The prevalence of chronic kidney disease in Samoans living in Auckland, New Zealand.

AIMS: Pacific peoples have higher rates of chronic kidney disease (CKD) and are five times more likely to commence kidney replacement therapy compared with New Zealand (NZ) Europeans. As the majority live Auckland, this study looked at the prevalence of CKD in two Auckland Pacific Island health providers caring for a large proportion of Pacific peoples, of which almost 50% are Samoan, as well as NZ Europeans. METHODS: De-identified information was requested on individuals who had two or more CKD tests (serum creatinine and urinary albumin creatinine ratios) more than 3 months apart. CKD prevalence across different demographic groups was determined. Logistic regression was used to look at associations of known risk factors and CKD. RESULTS: Data from 25 127 patients was evaluated. Of the total sample, 7451 individuals identified as Samoans. The prevalence of CKD amongst all Samoans in this sample was 17.8% increasing to 36.3% in those Samoans that had been tested for CKD. The prevalence of CKD in this total sample was 13% increasing to 27.5% considering only those who had CKD testing. The odds of Samoans having CKD (adjOR: 1.9 [95%CI 1.7, 2.2]), all other Pacific Island ethnicities identified and NZ Maori (adjOR:1.5 [95%CI 1.3, 1.8]), were increased compared with non-Maori-non-Pacific (likelihood p value <.001). CONCLUSION: We report the high prevalence of CKD (15.9%-33.4%) in Samoans living in New Zealand. This reveals an urgent need for further studies to develop strategies to prevent or reduce the development of kidney failure and premature death.

Dual use of electronic nicotine delivery systems (ENDS) and smoked tobacco: a qualitative analysis.

INTRODUCTION: Electronic nicotine delivery systems (ENDS) arguably pose fewer health risks than smoking, yet many smokers adopt ENDS without fully relinquishing smoking. Known as 'dual use', this practice is widespread and compromises the health benefits that ENDS may offer. To date, few studies have explored how dual use practices arise and manifest. METHODS: We conducted in-depth, semi-structured interviews with 20 current ENDS users from New Zealand who reported smoking tobacco at least once a month. We explored participants' smoking history, their recent and current smoking, trial, uptake and patterns of ENDS use, and future smoking and vaping intentions. We managed the data using NVivo V.11 and used a thematic analysis approach to interpret the transcripts. RESULTS: Dual use practices among participants evolved in four ways. First, as an attempt to manage the 'inauthenticity' of vaping relative to smoking and to retain meaningful rituals. Second, as complex rationalisations that framed decreased tobacco use, rather than smoking cessation, as 'success'. Third, as a means of alleviating the financial burden smoking imposed and to circumvent smoke-free policies. Lastly, dual use reflected attempts to comply with social group norms and manage stigma. CONCLUSIONS: Dual use reflects both social and physical cues. It assisted participants to navigate smoking restrictions and allowed them to manage divergent norms. Policies that discourage smoking, particularly excise tax increases on smoked tobacco and smoke-free space restrictions, appear important in prompting ENDS use. Future research could explore whether these policies also help foster complete transition from smoking to exclusive ENDS use.

The effect of mild sleep deprivation on diet and eating behaviour in children: protocol for the Daily Rest, Eating, and Activity Monitoring (DREAM) randomized cross-over trial.

