From infancy to eight: How early maternal mental health, emotion reminiscing, and language shape children's mental health.

To test the transmission of mental health difficulties from mother to child, we examined mediation through emotion reminiscing conversations and child language. Maternal depression symptoms were measured at 9 months post-partum, and child mental health outcomes were measured at age 8 years. Emotion reminiscing conversations between 1,234 mother-child pairs (624 boys, 610 girls) were recorded as part of a large, diverse, longitudinal cohort Growing Up in New Zealand. The 1,234 reminiscing conversations were transcribed and coded for maternal elaboration and emotion resolution quality (mother and child). The coded reminiscing variables did not mediate the pathway from maternal depression to child mental health outcomes; however, each maternal reminiscing variable together with child language skill serially mediated the relationship from maternal depression symptoms to child-reported anxiety and depression symptoms, and parent-reported child externalizing symptoms. Language as a skill and it's use as a tool for making shared meaning from past events are highlighted as possible mechanisms for the intergenerational transmission of mental health difficulties. These findings point to potential opportunities for early interventions, including prevention of and support for postnatal depression, family intervention in reminiscing training, and supporting child language development.

Harti Hauora Tamariki: randomised controlled trial protocol for an opportunistic, holistic and family centred approach to improving outcomes for hospitalised children and their families in Aotearoa, New Zealand.

Background: Health and wellbeing inequities between the Indigenous Maori and non-Maori populations in Aotearoa, New Zealand continue to be unresolved. Within this context, and of particular concern, hospitalisations for diseases of poverty are increasing for tamariki Maori (Maori children). To provide hospitalised tamariki Maori, and their whanau (families) comprehensive support, a wellbeing needs assessment; the Harti Hauora Tamariki Tool (The Harti tool) was developed. The purpose of this study is to determine how effective the Harti tool is at identifying wellbeing needs, ensuring the documentation of needs, enabling access to services and improving wellbeing outcomes for tamariki and their whanau. Methods: The study uses a Kaupapa Maori methodology with qualitative and quantitative methods. Qualitative methods include in-depth interviews with whanau. This paper presents an overview of a randomised, two parallel, controlled, single blinded, superiority trial for quantitative evaluation of the Harti programme, and hospital satisfaction with care survey. Participants will be Maori and non-Maori tamariki/children aged 0-4 years admitted acutely to the paediatric medical wards at Waikato Hospital, Hamilton, Aotearoa New Zealand. They will be randomised electronically into the intervention or usual care group. The intervention group will receive usual care in addition to the Harti programme, which includes a 24-section health needs assessment delivered by trained Maori navigators to whanau during the time they are in hospital. The primary endpoint is the relative risk of an acute hospital readmission in the 30 days following discharge for the intervention group patients compared with control group patients. Secondary outcomes include access and utilisation of preventative health services including: oral health care, general practice enrolment, immunisation, healthy home initiatives, smoking cessation and the Well Child Tamariki Ora universal health checks available free of charge for children in Aotearoa New Zealand. Discussion: Randomised controlled trials are a gold standard for measuring efficacy of complex multifaceted interventions and the results will provide high quality evidence for implementing the intervention nationwide. We expect that this study will provide valuable evidence for health services and policy makers who are considering how to improve the configuration of paediatric hospital services. Trial registration: The study is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), registration number: ACTRN12618001079235.

Maternal depressive symptoms and child language development: Exploring potential pathways through observed and self-reported mother-child verbal interactions.

Maternal depressive symptoms (MDS) in the postnatal period may impact children's later development through poorer quality parent-child interactions. The current study tested a specific pathway from MDS (child age 9 months) to child receptive vocabulary (4 ½ years) through both self-reported and observed parent-child verbal interactions (at both 2 and 4 ½ years). Participants (n = 4,432) were part of a large, diverse, contemporary pre-birth national cohort study: Growing Up in New Zealand. Results indicated a direct association between greater MDS at 9 months and poorer receptive vocabulary at age 4 ½ years. There was support for an indirect pathway through self-reported parent-child verbal interactions at 2 years and through observed parent-child verbal interactions at 4 ½ years. A moderated mediation effect was also found: the indirect effect of MDS on child vocabulary through observed verbal interaction was supported for families living in areas of greater socioeconomic deprivation. Overall, findings support the potential role of parent-child verbal interactions as a mechanism for the influence of MDS on later child language development. This pathway may be particularly important for families experiencing socioeconomic adversity, suggesting that effective and appropriate supportive parenting interventions be preferentially targeted to reduce inequities in child language outcomes.

