Chlamydia Testing in New Zealand: Analysis of the 2014/2015 National Health Survey.

BACKGROUND: Diagnosis rates of Chlamydia trachomatis are high in New Zealand; 1.3% of men and 3.7% of women aged 15 to 29 years were diagnosed in 2016. Because testing rates are also higher in women, we sought to understand chlamydia testing by demographic and behavioral characteristics. METHODS: Chlamydia testing in the past year, sexual behavior, and demographic characteristics were reported in the population-based 2014/2015 New Zealand Health Survey. Those aged 16 to 44 years who had a sexual partner in the past year were included. Testing prevalence was calculated, and associations were modeled. RESULTS: A total of 1677 men and 2323 women participated (89% response rate). Of these, 5.6% (95% confidence interval, 4.3%-7.2%) of men and 16.6% (14.7%-18.7%) of women were tested in the past year. Likelihood of testing in men was associated with having multiple partners and any condomless sex (adjusted relative risk, 11.93; 95% confidence interval, 5.70-24.98) and multiple partners with consistent condom use (3.77, 1.40-10.15) compared with one sexual partner and consistent condom use, and with Maori ethnicity (1.87, 1.05-3.31) compared with European/other. Among women, testing was associated with multiple partners with and without condomless sex (3.61 [2.69-4.85] and 2.81 [1.95-4.05], respectively), pregnancy (1.61, 1.18-2.18), and Asian ethnicity (0.52, 0.30-0.89). CONCLUSIONS: The study confirms that New Zealand men are much less likely to be tested than women, a potential reason for ongoing high chlamydia incidence among both sexes. The high testing rate in women includes many at low risk, and this divergence from recommendations is another issue to address.

Effects of small incentives on survey response fractions: randomised comparisons in national alcohol surveys conducted in New Zealand.

We experimentally evaluate inexpensive interventions to increase response fractions in two alcohol surveys. Residents on the New Zealand General and Maori 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.

Alcohol Involvement in Sexual Behaviour and Adverse Sexual Health Outcomes from 26 to 38 Years of Age.

BACKGROUND: Research on alcohol and sexual behaviour has focused on young adults or high-risk groups, showing alcohol use contributing to riskier sexual choices. Adults now in their late thirties have been exposed to heavier drinking norms than previously, raising questions about effects on sexual wellbeing. We examined self-reported use and consequences of alcohol in sexual contexts, and its association with usual drinking pattern at age 38, and also associations of heavy drinking occasion (HDO) frequency with number of sexual partners, sexually transmitted infections (STIs), and terminations of pregnancy (TOPs), from 26-32 and 32-38 years of age. METHODS: Members of the Dunedin Study birth cohort answered computer-presented questions about sexual behaviour and outcomes, and interviewer-administered alcohol consumption questions, at age 26, 32 and 38 years. RESULTS: Response level was >90% at each assessment. At 38, drinking before or during sex in the previous year was common (8.2% of men; 14.6% of women reported "usually/always"), and unwanted consequences were reported by 13.5% of men and 11.9% of women, including regretted sex or failure to use contraception or condoms. Frequent heavy drinkers were more likely to "use alcohol to make it easier to have sex" and regret partner choice, particularly women. Heavy drinking frequency was strongly associated with partner numbers for men and women at 32, but only for women at 38. Significantly higher odds of STIs amongst the heaviest drinking men, and TOPs amongst the heaviest drinking women were seen at 32-38. CONCLUSIONS: Alcohol involvement in sex continues beyond young adulthood where it has been well documented, and is common at 38. Women appear to be more affected than men, and heavy drinking is associated with poorer outcomes for both. Improving sexual health and wellbeing throughout the life course needs to take account of the role of alcohol in sexual behaviour.

Effects of the Campus Watch intervention on alcohol consumption and related harm in a university population.

BACKGROUND: High levels of drinking and alcohol-related problems are pervasive among university students in New Zealand and other high-income countries, where controls on alcohol availability and promotion are typically weak. Environmental interventions to reduce hazardous drinking and harm have shown promise in general populations, but require further evidence of effectiveness in university settings. The aim of this study was to estimate the effect of a community liaison and security program, Campus Watch, on drinking patterns and alcohol-related harm among university students. METHODS: The study used a quasi-experimental design with non-equivalent control sites using before (2005) and after (2009) observations. Participants were full-time students aged 17-25 years selected randomly from the enrolment lists of six New Zealand universities. Changes in scores on the alcohol use disorders identification consumption scale (AUDIT-C) and alcohol-related harms at the intervention campus were compared with those at control campuses using linear and logistic regression models. RESULTS: Compared to control campuses, AUDIT-C scores decreased in students at the intervention campus (ß=-0.5, 95% CI: -0.6 to -0.3). Campus Watch was associated with reductions in some harms (independent of its effect on drinking), such as aggression (aOR 0.66, 95% CI: 0.46 to 0.94), but not other harms, e.g., blackouts (aOR 1.06, 95% CI: 0.89 to 1.27). CONCLUSION: While not being focused on alcohol per se, Campus Watch reduced alcohol consumption and some related harms. Such programs may be useful in similar environments where controls on alcohol availability and promotion cannot be affected and where informal controls are weak.