BACKGROUND: Although insufficient sleep has emerged as a strong, independent risk factor for obesity in children, the mechanisms by which insufficient sleep leads to weight gain are uncertain. Observational research suggests that being tired influences what children eat more than how active they are, but only experimental research can determine causality. Few experimental studies have been undertaken to determine how reductions in sleep duration might affect indices of energy balance in children including food choice, appetite regulation, and sedentary time. The primary aim of this study is to objectively determine whether mild sleep deprivation increases energy intake in the absence of hunger. METHODS: The Daily, Rest, Eating, and Activity Monitoring (DREAM) study is a randomized controlled trial investigating how mild sleep deprivation influences eating behaviour and activity patterns in children using a counterbalanced, cross-over design. One hundred and ten children aged 8-12 years, with normal reported sleep duration of 8-11 h per night will undergo 2 weeks of sleep manipulation; seven nights of sleep restriction by going to bed 1 hr later than usual, and seven nights of sleep extension going to bed 1 hr earlier than usual, separated by a washout week. During each experimental week, 24-h movement behaviours (sleep, physical activity, sedentary behaviour) will be measured via actigraphy; dietary intake and context of eating by multiple 24-h recalls and wearable camera images; and eating behaviours via objective and subjective methods. At the end of each experimental week a feeding experiment will determine energy intake from eating in the absence of hunger. Differences between sleep conditions will be determined to estimate the effects of reducing sleep duration by 1-2 h per night. DISCUSSION: Determining how insufficient sleep predisposes children to weight gain should provide much-needed information for improving interventions for the effective prevention of obesity, thereby decreasing long-term morbidity and healthcare burden. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12618001671257 . Registered 10 October 2018.

The experiences of young people with chronic illness in New Zealand: A qualitative study.

BACKGROUND: Around 10% of young people suffer from chronic health conditions, and their health care needs are different from those of children or adults. Most research about young people's chronic illness focuses on specific conditions, on younger children's experience, and on the perspectives of parents. This study explored the experiences of young people with two very different chronic conditions (asthma and cancer) and their perception of the New Zealand health system's response to their needs. METHODS: This was a collaborative research process where eight young co-researchers who had asthma or cancer were employed to work alongside the research team to develop protocols, interview peers, and assist with analysis. The challenges of this process are described in the article. Twenty-one young people between ages 15 and 27 from two urban areas of New Zealand participated in semistructured open-ended interviews about their health care experiences. Sixteen participants were female, and five male. Eleven of the participants had finished cancer treatment (with an average of 3.6 years since diagnosis), and 10 had asthma. Purposeful sampling meant that 80% of the participants with asthma were identified as Maori and the other participants identified with a range of other ethnic groups. Data were thematically coded, and coresearchers were consulted to derive the ultimate findings. RESULTS: Chronic illness disrupted the trajectory of young people's lives and had significant effects on their relationships. The New Zealand health system generally did not respond well to the needs of these young people, but many encountered extraordinary individuals who supported them effectively. The experiences of some indigenous participants indicate that health professionals require effective cultural competence training. CONCLUSIONS: This study provides insights into how young people with very different conditions experience the health system. Young people should be consulted and actively included in decision making about making health systems responsive to their diverse needs.

SunSmart news? Traditional media coverage of sun protection issues during springtime in New Zealand.

ISSUES ADDRESSED: Cutaneous melanomas and keratinocyte carcinomas (nonmelanoma skin cancer) are highly prevalent in New Zealand (NZ), making skin cancer a priority area for cancer control. Spring is an important time for encouraging sun-safety, due to ultraviolet radiation (UVR) levels becoming hazardous. The news media have a potential to play an important role in reminding people and emphasising the importance of sun-safety. This study aimed to describe how the traditional NZ media portrayed sun-safety and skin cancer in spring news stories. METHODS: A media monitoring company collated stories related to cancer during spring 2016. These were reviewed for inclusion and content was coded according to the cancer type described. Stories focused on skin cancer and sun protection issues were coded according to the position on the cancer control continuum. RESULTS: Skin cancer and sun-safety represented 3.6% (n = 110) of all cancer stories published. Stories mainly related to primary prevention (72%), early detection (37%) and survivorship (27%). The main risk factors identified included sun exposure (49%) and tanning (25%). CONCLUSIONS: Traditional media coverage of skin cancer remains relatively low during springtime. It is heartening to see that most stories included prevention information. SO WHAT?: Given the impact of skin cancer in NZ, and the importance of springtime as a period for behaviour change to reduce risk, there is considerable scope for increased media coverage and advocacy. Further research could usefully analyse media trends throughout the year and within specific media platforms, both traditional and new, in order to further disseminate information to the NZ public.

Media reporting of health interventions in New Zealand: a retrospective analysis.

