2014/2015 (CAANZ15, n = 1064) and its comparison with a similar 2001 study (CAANZ01, n = 438). Both aimed to describe current cancer awareness among a national sample of New Zealand (NZ) adults, with additional aims for CAANZ15 being to explore emerging issues in information provision and supportive care. Follow-up studies are challenged by changes in communication technologies and, in turn, potential issues in sampling. However, given the value of information about changing awareness, pragmatic steps were taken in CAANZ15 to maximise the response rate and comparability of the surveys. A response rate of 64 % was achieved for both samples. When compared to the adult NZ population, the CAANZ15 sample tended to be older, of higher socioeconomic status and under-representative of people with Pacific, Asian or, to a lesser extent, Māori (the indigenous population of NZ) ethnicity. To compensate for possible disproportionate age-by-ethnicity (Māori/non-Māori) groups in the sample, poststratification weighting was adopted. While caution will need to be exercised in drawing conclusions from comparisons made between these two cohorts, the dearth of such studies means that insights gained should be useful for guiding reflection on future cancer control directions and the generation of new hypotheses.
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Affiliation(s)
- Rosalina Richards
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9016, New Zealand.
| | - Bronwen McNoe
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9016, New Zealand
| | - Ella Iosua
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9016, New Zealand
| | - Anthony Reeder
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9016, New Zealand
| | - Richard Egan
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9016, New Zealand
| | - Louise Marsh
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9016, New Zealand
| | - Lindsay Robertson
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9016, New Zealand
| | - Brett Maclennan
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9016, New Zealand
| | - Anna Dawson
- Kōhatu - Centre for Hauora Māori, Division of Health Sciences, University of Otago, PO Box 56, Dunedin, 9016, New Zealand
| | - Robin Quigg
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9016, New Zealand
| | - Anne-Cathrine Petersen
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9016, New Zealand
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Richards R, McNoe B, Iosua E, Reeder AI, Egan R, Marsh L, Robertson L, Maclennan B, Latu ATF, Quigg R, Petersen AC. Knowledge of Evidence-Based Cancer Risk Factors Remains Low Among New Zealand Adults: Findings from Two Cross-Sectional Studies, 2001 and 2015. Asian Pac J Cancer Prev 2017; 18:2931-2936. [PMID: 29172261 PMCID: PMC5773773 DOI: 10.22034/apjcp.2017.18.11.2931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective: Cancer risk reduction messages are a part of cancer control efforts around the world. The complex reality is that risk factors differ for different types of cancer, making clear communication of desired behavioural changes more difficult. This study aims to describe awareness of risk factors for breast, bowel, cervical, prostate and lung cancer and cutaneous melanoma among New Zealanders in 2014/15 and identify changes in awareness since 2001. Methods: Two national telephone surveys, the first (CAANZ01) conducted in 2001, included 438 adults (231 females and 207 males, 64% response rate). The second, conducted in 2014/15 (CAANZ15), included 1064 adults (588 females and 476 males, 64% response rate). Results: In 2014/5, most participants could identify evidence-based risk factors for lung cancer and melanoma. In contrast, many participants were unable to name any risk factors (evidence-based or otherwise) for bowel (34.8%), breast (48.8%), cervical (53.9%) and prostate cancer (60.9%). Between 2001 and 2014/5 there were increases in the proportion of individuals identifying sunbeds as increasing melanoma risk, and alcohol consumption and family history as increasing risk for bowel and breast cancer. Conclusions: Effective communication of risk information for specific cancers remains a challenge for cancer control. Although some positive changes in awareness over the 14 year period were observed, there remains substantial room for progressing awareness of evidence-based risk factors.