Maternal factors associated with heavy periconceptional alcohol intake and drinking following pregnancy recognition: a post-partum survey of New Zealand women.

INTRODUCTION AND AIMS: Alcohol consumption during pregnancy places the foetus at risk of Foetal Alcohol Spectrum Disorders. Little is known about the current prevalence and patterns of alcohol consumption before and following pregnancy recognition in New Zealand. DESIGN AND METHODS: A retrospective survey of 723 post-partum women resident in maternity wards located across New Zealand was conducted using a self-administered questionnaire. Maternal sociodemographic and obstetric characteristics and alcohol intake before and after pregnancy recognition were assessed. RESULTS: Of the 968 women invited to participate, 78% agreed. Eighty-two percent of women reported consuming alcohol prior to pregnancy and 20% reported typically consuming >4 New Zealand standard drinks per occasion. Overall, 34% of women reported drinking at some time during pregnancy. Twelve percent of pregnancies were at high risk of heavy alcohol exposure in early gestation. In fully adjusted analysis, pregnancies most at risk were those of indigenous Maori women, Pacific women, smokers and drug users. Almost one-quarter (24%) of drinkers continued to drink following pregnancy recognition, and in fully adjusted analysis, continuing to drink was positively associated with frequency of alcohol consumption before pregnancy (P < 0.001 for linear trend). DISCUSSION AND CONCLUSIONS: To reduce the burden of alcohol-related harm to the foetus, these findings suggest that New Zealand alcohol policy should be focused not only on promoting total abstinence when planning a pregnancy and when pregnant, but also on reducing 'binge drinking' culture and the frequent consumption of lower levels of alcohol.

Drinking concordance and relationship satisfaction in New Zealand couples.

AIMS: The aim of the study was to examine alcohol consumption patterns in New Zealand couples and the associations of these patterns with time spent drinking together and the level of satisfaction with the relationship. METHODS: Cross-sectional survey of a nationally representative sample of New Zealand residents aged 18-70 on the combined electoral roll in 2007. Using reports of the respondents' own drinking patterns and their reports of their partners' drinking, couples were classified as concordant, mildly discordant or discordant for both their drinking frequency and quantity of alcohol consumed per typical drinking occasion. The level of concordance was compared by demographic characteristics and relationship type. Ordinal logistic regression models were used to examine the associations between levels of concordance and both time spent drinking as a couple and level of happiness in the relationship (both reported by the respondent). RESULTS: The largest proportion of couples was classified as concordant for both frequency and quantity of alcohol consumed per typical drinking occasion regardless of the relationship type. For both drinking frequency and quantity per occasion, couples identified as discordant or mildly discordant were less likely to report having spent a large amount of time drinking with their partner (odds ratio 0.2-0.5). Reported level of happiness with the relationship was also associated with the degree of concordance of both drinking frequency and quantity. CONCLUSION: These findings suggest that drinking frequency and quantity of alcohol consumed per typical drinking occasion are concordant in most intimate partnerships and that discordance in either is associated with a lower level of happiness within the relationship.

Training medical students in Pacific health through an immersion programme in New Zealand.

AIMS: Medical schools are required to adequately prepare students to work in increasingly diverse and multi-ethnic societies. Students need to be able to integrate clinical knowledge with an understanding of the society they live in. Pacific peoples are a disadvantaged migrant minority ethnic group in New Zealand. This paper discusses the development of, and lessons learnt from a Pacific Immersion Programme for medical students at the University of Otago, New Zealand. METHODS: A cultural programme was developed where fourth-year medical students spent a week-end with a local Pacific family in Dunedin. Students were invited as part of the programme evaluation to provide feedback on their experiences and lessons learnt. Student evaluations were analysed and are reported here in summary form. RESULTS: Medical students were able to learn from observations, participation in activities and stories shared by families about issues that influenced the health of the community. This provided insight about factors that are important to consider, when working with Pacific peoples in New Zealand. The programme also provided positive benefits for the local community. CONCLUSIONS: This cultural immersion programme provided important learning opportunities for medical students. It is important to value and empower communities when developing cultural teaching programmes. The incorporation of the programme as part of the curriculum, and its implications for overall assessment and performance of students, makes it a valued part of learning.