AIM: To evaluate New Zealand media articles on their coverage of key issues regarding health interventions and whether it is consistent with available evidence. METHODS: A retrospective analysis was carried out of all articles published in five New Zealand media sources over a 6-week period between 15 October and 26 November 2014. Articles were included if their primary focus was on health interventions involving medications, devices or in-hospital procedures. Articles were assessed for coverage of key issues using previously validated 10-point criteria. A literature review was performed to compare content with scientific evidence. RESULTS: We identified 30 articles for review. Only 4 of 30 articles covered indications, benefits and risks, and of these, two were consistent with available evidence (7%, 95% CI 1%-22%). For articles that discussed at least one of indications, benefits or risks, and there was corresponding evidence available, there was a high level of consistency with the evidence (89%, 95% CI 77%-95%). The overall mean value of coverage from the 10-point criteria was 51% (95% CI 45%-58%). Single questions regarding the potential harm, costs associated with the intervention and the availability of alternative options were particularly poorly covered. They were rated as 'satisfactory' in 13%, 23% and 33% of the 30 articles respectively. CONCLUSION: New Zealand news articles covering medical treatments and interventions are largely consistent with available evidence but are incomplete. Vital information is being consistently missed, especially around the potential harms and costs of medical interventions.

Reflections: Spirituality and Cancer Researchers.

Spirituality is increasingly acknowledged as an essential element to consider within care for cancer and other chronic health conditions. As our colleagues in frontline healthcare roles integrate these concepts into their professional practice, it seems timely for the cancer research community to reflect on the place of spirituality within our work. This reflections article discusses challenges and opportunities for researchers considering spirituality in their own work roles and within broader discussions about health needs, care and research agendas.

Cancer Information Seeking Among Adult New Zealanders: a National Cross-Sectional Study.

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.

Cancer Awareness in Aotearoa New Zealand (CAANZ), 2001 and 2015: Study Protocols.

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, Maori (the indigenous population of NZ) ethnicity. To compensate for possible disproportionate age-by-ethnicity (Maori/non-Maori) 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.

Is parent education a factor in identifying autism/takiwatanga in an ethnic cohort of Pacific children in Aotearoa, New Zealand? A national cross-sectional study using linked administrative data.

LAY ABSTRACT: Previous studies of autism in Aotearoa, New Zealand, suggest that fewer Pacific children receive an autism diagnosis compared to European children. This study aimed to explore if formal education qualification of parents is related to receiving an autism diagnosis for their Pacific child. Our findings show that autism was identified in 1.1% of Pacific children compared with 1.6% among non-Maori, non-Pacific children. Parents with higher levels of education were more likely to receive an autism diagnosis for their Pacific child. While the study findings indicate education plays a positive role in receiving a diagnosis for autistic children, they suggest a systemic failure of supporting Pacific parents and communities to navigate the health and education systems that exist in Aotearoa, New Zealand.

Promotion and support of physical activity among cancer survivors: a service provider perspective.

OBJECTIVE: Cancer survivors are a population group at higher risk of a number of adverse health outcomes. Physical activity during and post-treatment is beneficial, yet participation in physical activity tends to be low amongst cancer survivors. There is still much to be learnt about how service providers can successfully translate research evidence about the benefits of physical activity for cancer survivors into effective and widely available interventions to support physical activity participation. The aim of this qualitative study is to describe some of the current approaches used by the Cancer Society of New Zealand (CSNZ) to supporting physical activity among survivors and the opportunities and challenges associated with this. METHODS: Participants were Supportive Care Managers and representatives of the CSNZ. A generic qualitative approach included semi-structured interviews, transcription, member checking and analysis via thematic coding by two of the research team. RESULTS: Four major themes frame the discussion of the results: (i) existing physical activity programmes and resources for cancer survivors; (ii) gaps and needs in the provision of physical activity programmes for cancer survivors; (iii) barriers, facilitators and preferences in relation to physical activity participation; and (iv) considerations for service providers involved in developing physical activity programmes for cancer survivors. CONCLUSIONS: The implications for future research and for service provision of physical activity programmes for cancer survivors are discussed. Potential strategies to increase physical activity participation among cancer survivors are put forward.