Maternal reminiscing during middle childhood: Associations with maternal personality and child temperament from the Growing Up in New Zealand cohort study.

The way that mothers talk about the past (reminisce) with young children is linked to key memory, language, and socioemotional outcomes. The present research explored the role of a range of child, maternal, socioeconomic, and cultural factors that predict maternal reminiscing style, with a particular focus on maternal personality and child temperament. A total of 1,404 mother-child dyads from the prebirth longitudinal cohort study Growing Up in New Zealand (https://www.growingup.co.nz) participated in a reminiscing task about a negative event when children were 8 years old. This broader cohort is broadly representative of the New Zealand population in terms of maternal ethnicity and socioeconomic status. Conversations were scored using a revised version of the Elaborative Reminiscing Scale. Child temperament during infancy, but not childhood, uniquely predicted maternal reminiscing style. Maternal extraversion also predicted a more elaborative reminiscing style. Other maternal factors, including education, ethnicity, and age, were also identified as unique predictors of maternal reminiscing style. These findings fit well with an ecological systems view of maternal reminiscing as a function of child, maternal, and cultural factors. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Holistic antenatal education class interventions: a systematic review of the prioritisation and involvement of Indigenous Peoples' of Aotearoa New Zealand, Australia, Canada and the United States over a 10-year period 2008 to 2018.

BACKGROUND: Research into the effectiveness of antenatal education classes is crucial for Indigenous Peoples from Aotearoa New Zealand, Australia, Canada and the United States who experience poorer maternal and infant health outcomes compared to non-Indigenous populations. Our systematic review questions were intended to determine the extent of Indigenous Peoples prioritisation and involvement in antenatal education classes, and to understand the experience of Indigenous Peoples from these countries in antenatal education classes. METHODS: Using a standardised protocol, we systematically searched five electronic databases for primary research papers on antenatal education classes within the four countries noted and identified 17 papers that met the criteria. We undertook a qualitative meta-synthesis using a socio-critical lens. RESULTS: Systematic review of the academic literature demonstrates that Indigenous Peoples of Aotearoa New Zealand, Australia, Canada and the United States are not prioritised in antenatal education classes with only two of 17 studies identifying Indigenous participants. Within these two studies, Indigenous Peoples were underrepresented. As a result of poor engagement and low participation numbers of Indigenous Peoples in these antenatal education classes, it was not possible to understand the experiences of Indigenous Peoples. CONCLUSION: Given that Indigenous Peoples were absent from the majority of studies examined in this review, it is clear little consideration is afforded to the antenatal health needs and aspirations of Indigenous Peoples of Aotearoa New Zealand, Australia, Canada and the United States. To address the stark antenatal health inequities of Indigenous Peoples, targeted Indigenous interventions that consider culture, language, and wider aspects of holistic health must be privileged. TRIAL REGISTRATION: PROSPERO Registration ID: CRD4202017658.

Structural disadvantage for priority populations: the spatial inequity of COVID-19 vaccination services in Aotearoa.

AIM: To examine the spatial equity, and associated health equity implications, of the geographic distribution of COVID-19 vaccination services in Aotearoa New Zealand. METHOD: The distribution of Aotearoa's population was mapped, and the enhanced two-step floating catchment method (E2SFCA) applied to estimate spatial access to vaccination services. The Gini coefficient and spatial autocorrelation measures assessed the spatial equity of vaccination services. Additional statistics included an analysis of spatial accessibility for priority populations, and by District Health Board (DHB) region. RESULTS: Spatial accessibility to vaccination services varies across Aotearoa, and appears to be better in major cities than rural regions. A Gini coefficient of 0.426 confirms that spatial accessibility scores are not shared equally across the vaccine-eligible population. Furthermore, priority populations including Maori, Pasifika, and older people have statistically significantly lower spatial access to vaccination services. This is also true for people living in rural areas. Spatial access to vaccination services also varies significantly by DHB region as does the Gini coefficient, and the proportion of DHB priority population groups living in areas with poor access to vaccination services. A strong and significant positive correlation was identified between average spatial accessibility and the Maori vaccination rate ratio of DHBs. CONCLUSION: COVID-19 vaccination services in Aotearoa are not equitably distributed. Priority populations, with the most pressing need to receive COVID-19 vaccinations, have the worst access to vaccination services.

Determinants of exclusive breastfeeding for wahine Maori.