Alcohol involvement in aggression between intimate partners in New Zealand: a national cross-sectional study.

OBJECTIVES: To examine the role of alcohol at the time of aggressive incidents between intimate partners in the general population by gender, by estimating (1) prevalence and severity of aggression, and drinking at the time, (2) associations of drinking at the time of the aggression with reported severity, anger and fear, and (3) association of usual drinking patterns with partner aggression. DESIGN: A national survey of 18-70-year-olds using an electoral roll sample obtained self-reported alcohol consumption, partner's alcohol consumption and details of the most severe partner aggression by the respondent and towards the respondent in the past 2 years. The mean scores for associated severity, anger and fear were analysed by gender and alcohol involvement. Multinomial models estimated associations of drinking patterns with aggression to and from the respondent. RESULTS: The response rate was 49% (n=1925). Men and women reported similar prevalence of victimisation and perpetration of aggression (11-15%). Alcohol was involved in more than 25% of incidents, and reported more by women than by men, particularly male-only drinking when the respondent was the victim. Women reported greater severity, anger and fear with victimisation than men, and drinking was associated with greater reported severity. Heavy episodic drinking by respondents was associated with a threefold increase in victimisation and doubling of perpetration of aggression involving alcohol. Heavy episodic drinking by either partner was also associated with drinking being involved in reported aggression. CONCLUSIONS: The experience of intimate-partner aggression in a cross-section of households differs by gender and the involvement of alcohol, and 'counts' of aggressive acts in a population-based survey do not reflect the reality of gender differences. Heavy episodic drinking patterns are associated with more aggression involving alcohol within relationships, and alcohol involvement is associated with increased severity.

Alcohol outlet density, levels of drinking and alcohol-related harm in New Zealand: a national study.

BACKGROUND: Previous research shows associations of geographical density of alcohol outlets with a range of alcohol-related harms. Socioeconomic conditions that are associated with both outlet density and alcohol-related outcomes may confound many studies. We examined the association of outlet density with both consumption and harm throughout New Zealand while controlling for indicators of area deprivation and individual socioeconomic status (SES). METHODS: Individual alcohol consumption and drinking consequences were measured in a 2007 national survey of 18-70 year olds (n=1925). All alcohol outlets in New Zealand were geocoded. Outlet density was the number of outlets of each type (off-licences (stores that sell alcoholic beverages for consumption elsewhere), bars, clubs, restaurants) within 1 km of a person's home. We modelled the association of outlet density with total consumption, binge drinking, risky drinking (above New Zealand guidelines) and two measures of effects ('harms' and 'troubles' due to drinking) in the previous year. Logistic regression and zero-inflated Poisson models were used, adjusting for sex, educational level, a deprivation index (NZDep06) and a rurality index. RESULTS: No statistically significant association was seen between outlet density and either average alcohol consumption or risky drinking. Density of off-licences was positively associated with binge drinking, and density of all types of outlet was associated with alcohol-related harm scores, before and after adjustment for SES. Associations of off-licences and clubs with trouble scores were no longer statistically significant in the adjusted analysis. CONCLUSIONS: The positive associations seen between alcohol outlet density and both individual level binge drinking and alcohol-related problems appear to be independent of individual and neighbourhood SES. Reducing density of alcohol outlets may reduce alcohol-related harm among those who live nearby.

The link between fatigue and safety.

The objective of this review was to examine the evidence for the link between fatigue and safety, especially in transport and occupational settings. For the purposes of this review fatigue was defined as 'a biological drive for recuperative rest'. The review examined the relationship between three major causes of fatigue - sleep homeostasis factors, circadian influences and nature of task effects - and safety outcomes, first looking at accidents and injury and then at adverse effects on performance. The review demonstrated clear evidence for sleep homeostatic effects producing impaired performance and accidents. Nature of task effects, especially tasks requiring sustained attention and monotony, also produced significant performance decrements, but the effects on accidents and/or injury were unresolved because of a lack of studies. The evidence did not support a direct link between circadian-related fatigue influences and performance or safety outcomes and further research is needed to clarify the link. Undoubtedly, circadian variation plays some role in safety outcomes, but the evidence suggests that these effects reflect a combination of time of day and sleep-related factors. Similarly, although some measures of performance show a direct circadian component, others would appear to only do so in combination with sleep-related factors. The review highlighted gaps in the literature and opportunities for further research.