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Affiliation(s)
- Rosalina Richards
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
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Connor J, Kydd R, Maclennan B, Shield K, Rehm J. Alcohol-attributable cancer deaths under 80 years of age in New Zealand. Drug Alcohol Rev 2017; 36:415-423. [PMID: 27306121 DOI: 10.1111/dar.12443] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/20/2016] [Accepted: 05/11/2016] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND AIMS Cancer deaths made up 30% of all alcohol-attributable deaths in New Zealanders aged 15-79 years in 2007, more than all other chronic diseases combined. We aimed to estimate alcohol-attributable cancer mortality and years of life lost by cancer site and identify differences between Māori and non-Māori New Zealanders. DESIGN AND METHODS We applied the World Health Organization's comparative risk assessment methodology at the level of Māori and non-Māori subpopulations. Proportions of specific alcohol-related cancers attributable to alcohol were calculated by combining alcohol consumption estimates from representative surveys with relative risks from recent meta-analyses. These proportions were applied to both 2007 and 2012 mortality data. RESULTS Alcohol consumption was responsible for 4.2% of all cancer deaths under 80 years of age in 2007. An average of 10.4 years of life was lost per person; 12.7 years for Māori and 10.1 years for non-Māori. Half of the deaths were attributable to average consumption of <4 standard drinks per day. Breast cancer comprised 61% of alcohol-attributable cancer deaths in women, and more than one-third of breast cancer deaths were attributable to average consumption of <2 standard drinks per day. Mortality data from 2012 produced very similar findings. DISCUSSION AND CONCLUSIONS Alcohol is an important and modifiable cause of cancer. Risk of cancer increases with higher alcohol consumption, but there is no safe level of drinking. Reduction in population alcohol consumption would reduce cancer deaths. Additional strategies to reduce ethnic disparities in risk and outcome are needed in New Zealand. [Connor J, Kydd R, Maclennan B, Shield K, Rehm J. Alcohol-attributable cancer deaths under 80 years of age in New Zealand. Drug Alcohol Rev 2017;36:415-423].
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Affiliation(s)
- Jennie Connor
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Robyn Kydd
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Brett Maclennan
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Kevin Shield
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Jürgen Rehm
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Richards R, McNoe B, Iosua E, Reeder AI, Egan R, Marsh L, Robertson L, Maclennan B, Dawson A, Quigg R, Petersen AC. Changes in awareness of cancer risk factors among adult New Zealanders (CAANZ): 2001 to 2015. Health Educ Res 2017; 32:153-162. [PMID: 28334909 DOI: 10.1093/her/cyx036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 02/06/2017] [Indexed: 05/21/2023]
Abstract
Behaviour change, specifically that which decreases cancer risk, is an essential element of cancer control. Little information is available about how awareness of risk factors may be changing over time. This study describes the awareness of cancer risk behaviours among adult New Zealanders in two cross-sectional studies conducted in 2001 and 2014/5.Telephone interviews were conducted in 2001 (n = 436) and 2014/5 (n = 1064). Participants were asked to recall things they can do to reduce their risk of cancer. They were then presented with a list of potential risk behaviours and asked if these could increase or decrease cancer risk.Most New Zealand adults could identify at least one action they could take to reduce their risk of cancer. However, when asked to provide specific examples, less than a third (in the 2014/5 sample) recalled key cancer risk reduction behaviours such as adequate sun protection, physical activity, healthy weight, limiting alcohol and a diet high in fruit. There had been some promising changes since the 2001 survey, however, with significant increases in awareness that adequate sun protection, avoiding sunbeds/solaria, healthy weight, limiting red meat and alcohol, and diets high in fruit and vegetables decrease the risk of developing cancer.
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Affiliation(s)
- R Richards
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine
| | - B McNoe
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine
| | - E Iosua
- Department of Preventive and Social Medicine, Dunedin School of Medicine
| | - A I Reeder
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine
| | - R Egan
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine
| | - L Marsh
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine
| | - L Robertson
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine
| | - B Maclennan
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine
| | - A Dawson
- Kohatu - Centre for Hauora Maori, Division of Health Sciences, University of Otago, PO Box 56, Dunedin 9016, New Zealand
| | - R Quigg
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine
| | - A-C Petersen
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine
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Marsh L, Mcgee R, Maclennan B, Robertson L, Llewellyn R, Ward M. Alcohol imagery on New Zealand Television: Ten years on. Drug Alcohol Rev 2017; 36:E1-E2. [PMID: 28229492 DOI: 10.1111/dar.12491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 08/11/2016] [Accepted: 08/12/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Louise Marsh
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Rob Mcgee
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Brett Maclennan
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Lindsay Robertson
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Rebecca Llewellyn
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Matthew Ward
- Department of Media, Film and Communication, University of Otago, Dunedin, New Zealand
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Kypri K, Maclennan B, Connor JL. Effects of small incentives on survey response fractions: randomised comparisons in national alcohol surveys conducted in New Zealand. Eur J Public Health 2016; 26:430-2. [PMID: 27013546 DOI: 10.1093/eurpub/ckw035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We experimentally evaluate inexpensive interventions to increase response fractions in two alcohol surveys. Residents on the New Zealand General and Māori electoral rolls were randomized to receive a survey pack with or without an offer of entry to a $500 prize draw. Subsequent randomization of sample members who did not initially respond allowed estimation of effects of offering a $5 donation to charity as an incentive to respond. Offering prize draw entry did not significantly increase responses in either population. Contrary to expectation, promising a $5 donation to non-respondents reduced subsequent responding in the group previously offered the prize draw incentive.