Parents' education and Pasifika children's oral health in Aotearoa/New Zealand: A national linked data study using Aotearoa/New Zealand's integrated data infrastructure.

OBJECTIVES: A wide inequality in incidence and severity of childhood oral health conditions between Pasifika and non-Pasifika in Aotearoa/New Zealand (Aotearoa/NZ) persists with some evidence that the gap is widening. To develop an evidence base for strengths-based solutions, this study seeks to investigate the association between parental education and detected oral health conditions in Pasifika children. METHOD: A secondary cross-sectional analysis of linked routinely collected national databases of children (Pasifika and Non-Maori non-Pasifika [NMNP]) aged 0-9 years in 2013 who completed a Before School Check (B4SC) and had their birth parents file a 2013 New Zealand census return. Parental education is represented by their self-reported highest qualification level gained. Logistic regression models were employed to investigate childhood caries and hospitalisations related to oral health conditions after adjusting for social and economic factors. RESULTS: During the five-year period of 2013-2017, 21 744 (10.2%) children (Pasifika and NMNP) completed the B4SC and experienced caries. Pasifika children experienced caries three times more than NMNP children (23.6% and 7.9%, respectively) and 1.8 times more dental hospitalisations (6.0% and 3.4%, respectively). Each additional level of parental education reduced their Pasifika child's odds of experiencing caries (unadjusted odds ratio [OR] = 0.83, 95% CI: 0.82-0.85) and dental hospitalization (unadjusted OR = 0.89, 95% CI: 0.87-0.91). Less than half of the reduced odds for parental education could be attributed to other covariate factors, by 43% and 25%; respectively, for caries and hospitalisations. CONCLUSIONS: Our findings show good educational achievement is associated with better oral health for offspring beyond other benefits that can be attributed to non-education influences. Increased education for Pasifika parents is likely to directly confer better oral health for their children. The findings from this study may provide meaningful evidence for future developments in Pasifika education policy as an investment into the health of subsequent generations of Pasifika children.

The relationship between sleep duration and health among Pacific adolescents within New Zealand: Findings from the Pacific Islands families study.

OBJECTIVE: Sleep insufficiency is bi-directionally associated with adverse behavioural, physical and mental health outcomes in paediatric populations. However, little is known about the degree of sleep insufficiency and its effect on Pacific adolescents' wellbeing. METHODS: A cross-sectional study of 14-year old Pacific adolescents nested within a longitudinal birth cohort was conducted. Self-reported sleep duration was related to sentinel physical, mental, and risk taking behaviour measures in crude and adjusted logistic regression models. Complete case and multiple imputed analyses were conducted. RESULTS: 916 Pacific adolescents were eligible, with a mean age of 14.2 years. Valid sleep data were available from 828 (90.4%) participants, with only 220 (26.6%) meeting the recommended amount of sleep. Insufficient sleep duration was associated with significantly higher rates of depressive symptoms and risk taking behaviours. In multiple imputed analyses, increased body mass index was also significantly related. CONCLUSIONS: Sleep insufficiency is ubiquitous among Pacific adolescents and associated with negative impacts on their health and wellbeing. IMPLICATIONS FOR PUBLIC HEALTH: Insufficient sleep duration is amenable to change. Bespoke, culturally responsive public health strategies that draw attention to the importance of positive sleep practices are needed. Particularly, among adolescents who are at risk of experiencing the greatest burden of insufficient sleep.

How did New Zealand's regional District Health Board groupings work to improve service integration and health outcomes: a realist evaluation.

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, Maori 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.

Results of a community-based screening programme for chronic kidney disease and associated risk factors, (obesity, diabetes and hypertension) in a Samoan cohort.