AIM: Breastfeeding is a fundamental aspect of tikanga Maori (Maori cultural traditions/practices) requiring protection and promotion. This study identifies determinants of exclusive breastfeeding in wahine Maori. METHODS: Wahine Maori enrolled in the Growing Up in New Zealand child cohort study participated (n=1060). Exclusive breastfeeding duration was self-reported. Hierarchical regression analyses were framed by a model of Maori health and wellbeing. RESULTS: Most wahine Maori initiated breastfeeding (96%), with 12% exclusively breastfeeding for six or more months. Wahine Maori had increased odds of exclusively breastfeeding for six or more months if they: thought it best to breastfeed for >6 months (adjusted odds ratio (aOR)=1.94, 95% confidence interval (CI)=1.05-3.78); thought returning to work would not (aOR=2.17, 95% CI=1.17-4.24) or may (aOR=4.25, 95% CI=1.86-9.85) limit breastfeeding; were experienced mothers (aOR=2.55, 95% CI=1.35-5.06); or were undecided about vaccination (aOR=3.16, 95% CI=1.55-6.39). Exclusive breastfeeding for six or more months was less likely if mothers experienced depression during pregnancy (aOR=0.47, 95% CI=0.20-0.99) or viewed cultural traditions/practices as "fairly important" (aOR=0.53, 95% CI=0.27-0.99), compared to "very important". CONCLUSION: Determinants of exclusive breastfeeding in wahine Maori are knowledge of breastfeeding recommendations, return to work, motherhood experience, connection to Te Ao Maori (Maori worldview) and tikanga Maori, antenatal depression and vaccine indecision. Interventions delivered within a Kaupapa Maori framework will best address breastfeeding inequities in Aotearoa New Zealand.

Residential mobility and potentially avoidable hospitalisations in a population-based cohort of New Zealand children.

BACKGROUND: Residential moves are common in early childhood and associations have been found between residential mobility and adverse child health and well-being outcomes. Although there are studies on potentially avoidable hospitalisations (PAH) in children, few have examined PAH in relation to residential mobility. Our aim, therefore, was to investigate residential mobility and PAH in a population-based cohort of New Zealand children. METHODS: Using a retrospective cohort design, we analysed data from the Integrated Data Infrastructure for a cohort of 314 283 children born since the start of 2004, who had at least one residential address recorded by 2 years of age. Residential mobility was derived from address data and PAH were determined from hospital discharge data. RESULTS: Half of the cohort children (52%) experienced at least one residential move by 2 years of age, and 22% experienced two or more moves. Fifteen per cent of the cohort experienced one or more PAH between 2 and 4 years of age. A linear association between residential mobility and PAH was found (relative risk (RR)=1.18, CI 1.17 to 1.19) and this remained robust when adjusting for several covariates. Sensitivity analyses for ambulatory care sensitive hospitalisations (ACSH) and PAH attributable to the housing/physical environment (PAH-HE) produced results very similar to those for PAH (ACSH: adjusted RR (aRR)=1.10, CI 1.09 to 1.11; PAH-HE: aRR=1.11, CI 1.10 to 1.12). CONCLUSION: This study found a linear association between higher residential mobility and an increased likelihood of PAH in young children. Avenues for further investigation are suggested.

Demographic discrepancies between administrative-prioritisation and self-prioritisation of multiple ethnic identifications.

Ethnic classification is an inherently subjective process, especially when multiple ethnic identifications are involved. There are two methods commonly used to classify multiple ethnicities into single categories: administrative-prioritisation (assignment via a predetermined hierarchy) and self-prioritisation (where individuals select their "main" ethnicity). Currently, little is known about whether the demographic composition of outputted ethnic groups differs by prioritisation method. This study utilised large-scale data of multi-ethnic children (N = 1,860), adolescents (N = 2,413), and adults (N = 1,056) from Aotearoa New Zealand to examine individual and contextual demographic characteristics associated with discrepancies between administratively-prioritised and self-prioritised ethnicity. Results showed that discrepancy rates, which exceeded 50%, were systematically associated with neighbourhood ethnic composition and socioeconomic deprivation, but largely not associated with gender, age, and birthplace. The contextual nature of self-prioritisation highlights the importance of researchers' choice of ethnic classification method. Implications are discussed in the context of increasing multi-ethnic prevalence.

Selecting Health Need Indicators for Spatial Equity Analysis in the New Zealand Primary Care Context.

