Understanding ethnic inequities associated with tobacco use in Aotearoa New Zealand: a quantitative analysis.

Despite the inclusion of both individual interventions and population-based measures in the Aotearoa New Zealand (Aotearoa NZ) Tobacco Control Programme, the gap between Maori, Pacific peoples and European/Asian/Other (EAO) populations in tobacco use has not decreased significantly. Tobacco control interventions that focus on individual behaviour change have produced little impact towards reducing tobacco smoking inequities for Maori and Pacific peoples in Aotearoa NZ. Using data from the New Zealand Health Survey (NZHS), this research investigates the impact of the wider determinants of health and individual-level factors on inequities in tobacco use between Maori, Pacific peoples and EAO. A conceptual framework was developed to support the theoretical positioning of this research and to inform data categorization, framing, discourse, analyses and interpretation. We conducted hierarchical regression to examine the effect of factors from each domain on ethnic inequities in tobacco use. We found that socioeconomic factors accounted for a significant amount of the disparity in adults currently smoking between Maori and Pacific peoples and EAO. Our results suggest that socioeconomic factors may be a more effective target of intervention than individual behaviours for reducing tobacco-related inequities. Addressing the broader determinants of health through comprehensive cross-agency cooperation to reduce ethnic inequities in tobacco use in Aotearoa NZ is likely to be more effective than individual behaviour change approaches.

Cultural challenges for adapting behavioral intervention frameworks: A critical examination from a cultural psychology perspective.

We introduce the bias and equivalence framework to highlight how concepts, methods, and tools from cultural psychology can contribute to successful cultural adaptation and implementation of behavioral interventions. To situate our contribution, we provide a review of recent cultural adaptation research and existing frameworks. We identified 68 different frameworks that have been cited when reporting cultural adaptations and highlight three major adaptation dimensions that can be used to differentiate adaptations. Regarding effectiveness, we found an average effect size of zr = 0.24 (95%CI 0.20, 0.29) in 24 meta-analyses published since 2014, but also substantive differences across domains and unclear effects of the extent of cultural adaptations. To advance cultural adaptation efforts, we outline a framework that integrates key steps from previous cultural adaptation frameworks and highlight how cultural bias and equivalence considerations in conjunction with community engagement help a) in the diagnosis of behavioral or psychological problems, b) identification of possible interventions, c) the selection of specific mechanisms of behavior change, d) the specification and documentation of dose effects and thresholds for diagnosis, e) entry and exit points within intervention programs, and f) cost-benefit-sustainability discussions. We provide guiding questions that may help researchers when adapting interventions to novel cultural contexts.

Introducing 'Ngaruroro', a New Model for Understanding Maori Wellbeing.

Indigenous peoples around the world are revitalising their ancestral beliefs, practices, and languages, including traditional understandings of health and wellbeing. In the Aotearoa (New Zealand) context, a number of ground-breaking Maori health- and wellbeing-related models have emerged, each with their own scope and applications. We sought in our qualitative studies to explore and identify several key sources of wellbeing for Maori individuals. Nine interviews were conducted with members of Maori communities to identify key themes of Maori wellbeing. We performed a Reflexive Thematic Analysis on these data and then conducted a further fifteen interviews to revise, refine, and reposition the previously generated themes. The Ngaruroro model describes wellbeing as the embodied and active process of being well in relation with one's (1) here tangata (social and familial ties), (2) te taiao (the environment), and (3) taonga tuku iho (cultural treasures) while doing what one can to make lifestyle choices that are conducive to the health of one's (4) tinana (body) and (5) wairua (spirit) while cultivating a balanced (6) ngakau (inner-system), fulfilling (7) matea (core needs) and exercising your (8) mana (authority). These themes illustrate that Maori wellbeing is dynamic, interconnected, and holistic.

The Maori Cultural Embeddedness Scale (MaCES): Initial evidence of structural validity.

OBJECTIVES: The purpose of this article is to introduce a self-report measure of cultural embeddedness for Maori (Maori Cultural Embeddedness Scale [MaCES]), which builds on theoretical and qualitative research on the concept. METHOD: A total of 548 adults who self-identified as Maori responded to 49 items that were designed to measure aspects of Maori Cultural Values, Beliefs, and Practices. The data were analyzed using confirmatory factor analysis, and invariance was tested through multigroup confirmatory factor analysis. RESULTS: A total of six items were pruned from the measure for having low loadings on the latent factor, having ambiguous wording, and/or measuring contentious concepts. The remaining 43 items fit the data well when organized by three primary factors (i.e., Values, Beliefs, and Practices), further split into secondary subfactors. We also found that this nuanced subfactor model was invariant to sole/mixed identification as Maori, as well as growing up in urban or rural settings. We found evidence of structural validity for the MaCES, but ongoing validation, including convergent and divergent comparisons to other scales, is required in future work. CONCLUSIONS: The MaCES is a theoretically derived and statistically sound measure that offers significant research potential for exploring the various ways that embeddedness in Maori culture informs differential outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Indigenous people in Aotearoa New Zealand are overrepresented in cannabis convictions.

BACKGROUND: Previous work has demonstrated that cannabis laws have had a disproportionate impact on Maori, the Indigenous people of Aotearoa New Zealand. In 2019, the New Zealand Government amended cannabis laws, providing police with the power to determine whether a therapeutic or health-centred approach would be more beneficial than a conviction. In the current study, we use population level data to assess whether this law change has ameliorated the bias in cannabis convictions for Maori. METHODS: Data were drawn from the Integrated Data Infrastructure (IDI), a large government database hosted by Aotearoa New Zealand's national statistics office. In the IDI, we selected individuals who (1) were between 18 and 65, (2) were Maori or Pakeha (New Zealanders of European descent) and, (3) had any cannabis charges that proceeded to the courts. RESULTS: Maori ethnicity was a significant predictor of the odds of receiving a cannabis conviction for Maori males (Odds: 1.56), with a marginally significant effect for Maori females (Odds: 1.57). Further, for Maori, there was no reduction in the number of cannabis charges before vs. after the amendment to cannabis laws. CONCLUSION: The current study demonstrates that the bias in cannabis convictions for Maori remain. Given this, the New Zealand Government must follow other countries around the world and move forward on cannabis law reform.