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Affiliation(s)
- Kypros Kypri
- 1 Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand 2 School of Medicine and Public Health, University of Newcastle, Australia
| | - Brett Maclennan
- 1 Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Jennie L Connor
- 1 Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
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Maclennan B, Kypri K, Connor J, Potiki T, Room R. New Zealand's new alcohol laws: protocol for a mixed-methods evaluation. BMC Public Health 2016; 16:29. [PMID: 26759263 PMCID: PMC4710993 DOI: 10.1186/s12889-015-2638-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 12/17/2015] [Indexed: 11/10/2022] Open
Abstract
Background Alcohol consumption is a major cause of mortality and morbidity globally. In response to strong calls from the public for alcohol law reform, the New Zealand Government recently reduced the blood alcohol limit for driving and introduced the Sale and Supply of Alcohol Act which aim to (1) improve community input into local decision-making on alcohol; (2) reduce the availability of alcohol; and (3) reduce hazardous drinking and alcohol-related harm. In this project we seek to evaluate the new laws in terms of these objectives. Design and methods A policy evaluation framework is proposed to investigate the implementation and outcomes of the reforms. We will use quantitative and qualitative methods, employing a pre-post design. Participants include members of the public, local government staff, iwi (Māori tribal groups that function collectively to support their members) and community group representatives. Data will be collected via postal surveys, interviews and analysis of local government documents. Liquor licensing, police and hospital injury data will also be used. Community input into local government decision-making will be operationalised as: the number of objections per license application and the number of local governments adopting a local alcohol policy (LAP). Outcome measures will be the ‘restrictiveness’ of LAPs compared to previous policies, the number (per 1000 residents) and density (per square kilometre) of alcohol outlets throughout NZ, and the number of weekend late-night (i.e., post 10 pm) trading hours. For consumption and harm, outcomes will be the prevalence of hazardous drinking, harm from own and others’ drinking, community amenity effects, rates of assault, and rates of alcohol-involved traffic crashes. Multiple regression will be used to model how the outcomes vary by local government area from before to after the law changes take effect. These measures will be complemented by qualitative analysis of LAP development and public participation in local decision-making on alcohol. Discussion The project will evaluate how well the reforms meet their explicit public health objectives.
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Affiliation(s)
- Brett Maclennan
- Department of Preventive and Social Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - Kypros Kypri
- Department of Preventive and Social Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand. .,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.
| | - Jennie Connor
- Department of Preventive and Social Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - Tuari Potiki
- Office of Māori Development, University of Otago, Dunedin, New Zealand.
| | - Robin Room
- Centre for Alcohol Policy and Research, La Trobe University, Melbourne, Australia. .,Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden.
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Affiliation(s)
- Kypros Kypri
- School of Medicine and Public Health, University of Newcastle, Australia; Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, New Zealand
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Maclennan B, Wyeth E, Davie G, Wilson S, Derrett S. Twelve-month post-injury outcomes for Māori and non-Māori: findings from a New Zealand cohort study. Aust N Z J Public Health 2014; 38:227-33. [DOI: 10.1111/1753-6405.12228] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 01/01/2014] [Accepted: 02/01/2014] [Indexed: 11/30/2022] Open
Affiliation(s)
- Brett Maclennan
- Injury Prevention Research Unit, Department of Preventive and Social Medicine; University of Otago; New Zealand
| | - Emma Wyeth
- Te Roopū Rakahau Hauora Māori a Kāi Tahu (Ngāi Tahu Māori Health Research Unit), Department of Preventive and Social Medicine; University of Otago; New Zealand
| | - Gabrielle Davie
- Injury Prevention Research Unit, Department of Preventive and Social Medicine; University of Otago; New Zealand
| | - Suzanne Wilson
- Injury Prevention Research Unit, Department of Preventive and Social Medicine; University of Otago; New Zealand
| | - Sarah Derrett
- Injury Prevention Research Unit, Department of Preventive and Social Medicine; University of Otago; New Zealand
- School of Health and Social Services, College of Health; Massey University; New Zealand
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Kypri K, Maclennan B. Public participation in local alcohol regulation: Findings from a survey of New Zealand communities. Drug Alcohol Rev 2013; 33:59-63. [PMID: 24400703 DOI: 10.1111/dar.12094] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 10/30/2013] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS In many high-income countries, the responsibility for alcohol regulation is being devolved from central to local governments. Although seeking public input is typically required by law, there remains little empirical evidence on whether and how the public is involved. We investigated public participation in local liquor licensing and related regulation in New Zealand. DESIGN AND METHODS In 2007, we randomly sampled 2337 residents from the national electoral roll in seven communities and invited them to complete a postal questionnaire assessing their level of general community engagement, whether they had taken action on alcohol issues, and barriers to participation they perceived or encountered. RESULTS A total of 1372 individuals responded (59% response). Fifty-two percent were current members of community organisations, and 40% had ever taken action on a local issue. Respondents considered alcohol to be a major problem locally, but only 4% had been involved in action to address a problem, whereas 18% had considered taking action. In their communities, 12% and 24%, respectively, felt they could influence the number or location of alcohol outlets. There was little variation across communities. DISCUSSION AND CONCLUSION Despite high levels of general community engagement and alcohol being widely regarded as a local problem, few community members reported acting on alcohol issues, and their self-efficacy to effect change was low.
