A multistate transition model of changes in loneliness and carer stress among community-dwelling older adults in Aotearoa New Zealand.

OBJECTIVES: To identify changes in loneliness and carer stress between two time points for older people of different ethnicities who had repeated interRAI home care assessments. METHODS: Participants consisted of community-dwelling older adults across New Zealand who received two interRAI-HC assessments between 5 July 2012 and 31 December 2019. Two multistate models were developed: the first model was not lonely versus lonely, and the second model was no carer stress versus carer stress. The one-year transition probabilities were calculated. Mean sojourn times were calculated for each state except death. Paired t-tests assessed the differences in transition probabilities between the different ethnic groups. RESULTS: The mean age of the cohort was 82.5 years (SD 7.7 years). At first assessment, 14,646 (21%) older people stated they were lonely and 26,789 carers (38%) experienced stress. The most common first transition type was not lonely to not lonely: Maori 42%, Pacific 54%, Asian, 48% and Other 40%. The highest one-year transition probability in the loneliness model was living in aged residential care to death (0.79). The most common first transition type for the carer stress was no carer stress to no carer stress: Maori 35%, Pacific, 46%, Asian, 43% and Other 33%. The highest one-year transition probability in the carer stress model was living in aged residential care to death (0.80). The statuses not lonely and no carer stress had a mean sojourn time of approximately one year, and eight months to one year, respectively. CONCLUSIONS: Loneliness can change over time due to circumstances and an individual's perception of loneliness at the time of assessment. Carer stress is enduring and has a low probability of improvement.

Mortality risk among Autistic children and young people: A nationwide birth cohort study.

LAY ABSTRACT: Existing literature indicates that Autistic people have shorter life expectancy, but little is known about the mortality risk among Autistic children and young people (0-24 years). We used a 15-year nationwide birth cohort study to estimate the mortality risk among Autistic children and young people in Aotearoa/New Zealand. The study included 895,707 children and 11,919 (1.4%) were Autistic. We found that autism was associated with a significantly higher mortality risk compared to the non-Autistic population. In addition, we found that this risk was significantly higher among females compared to males and for those with a co-occurring intellectual disability. Increased efforts are required to better meet the health needs of this population.

COVID-19 impact on overweight and obesity rates in Aotearoa | New Zealand 4-year-old children.

BACKGROUND: COVID-19 has had profound societal impacts. This study estimated overweight, obesity, and extreme obesity rates in 4-year-old children over pre- and post-COVID-19 periods, and investigated differential changes between sex, ethnic and deprivation groups. METHODS: A national screening programme of 4-year-old children undertaking B4 School Checks (B4SCs) between 1 January 2010 and 7 March 2023 was analysed. B4SCs include anthropometric measurements enabling sex-specific body mass index-for-age Z-scores (BMI z-scores) to be derived. Children with ≥85th, ≥95th, and ≥99.7th percentile BMI z-scores were classified as overweight, obese, and extremely obese. RESULTS: The eligible sample included 656,038 children (48.8% girls). Overall, 210,492 (32.1%) children were overweight, 95,196 (14.5%) obese, and 19,926 (3.0%) extremely obese. While decreasing in the pre-COVID-19 period, annual prevalence estimates for overweight, obese, and extremely obese significantly (all p < 0.001) increased in the year after COVID-restrictions were implemented. However, after three years, overweight and obese prevalence estimates were no different to pre-COVID levels overall or stratified by sex for ethnicity and deprivation groups. Extreme obesity prevalence estimates also decreased but remained higher than pre-COVID levels. CONCLUSION: The sharp and steep increases in prevalence estimates all dampened relatively quickly. The question remains whether these rates will continue to decrease in time. IMPACT: Compared to pre-COVID-19 estimates, the prevalence of overweight, obesity and extreme obesity significantly and substantially increased for 4-year-old children in the immediate post-COVID-19 period. These post-COVID-19 prevalence estimates dampened relatively quickly, returning to pre-COVID-19 rates for overweight and obesity after 3 years. Inequities between ethnic and social deprivation groups in overweight and obesity prevalence estimates remained similar between pre- and post-COVID-19 periods.