PURPOSE: To examine potential indicators of health need for primary care in spatial equity research, and evidence of the Inverse Care Law in the Waikato region of New Zealand. METHODS: A cross-sectional analysis of 7 health need indicators (ambulatory sensitive hospitalizations; cancer rate; mortality rate; New Zealand index of multiple deprivation-health domain; age; New Zealand index of deprivation; smoking rate) that were identified through a systematic review was carried out. Values of indicators were mapped and analyzed using geographic information systems (GIS). Spearman's correlations were calculated between indicators, and clusters of high need were identified through spatial autocorrelation. The impact of incorporating indicator-based weightings into an accessibility model was tested using analysis of variance and Spearman's correlations. General practice service spatial equity was assessed by comparing clusters of high access versus need, and quantified through the Gini coefficient. FINDINGS: Ambulatory sensitive hospitalization (ASH) rates were significantly correlated with all indicators. Health needs were significantly clustered, but incorporating indicator weightings into the spatial accessibility analysis did not impact accessibility scores. A misalignment of access and need, and a Gini coefficient of 0.281 suggest that services are not equitably distributed. CONCLUSION: ASH rates seem a robust indicator of health need. However, data access issues may restrict their use. Area-level socioeconomic deprivation measures incorporate some social determinants of health, and they have potential for wider use. High need clusters vary spatially according to the indicator used. GIS techniques can identify "hot-spots" of need, but these can be masked in accessibility models.

An eight-plex immunoassay for Group A streptococcus serology and vaccine development.

Group A Streptococcus (GAS) is a major human pathogen responsible for superficial infections through to life-threatening invasive disease and the autoimmune sequelae acute rheumatic fever (ARF). Despite a significant global economic and health burden, there is no licensed vaccine available to prevent GAS disease. Several pre-clinical vaccines that target conserved GAS antigens are in development. Assays that measure antigen-specific antibodies are essential for vaccine research. The aim of this study was to develop a multiplex beadbased immunoassay that can detect and quantify antibody responses to multiple GAS antigen targets in small volume blood samples. This builds on our existing triplex assay comprised of antigens used in clinical serology for the diagnosis of ARF (SLO, DNase B and SpnA). Five additional conserved putative GAS vaccine antigens (Spy0843, SCPA, SpyCEP, SpyAD and the Group A carbohydrate), were coupled to spectrally unique beads to form an 8-plex antigen panel. After optimisation of the assay protocol, standard curves were generated, and assessments of assay specificity, precision and reproducibility were conducted. A broad range of antibody (IgG) titres were able to be quickly and accurately quantified from a single serum dilution. Assay utility was assessed using a panel of 62 clinical samples including serum from adults with GAS bacteraemia and children with ARF. Circulating IgG to all eight antigens was elevated in patients with GAS disease (n = 23) compared to age-matched controls (n = 39) (P < 0.05). The feasibility of using dried blood samples to quantify antigen-specific IgG was also demonstrated. In summary, a robust and reproducible 8-plex assay has been developed that simultaneously quantifies IgG antibodies to GAS vaccine and diagnostic antigens.

Mind the gap - unequal from the start: evidence from the early years of the Growing Up in New Zealand longitudinal study.

Growing Up in New Zealand is this country's largest contemporary longitudinal study of child development. The study has been designed to provide insight into the lives of children and young people growing up in the context of twenty-first century New Zealand. The Growing Up in New Zealand cohort recruited 6853 children representative of the current ethnic and socioeconomic diversity of births in Aotearoa, New Zealand in 2009 and 2010. The developmental wellbeing of the children has been tracked in detail over their first thousand days of life and every two to three years since. While the majority of the cohort are growing up healthy and happy, a significant proportion of children are growing up in families who have been persistently burdened with multiple stressors associated with economic, material and social hardship. This has created a disproportionate burden of poorer overall wellbeing outcomes and limited life course opportunities for these children from an early age. This paper will explore some of the evidence collected from the diverse cohort of New Zealand children and their families and whanau from before birth to middle childhood, highlighting the key findings and the utility of the evidence to improve wellbeing.

'Seeing' our tamariki in longitudinal studies: exploring the complexity of ethnic identification trajectories within Growing Up in New Zealand.