Reducing alcohol-related harm and social disorder in a university community: a framework for evaluation.

BACKGROUND: In New Zealand and other middle to high income countries, university student are at high risk of alcohol-related injury and other problems due to their typical pattern of episodic heavy drinking. In 2007, one university implemented Campus Watch, a novel and extensive programme to reduce social disorder, including alcohol-related injury, in the university area. OBJECTIVES: To quantify the effects of this complex intervention. SETTING: A large public university campus and surrounding community in New Zealand. DESIGN: A health promotion evaluation model was used, examining: (1) how the programme was developed, introduced and received by the community? (process); (2) whether the programme affected behaviour? (impact); and (3) whether the programme reduced social disorder and alcohol-related harm in particular? (outcome). The outcome phase uses a non-equivalent control group design to measure changes occurring in the Campus Watch area compared with other universities, and with a same-city control site. PARTICIPANTS: Programme staff, university students and other community members. DATA: Interviews with university administrators and Campus Watch staff; surveys of local residents' views; Campus Watch incident data; national surveys of university students in 2005, 2007 and 2009; police data; fire department data. OUTCOME MEASURES: Prevalence of heavy episodic drinking; number of acute alcohol-related harms; incidence of antisocial behaviour, assault and street fires. ANALYSIS: Regression analyses will be used to examine changes in the intervention site relative to changes in the control areas.

Harmful effects of alcohol on sexual behaviour in a New Zealand university community.

INTRODUCTION AND AIMS: The prevalence of hazardous drinking among university students in New Zealand is very high, but the impacts on sexual behaviour are largely unknown. The aim of this study was to estimate the prevalence and correlates of alcohol-related risky and unwanted sexual experiences. METHODS: We conducted a web-based survey of a random sample of university students, asking about specific experiences resulting from their own drinking or the drinking of others, and some beliefs about drinking. RESULTS: A total of 1564 students responded (82%) and the following were reported as the result of drinking, by women and men respectively, in the last 3 months: unprotected sex 11% and 15%; sex they were not happy with at the time 6% and 7%; sex later regretted 16% and 19%. Also, 34% of women and 25% of men reported unwanted sexual advances in the past 4 weeks as a result of other people's drinking. These experiences were all associated positively with Alcohol Use Disorders Identification Test (AUDIT) scores of the respondents, certain types of living arrangements and specific attitudes to drinking. In addition, 1% of women and 0.5% of men reported sexual assault in the past 4 weeks. DISCUSSION AND CONCLUSIONS: Interventions to reduce alcohol-related risky sexual behaviours should target both male and female drinkers and identifiable subgroups at higher risk. Prevention policy should also address the high levels of availability and promotion of alcohol in the campus environment.

A population-based cohort study of longer-term changes in health of car drivers involved in serious crashes.

STUDY OBJECTIVE: Evidence about the burden of disability after motor vehicle crashes has relied primarily on trauma center-based studies. We examine the impact of serious crashes on the longer-term health of car drivers, independent of natural variation, in a population-based study in Auckland, New Zealand. METHODS: The study population comprised 218 car drivers surviving nonfatal crashes in Auckland, in which at least 1 occupant in the vehicle was admitted to a hospital, and a representative sample of 254 car drivers in the region, recruited from roadside surveys. All participants were interviewed at recruitment (subjects reported their precrash health) and 5 and 18 months later. The drivers' changes in health were obtained with a global health transition indicator and the Short Form-36, with analyses adjusting for potential confounders. RESULTS: Compared with 7% of drivers in the comparison group, 43% of crash drivers admitted to the hospital (adjusted odds ratio 10.4; 95% confidence interval 5.5 to 19.6) and 20% of those not admitted (odds ratio 3.3; 95% confidence interval 1.4 to 8.3) reported that their overall health at 18-month follow-up was worse than at baseline (precrash). Among the drivers reporting worsened health, prospectively ascertained Short Form-36 scores revealed greater reductions in physical health in those admitted after the crash, but these scores improved from 5 to 18 months. In contrast, mental and general health scores worsened from 5 to 18 months in admitted and nonadmitted crash drivers. CONCLUSION: A substantial proportion of drivers surviving serious crashes experience reductions in longer-term health, a burden likely to be underappreciated among those not admitted to a hospital. Emergency departments could serve as useful settings in which to develop and validate clinical decision rules that can help target services for crash survivors at increased risk of adverse outcomes.