Multimorbidity associated with urinary incontinence among older women and men with complex needs in Aotearoa | New Zealand.

AIMS: To investigate the association between multimorbidity and urinary incontinence (UI) among community living older adults with complex needs in sex-specific crude and adjusted analyses. METHODS: Since 2012 in Aotearoa | New Zealand (NZ) all community-living older people with complex needs who require publicly funded assistance undergo a comprehensive standardized geriatric needs assessment using the interRAI-HC instrument. Consenting adults aged ≥65 years who undertook this assessment between July 5, 2012 and December 31, 2020 were investigated. Multimorbidity was defined as having ≥2 chronic conditions. Recent bladder incontinence episodes were elicited and UI dichotomized into continent and incontinent groups. RESULTS: The study included 140 401 participants with an average age of 82.0 years (range: 65-107 years), of whom 85 746 (61.1%) were female. Overall, 36 185 (42.2%) females and 17 988 (32.9%) males reported UI. Participants had a median of 3 (range: 0-12) chronic conditions, with 109 135 (77.9%) classified as having multimorbidity. In adjusted modified Poisson regression analyses, the prevalence ratio for UI was 1.21 (95% confidence interval [CI]: 1.19, 1.24) times higher in females and 1.18 (95% CI: 1.14, 1.22) times higher for males with multimorbidity compared to those without multimorbidity. CONCLUSIONS: Although significant, the estimated sex-specific effect sizes were modest for the association between multimorbidity and UI in this population. However, despite using the comprehensive interRAI-HC instrument, several potentially core chronic conditions were not adequately captured. Although increasingly recognized as an important and growing public health issue, capturing all relevant chronic conditions challenges many epidemiological investigations into multimorbidity.

In the COVID-19 pandemic, who did we trust? An eight-country cross-sectional study.

Background: Trust is a key determinant of health, but has been undermined by the COVID-19 pandemic and the associated infodemic. Using data from eight countries, we aimed to epidemiologically describe levels of trust in health, governments, news media organisations, and experts, and measure the impact of political orientation and COVID-19 information sources on participant's levels of trust. Methods: We simultaneously conducted a stratified randomised online cross-sectional study across eight countries on adults aged ≥18 years between 6 and 18 November 2020. We employed crude and adjusted weighted regression analyses. Results: We included 9027 adults with a mean age of 47 years (range = 18-99), of whom 4667 (51.7%) were female. Trust in health experts ranked highest across all countries (mean (x̄) = 7.83; 95% confidence interval (CI) = 7.79-7.88), while trust in politicians ranked lowest (x̄ = 5.34; 95% CI = 5.28, 5.40). In adjusted analyses, political orientation and utilised information sources were significantly associated with trust. Individuals using higher levels of health information sources trusted health authorities more than those using lower levels (mean difference = 1.12; 95% CI = 1.02, 1.14). Similarly, individuals using higher levels of government information sources (mean difference = 1.55; 95% CI = 1.43, 1.64) and those using higher levels of new media information sources (mean difference = 1.17; 95% CI = 1.06, 1.28) had highest trust in governments/politicians and news media, respectively. However, there was little difference in trust in health, government, or news media between individuals using higher or lower levels of social media information sources. Conclusions: Trust is a key determinant of health, but has been politically fragile during this infodemic. High compliance with public health measures is key to combatting infectious diseases. In terms of people's trust, our findings suggest that politicians and governments worldwide should coordinate their response with health experts and authorities to maximise the success of public health measures.

A national multiple baseline cohort study of mental health conditions in early adolescence and subsequent educational outcomes in New Zealand.