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Affiliation(s)
- Kypros Kypri
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia; Injury Prevention Research Unit, Department of Preventive & Social Medicine, University of Otago, Dunedin, New Zealand
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Maclennan B, Wyeth E, Hokowhitu B, Wilson S, Derrett S. Injury severity and 3-month outcomes among Maori: results from a New Zealand prospective cohort study. N Z Med J 2013; 126:39-49. [PMID: 24045351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIMS To examine the prevalence of health and social outcomes pre- and 3 months post-injury, and the association between New Injury Severity Scores (NISS) and 3-month outcomes, for the Maori cohort of the Prospective Outcomes of Injury Study. METHODS New Zealand residents were recruited from the Accident Compensation Corporation's entitlement claims register and participants interviewed at 3 months post-injury. Those who reported Maori ethnicity (n=566) were included in the Maori cohort. RESULTS States indicative of favourable health were less prevalent among the cohort post-injury than pre-injury for all measures examined. Approximately half the cohort were experiencing difficulties walking 3 months after their injury, over two-thirds a level of pain or discomfort, and more than half a level of psychological distress. The prevalence of disability was 49%. The prevalence of some adverse outcomes increased with increasing NISS but a high level of problems were still experienced by those classified as having a 'minor' injury. Nonetheless, a majority of the cohort were satisfied with life and they considered themselves to be of good to excellent overall health. CONCLUSIONS Findings emphasise the importance of injury prevention and appropriate post-injury care to reduce the burden experienced by Maori due to injury.
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Affiliation(s)
- Brett Maclennan
- Te Roopu Rakahau Hauora Maori a Kai Tahu/ Ngai Tahu Maori Health Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin 9054, New Zealand.
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Maclennan B, Kypri K, Room R, Langley J. Local government alcohol policy development: case studies in three New Zealand communities. Addiction 2013; 108:885-95. [PMID: 23130762 PMCID: PMC3652029 DOI: 10.1111/add.12017] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 05/08/2012] [Accepted: 10/15/2012] [Indexed: 11/29/2022]
Abstract
AIMS Local alcohol policies can be effective in reducing alcohol-related harm. The aim of this study was to examine local government responses to alcohol-related problems and identify factors influencing their development and adoption of alcohol policy. DESIGNSETTINGS AND PARTICIPANTS: Case studies were used to examine local government responses to alcohol problems in three New Zealand communities: a rural town, a provincial city and a metropolitan city. Newspaper reports, local government documents and key informant interviews were used to collect data which were analysed using two conceptual frameworks: Kingdon's Streams model and the Stakeholder model of policy development. MEASUREMENTS Key informant narratives were categorized according to the concepts of the Streams and Stakeholder models. FINDINGS Kingdon's theoretical concepts associated with increased likelihood of policy change seemed to apply in the rural and metropolitan communities. The political environment in the provincial city, however, was not favourable to the adoption of alcohol restrictions. The Stakeholder model highlighted differences between the communities in terms of power over agenda-setting and conflict between politicians and bureaucrats over policy solutions to alcohol-related harm. These differences were reflected in the ratio of policies considered versus adopted in each location. Decisions on local alcohol policies lie ultimately with local politicians, although the policies that can be adopted by local government are restricted by central government legislation. CONCLUSIONS The adoption of policies and strategies to reduce alcohol-related harm may be better facilitated by an agenda-setting process where no 'gate-keepers' determine what is included into the agenda, and community mobilization efforts to create competitive local government elections around alcohol issues. Policy adoption would also be facilitated by more enabling central government legislation.