Longitudinal research provides unique opportunities for ethnic identification research and for understanding ethnic identity development. However, ethnic identification is subjective, fluid, multi-dimensional, and context-specific. This study draws on Growing Up in New Zealand longitudinal data to explore: how children identify their ethnicity/culture; and how these descriptions compare with ethnic identification patterns described by their parent. At eight years of age children described their ethnicity/culture as Pakeha/New Zealand European (52%); Maori (22%); Samoan (8%); Tongan (5%); Cook Islands (4%); Chinese (4%); Indian (5%); Niuean (2%); Australian (4%); and 14% said they don't think about their ethnicity. Across time, approximately 60% of the cohort have always been identified as or identified themselves as European, Maori and Asian respectively and 72% had always been identified as (or identified themselves) as Pacific. These findings show that emerging ethnic identification is complex, and differs according to who is responding and when, as well as according to ethnic identification itself. Measuring and interpreting ethnicity is an important opportunity for longitudinal studies. However, given the fluidity and contingency of this data, researchers face ongoing challenges in: maintaining kaitiakitanga (stewardship); providing robust evidence to guide policies that enhance wellbeing equity; and upholding Treaty of Waitangi obligations.

Vaccination information fathers receive during pregnancy and determinants of infant vaccination timeliness.

The information fathers receive about infant vaccination may influence their decision to vaccinate. We describe fathers' sources of vaccination information and paternal determinants of timely infant vaccinations. Participants were from a child cohort study in New Zealand. The child cohort was established by enrolling pregnant women and their partners. During pregnancy, fathers (n = 4017) of the cohort children born 2009-2010 described information sources that encouraged or discouraged infant vaccination. The National Immunization Register provided infant vaccination data. Independent associations of the vaccination information received by fathers with the timeliness of their infant's vaccination were determined using multivariable logistic regression. Associations were described using adjusted odds ratios and 95% confidence intervals. One-third of fathers (1430/4017 [36%]) recalled receiving vaccination information, 64% of which encouraged vaccination. Most infants (2900/4017 [72%]) received all their vaccinations on time, however only 58% of Maori infants were vaccinated on time. Paternal determinants of vaccination timeliness were the father receiving discouraging or conflicting information about vaccination, father's ethnicity, father's vaccination hesitancy, and whether the mother received vaccination information. To improve vaccination uptake and timeliness, a vaccination conversation with mothers, fathers and whanau could be included in routine antenatal care, informing and supporting decision-making, and addressing concerns. Vaccination education should address present and historic distrust of the health system. Framing vaccination within a Maori model of health and including fathers and whanau in decision-making will address vaccination inequities in New Zealand.

Mapping Autoantibodies in Children With Acute Rheumatic Fever.

Background: Acute rheumatic fever (ARF) is a serious sequela of Group A Streptococcus (GAS) infection associated with significant global mortality. Pathogenesis remains poorly understood, with the current prevailing hypothesis based on molecular mimicry and the notion that antibodies generated in response to GAS infection cross-react with cardiac proteins such as myosin. Contemporary investigations of the broader autoantibody response in ARF are needed to both inform pathogenesis models and identify new biomarkers for the disease. Methods: This study has utilised a multi-platform approach to profile circulating autoantibodies in ARF. Sera from patients with ARF, matched healthy controls and patients with uncomplicated GAS pharyngitis were initially analysed for autoreactivity using high content protein arrays (Protoarray, 9000 autoantigens), and further explored using a second protein array platform (HuProt Array, 16,000 autoantigens) and 2-D gel electrophoresis of heart tissue combined with mass spectrometry. Selected autoantigens were orthogonally validated using conventional immunoassays with sera from an ARF case-control study (n=79 cases and n=89 matched healthy controls) and a related study of GAS pharyngitis (n=39) conducted in New Zealand. Results: Global analysis of the protein array data showed an increase in total autoantigen reactivity in ARF patients compared with controls, as well as marked heterogeneity in the autoantibody profiles between ARF patients. Autoantigens previously implicated in ARF pathogenesis, such as myosin and collagens were detected, as were novel candidates. Disease pathway analysis revealed several autoantigens within pathways linked to arthritic and myocardial disease. Orthogonal validation of three novel autoantigens (PTPN2, DMD and ANXA6) showed significant elevation of serum antibodies in ARF (p < 0.05), and further highlighted heterogeneity with patients reactive to different combinations of the three antigens. Conclusions: The broad yet heterogenous elevation of autoantibodies observed suggests epitope spreading, and an expansion of the autoantibody repertoire, likely plays a key role in ARF pathogenesis and disease progression. Multiple autoantigens may be needed as diagnostic biomarkers to capture this heterogeneity.

Modifiable Early Childhood Risk Factors for Obesity at Age Four Years.