OBJECTIVES: In 2019, under the World Kidney Day theme of 'Kidney health for everyone everywhere', the National Kidney Foundation of Samoa undertook an extensive community screening campaign to detect the estimated prevalence of chronic kidney disease (CKD) and its associated risk factors in the community. SETTING: Fifteen screening sites, with 11 urban and rural sites on the main island of Upolu, and 4 in different rural areas on the island of Savaii. PARTICIPANTS: All participants were self-referrals to the various screening sites. In total, 1163 Samoans were screened, with similar numbers from both urban and rural areas and similar numbers of female and male. SCREENING ACTIVITIES: All participants were screened for CKD using point of care serum creatinine determinations, with calculation of estimated glomerular filtration rate using the CKD-EPI formula and dipstix urinalysis. A standardised screening survey was used to capture demographic and medical history with associated risk factors of obesity, diabetes, using point of care determination of HbA1c and hypertension. Logistic regression was used to investigate the association of CKD with risk factors. RESULTS: In total, 1163 people were screened for CKD within the month of March 2019. The prevalance of CKD (grades 1-5) was 44.5% (95% CI 41.6% to 47.4) with individual grade prevalence CKD 1: 3.7%, CKD 2: 6.1%, CKD 3: 30.7%, CKD 4: 2.9% and CKD 5: 1.0%. The prevalence of obesity (body mass index ≥32), diabetes and hypertension was 66.3%, 30.8% and 54.3%, respectively. CONCLUSIONS: This is the first paper to report the estimated prevalence of CKD in Samoa or any other Pacific Island nation. It reveals an urgent need for further studies on the epidemiology of CKD in Samoa, to develop country-specific prevention strategies to mitigate this growing burden and prevent subsequent CKD associated complications including development of kidney failure and premature death.

Parental education related to their children's health in late childhood and early adolescence for Pacific families within New Zealand.

Pacific people continue to carry a disproportionately heavy social and health burden relative to their non-Pacific peers in New Zealand, and those with less formal education are experiencing social and health declines. Improving education and educational needs is seen as being central to decreasing these health inequities. While expansive, the empirical evidence-base supporting this stance is relatively weak and increasingly conflicting. Using a large birth cohort of 1,368 eligible Pacific children, together with their mothers and fathers, this study longitudinally investigates the relationship between paternal education levels and sentinel measures of their children's physical health, mental health and health risk taking behaviours during late childhood and early adolescence. In adjusted analyses, it was found that mothers and fathers who undertook further schooling over the 0-6 years postpartum period had children with significantly lower logarithmically transformed body mass index increases at 11-years and 14-years measurement waves compared to 9-years levels than those who did not study (p = 0.017 and p = 0.022, respectively). Furthermore, fathers who undertook further schooling over this 0-6 years postpartum period also had children with significantly lower odds of risk taking behaviours (p = 0.013). These results support policy aimed at increasing educational opportunities for Pacific people in New Zealand.

New Zealand postgraduate medical training by distance for Pacific Island country-based general practitioners: a qualitative study.

Introduction New Zealand health training institutions have an important role in supporting health workforce training programmes in the Pacific Region. Aim To explore the experience of Pacific Island country-based doctors from the Cook Islands, Niue, and Samoa, studying in New Zealand's University of Otago distance-taught Rural Postgraduate programme. Methods Document analysis (16 documents) was undertaken. Eight semi-structured interviews were conducted with Pacific Island country-based students. Thematic analysis of the interviews was undertaken using the framework method. The two data sources were analysed separately, followed by a process to converge and corroborate findings. Results For Pacific Island countries with no previous option for formal general practice training, access to a recognised academic programme represented a milestone. Immediate clinical relevance and applicability of a generalist medical curriculum with rural remote emphasis, delivered mainly at a distance, was identified as a major strength. Although technologies posed some issues, these were generally easily solved. The main challenges identified related to the provision of academic and other support. Traditional university support services and resources were campus focused and not always easily accessed by this group of students who cross educational pedagogies, health systems and national borders to study in a New Zealand programme. Study for individuals worked best when it was part of a recognised and supported Pacific in-country training pathway. Discussion The University of Otago's Rural Postgraduate programme is accessible, relevant and achievable for Pacific Island country-based doctors. The programme offers a partial solution for training in general practice for the Pacific region. Student experience could be improved by tailoring and strengthening support services and ensuring their effective delivery.