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Affiliation(s)
- Brett Maclennan
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of OtagoDunedin, New Zealand
| | - Kypros Kypri
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of OtagoDunedin, New Zealand,School of Medicine and Public Health, University of NewcastleCallaghan, NSW, Australia
| | - Robin Room
- Centre for Alcohol Policy Research, Turning Point Alcohol and Drug CentreFitzroy, Vic., Australia,School of Population Health, University of MelbourneParkville, Vic., Australia
| | - John Langley
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of OtagoDunedin, New Zealand
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Maclennan B, Kypri K, Langley J, Room R. Non-response bias in a community survey of drinking, alcohol-related experiences and public opinion on alcohol policy. Drug Alcohol Depend 2012; 126:189-94. [PMID: 22677457 DOI: 10.1016/j.drugalcdep.2012.05.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 04/13/2012] [Accepted: 05/13/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The continuing decline in response rates to household surveys is a concern for the health and social sciences as it increases the risk of selective non-response biasing the estimates of interest. METHODS We analysed non-response bias in a postal survey measuring drinking behaviour, experience of harm and opinion on local government alcohol policies among residents in six New Zealand communities. The Continuum of Resistance model, which suggests that late respondents to a survey are most similar to non-respondents on the measures of interest, was used to guide our investigation. RESULTS Men, younger people, those of Māori descent and those living in more deprived areas were less likely to respond to our survey than women, older people, those not of Māori descent and those living in comparatively affluent areas. Late respondents more closely resembled non-respondents demographically than early respondents. The prevalence of binge drinking and experience of assault was higher, and support for restrictive local government alcohol policies lower, among late respondents. Assuming the drinking behaviour and alcohol-related experiences of non-respondents were the same as those of late respondents, prevalence was under-estimated by 3.4% (relative difference: 13%) and 2.1% (relative difference: 21%) for monthly binge drinking and assault respectively. Policy support was not over-estimated. CONCLUSION The findings add to a growing body of evidence suggesting that surveys under-estimate risk behaviour because of selective non-response and this bias increases as response rates fall. Notably, public opinion may not be subject to such misestimation.
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Affiliation(s)
- Brett Maclennan
- Injury Prevention Research Unit, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand.
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Maclennan B, Kypri K, Langley J, Room R. NON-RESPONSE BIAS IN A COMMUNITY SURVEY OF DRINKING, ALCOHOL-RELATED EXPERIENCES AND PUBLIC OPINION ON ALCOHOL POLICY. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040580e.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kypri K, Maclennan B. Commentary on Melson et al. (2011): Pluralistic ignorance is probably real but important questions remain about its relation to drinking and role in intervention. Addiction 2011; 106:1085-6. [PMID: 21564373 DOI: 10.1111/j.1360-0443.2011.03457.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Kypros Kypri
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, Australia.
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Kypri K, Maclennan B, Langley JD, Connor JL. The Alcohol Reform Bill: more tinkering than reform in response to the New Zealand public's demand for better liquor laws. Drug Alcohol Rev 2011; 30:428-33. [PMID: 21518047 DOI: 10.1111/j.1465-3362.2011.00320.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kypri K, Paschall MJ, Maclennan B, Langley JD. Intoxication by drinking location: a web-based diary study in a New Zealand university community. Addict Behav 2007; 32:2586-96. [PMID: 17582691 DOI: 10.1016/j.addbeh.2007.05.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Revised: 05/24/2007] [Accepted: 05/28/2007] [Indexed: 11/29/2022]
Abstract
Drinking to intoxication is a modifiable risk factor for various health, social, and legal problems. The objective was to estimate the relative risk of intoxication by type of drinking location. Participants were 1614 university students (mean age 19.0 years) in residential halls who completed a web survey (67% response). Respondents reported their drinking for each day of the preceding week, in residential halls, pubs/bars/nightclubs, student flats/houses, and 'other' locations. An estimated blood alcohol concentration (EBAC) was computed and intoxication was defined as EBAC>0.08%. Pubs/bars/nightclubs accounted for 51% of all alcohol consumed, followed by residential halls (34%), student flats/houses (9%), and other locations (6%). Episodes resulting in intoxication comprised 61% of all drinking episodes in pubs/bars/nightclubs, 55% in student flats/houses, 53% in residential halls, and 37% in other locations. Multi-level analyses revealed positive associations between the first three location types (relative to 'other') and intoxication among women. Drinking in pubs/bars/nightclubs was associated with intoxication among men. Other significant predictors included hazardous drinking in the respondent's residential hall, pre-university drinking, and first-year status. Student intoxication is commonplace in licensed premises and residential halls. These environments are amenable to interventions to reduce the incidence of intoxication.
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Affiliation(s)
- Kypros Kypri
- School of Medicine and Public Health, University of Newcastle, David Maddison Building, King & Watt Streets, Newcastle NSW 2300, Australia.
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Maclennan B. News and reviews. Age Ageing 2006. [DOI: 10.1093/ageing/afl143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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