Background: Childhood obesity is associated with an increased risk of adult obesity and related chronic disease. Our aim was to identify modifiable exposures that are independently associated with obesity in the preschool age group. Methods: A prospective cohort study of 5734 children in New Zealand with anthropometric measurements was completed at age 4.5 years. The modifiable exposures of interest, measured at age 9 months and 2 years, were: food security during infancy; and, at age 2 years, screen time; sleep duration; and takeaway food and soft drink intake. The risk of obesity independently associated with each exposure was determined using Binomial and Poisson regression and described using adjusted risk ratios (RRs) and 95% confidence intervals (CIs), after controlling for confounding variables including gender, ethnicity, birth weight, and mother's age. The probability of obesity given cumulative exposures to the four risk factors and the population attributable fraction (PAF) were estimated. Results: Lower food security during infancy (1 hour/day; RR = 1.22; 95% CI : 1.01-1.48), shorter sleep duration (≤11.5 hours/day; RR = 1.30; 95% CI : 1.05-1.61), and weekly to daily consumption of takeaway/soft drink (RR = 1.25, 95% CI : 1.00-1.57) were independently associated with an increased risk of obesity at age 4.5 years. The cumulative PAF for childhood obesity was 42.9%, under an ideal scenario where all risk factors were eliminated. Conclusion: Exposure to modifiable factors by age 2 years is associated with obesity at age 4.5 years. Interventions to prevent childhood obesity need to be effective during infancy.

Residential mobility for a national cohort of New Zealand-born children by area socioeconomic deprivation level and ethnic group.

OBJECTIVES: The aims of this study are to describe area deprivation levels and changes that occur during residential moves involving New Zealand children from birth to their fourth birthday, and to assess whether these changes vary by ethnicity. DESIGN: Longitudinal administrative data. SETTING: Children born in New Zealand from 2004 to 2018. PARTICIPANTS: All (565 689) children born in New Zealand with at least one recorded residential move. OUTCOME MEASURES: A longitudinal data set was created containing lifetime address histories for our cohort. This was linked to the New Zealand Deprivation Index, a measure of small area deprivation. Counts of moves from each deprivation level to each other deprivation level were used to construct transition matrices. RESULTS: Children most commonly moved to an area with the same level of deprivation. This was especially pronounced in the most and least deprived areas. The number of moves observed also increased with deprivation. Maori and Pasifika children were less likely to move to, or remain in low-deprivation areas, and more likely to move to high-deprivation areas. They also had disproportionately high numbers of moves. CONCLUSION: While there was evidence of mobility between deprivation levels, the most common outcome of a move was no change in area deprivation. The most deprived areas had the highest number of moves. Maori and Pasifika children were over-represented in high-deprivation areas and under-represented in low-deprivation areas. They also moved more frequently than the overall population of 0 to 3 year olds.

What factors are associated with early childhood dental caries? A longitudinal study of the Growing Up in New Zealand cohort.

BACKGROUND: The relative importance of different strategies to prevent dental caries is not known. AIM: We explored the relationship between oral health behaviours, diet, and the incidence of dental caries. DESIGN: We conducted a study of children participating in the 'Growing Up in New Zealand' cohort. Exposures were oral health behaviours, a food frequency questionnaire, and sociodemographic characteristics that were recorded when the child was nine months and two years old. Outcomes were records of dental caries at ages four to seven years. RESULTS: 4111 children had dental examination records from between the ages of four and seven years. High levels of dental caries were reported in children of Pacific, Asian, and Maori ethnicity. Food frequency questionnaire information was summarised into two principal components. The major axis of variation was in the intake of food and drinks with high concentrations of sugar and refined starch, with this component strongly associated with caries (multivariable incidence rate ratio of caries 0.48; 95% confidence interval: 0.38-0.61, comparing the extreme quintiles of the first principal component). CONCLUSIONS: A diet high in sugar or refined starch was strongly linked to caries. Policies to reduce sugar and refined starch intake should be considered.

Physical Conflict During Pregnancy: A Socioecological, Cross-Cultural Examination of Risk and Protective Factors for New Zealand Women.

Participants were 5,831 women in their third trimester of pregnancy, part of a large, longitudinal, pre-birth national cohort study. Women reported on their experience of pushing and shoving, throwing or breaking objects within their relationship over the past month. Univariable regression models examined the association of a large number of potential risk and protective factors. Those significant at the univariable level were carried forward into final multivariable analyses, stratified by New Zealand's four main ethnic groups: European, Maori, Pacific, and Asian peoples. Relationship commitment, reduced family cohesion, and perceived stress were associated with increased risk across ethnic groups.