Sleep and parenting in ethnically diverse Pacific families in southern New Zealand: A qualitative exploration.

OBJECTIVES: Children's sleep has been shown to vary by ethnicity, but little is known about children's sleep in multiethnic households. In New Zealand, Pacific families are increasingly ethnically diverse, due to intermarriage and to people identifying as more than 1 ethnicity. Thus, the objective of this work was to explore children's sleep habits, and sleep-related parenting practices, in ethnically diverse Pacific families (EDPF). DESIGN: Ten qualitative interviews with adult members of EDPF were undertaken. Open-ended questioning was used. SETTING: Informal, conversational interviews conducted in homes and workplaces in southern New Zealand. PARTICIPANTS: Fifteen adults from 10 EDPF. MEASUREMENTS: Interviews were recorded and transcribed. Thematic open coding was used to analyze transcripts and identify themes. RESULTS: Sleep practices such as bedtime routines and preferred sleep environments varied both within and between EDPF. The EDPF in this sample responded to the context in which they lived, and the demands of everyday life in New Zealand, when managing children's sleep. Respectful communication between parents was key to navigating cultural differences and resolving areas of tension. The families in this study aspired to instill strong multi-cultural knowledge and identities in their children. Some families had sought out resources to help with this, but they were often either difficult to find, or expensive. CONCLUSIONS: A variety of sleep habits and related parenting practices were observed in this small sample of EDPF, who recognized that raising children in multi-ethnic families was associated with distinct opportunities as well as challenges.

Political activity for physical activity: health advocacy for active transport.

Effective health advocacy is a priority for efforts to increase population participation in physical activity. Local councils are an important audience for this advocacy. The aim of the current study was to describe features of advocacy for active transport via submissions to city council annual plans in New Zealand, and the impact of an information sheet to encourage the health sector to be involved in this process. Written submissions to city council's annual consultation process were requested for 16 city councils over the period of three years (2007/08, 2008/09, and 2009/10). Submissions were reviewed and categories of responses were created. An advocacy information sheet encouraging health sector participation and summarising some of the evidence-base related to physical activity, active transport and health was released just prior to the 2009/10 submission time. Over the period of the study, city councils received 47,392 submissions, 17% of which were related to active transport. Most submissions came from city residents, with a small proportion (2%) from the health sector. The largest category of submissions was in support of pedestrian and cycling infrastructure, design and maintenance of facilities and additional features to support use of these transport modes. Health arguments featured prominently in justifications for active transport initiatives, including concerns about injury risk, obesity, physical inactivity, personal safety and facilities for people with disabilities. There was evidence that the information sheet was utilised by some health sector submitters (12.5%), providing tentative support for initiatives of this nature. In conclusion, the study provides novel information about the current nature of health advocacy for active transport and informs future advocacy efforts about areas for emphasis, such as health benefits of active transport, and potential alliances with other sectors such as environmental sustainability, transport and urban planning and local communities.

The needs of Pacific families affected by age-related cognitive impairment in New Zealand: interviews with providers from health-care organisations.

INTRODUCTION Pacific populations in New Zealand are aging, but little is known in the health-care environment about their experiences with cognitive impairment. AIM The aim was to explore the needs of Pacific peoples affected by age-related cognitive decline from the perspectives of health-care providers. METHODS Six health-care service providers from organisations focused on Pacific patients were interviewed to determine services available to aged Pacific peoples, access, and whether they met Pacific people's needs. RESULTS Three areas of concern were identified by all participants: access to services; getting a diagnosis; and communication and language. Many experienced a lack of information and poor access to services. Diagnosis of cognitive impairment was frequently made difficult by inconsistent access to general practitioners in lower socio-economic areas. Communication was hindered by poor access to information in Pacific languages. DISCUSSION Common themes noted by all participating health-care providers indicated the needs of aged Pacific people experiencing cognitive decline were often not being met.