Young people experiencing mental health conditions are vulnerable to poorer educational outcomes for many reasons, including: social exclusion, stigma, and limited in-school support. Using a near-complete New Zealand population administrative database, this prospective cohort study aimed to quantify differences in educational attainment (at ages 15-16 years) and school suspensions (over ages 13-16 years), between those with and without a prior mental health condition. The data included five student cohorts, each starting secondary school from 2013 to 2017 respectively (N = 272,901). Both internalising and externalising mental health conditions were examined. Overall, 6.8% had a mental health condition. Using adjusted modified Poisson regression analyses, those with prior mental health conditions exhibited lower rates of attainment (IRR 0.87, 95% CI 0.86-0.88) and higher rates of school suspensions (IRR 1.63, 95% CI 1.57-1.70) by age 15-16 years. Associations were stronger among those exhibiting behavioural conditions, compared to emotional conditions, in line with previous literature. These findings highlight the importance of support for young people experiencing mental health conditions at this crucial juncture in their educational pathway. While mental health conditions increase the likelihood of poorer educational outcomes, deleterious outcomes were not a necessary sequalae. In this study, most participants with mental health conditions had successful educational outcomes.

Urban-rural disparity in body mass index: is dietary knowledge a mechanism? Evidence from the China Health and Nutrition Survey 2004-2015.

Background: The co-existence of undernutrition and overweight/obesity has been recognised as a severe challenge in China, with substantial urban-rural disparity. We evaluated short- and long-term associations of urban-rural locality on body mass index (BMI) in Chinese adults overall and stratified by sex, focusing on whether dietary knowledge plays a mediating role. Methods: We used cross-sectional and longitudinal study designs with structural equation modelling based on the 2004 (T1) and 2015 (T2) waves of the China Health and Nutrition Survey. We adjusted the models for covariates and performed sensitivity analyses. Results: We cross-sectionally analysed 8932 (53.1% women) and 11 216 adults (54.3% women) at T1 and T2, respectively, and longitudinally investigated 4073 adults (55.6% women) in both T1 and T2. The estimated average dietary knowledge and mean BMI increased from T1 to T2. At each time point, we found significant indications of direct (e.g. urban-rural locality to BMI, urban-rural locality to dietary knowledge, and dietary knowledge to BMI) and indirect associations (e.g. urban-rural locality to dietary knowledge to BMI) overall and for men and women (except that urban-rural locality to BMI) separately. The long-term association between urban-rural locality and BMI attenuated over time and was not mediated by dietary knowledge change alone. Nevertheless, dietary knowledge interacted with BMI, which acted as a pathway from urban-rural locality to BMI in the long term. Conclusions: Urban-rural disparity in BMI persists in Chinese adults and is mediated by dietary knowledge. Policy and educational efforts to improve dietary knowledge among rural people may reduce China's urban-rural disparity in BMI.

Utility of Big Data to Explore Medication Adherence in Maori and Non-Maori Community-Dwelling Older Adults with Heart Failure in Aotearoa New Zealand: A Cross-sectional Study.

BACKGROUND: Medication adherence improves morbidity and mortality-related outcomes in heart failure, and knowledge of patterns of medication adherence supports patient and clinician decision-making. Routinely collected national data facilitate the exploration of medication adherence and associated factors in older adults with heart failure, including the association between ethnicity and adherence. There are known inequities in access to medicines between Maori (Indigenous People of Aotearoa New Zealand) and non-Maori, yet ethnic variation in medicines adherence in community-dwelling older adults with heart failure has not been explored. OBJECTIVE: Here we identify medication adherence rates for community-dwelling older adults diagnosed with heart failure and differences in adherence rates between Maori and non-Maori. METHODS: Cross-sectional analysis of interRAI (comprehensive standardised assessment) data in a continuously recruited national cohort from 2012 to 2019. RESULTS: Overall, 13,743 assessments (Maori N = 1526) for older community-dwelling adults with heart failure diagnoses were included. The mean age of participants was 74.5 years [standard deviation (SD) 9.1 years] for Maori and 82.3 years (SD 7.8 years) non-Maori. In the Maori cohort, 21.8% did not adhere fully to their medication regimen, whereas in the non-Maori cohort, this figure was 12.8%. After adjusting for confounders, the Maori cohort were more likely to be medication non-adherent than non-Maori [prevalence ratio 1.53, 95% confidence interval (CI) 1.36-1.73]. CONCLUSIONS: There was a significant disparity between Maori and non-Maori concerning medication adherence. Given the international use of the interRAI-HC assessment tool, these results have significant transferability to other countries and allow the identification of underserved ethnic groups for which culturally appropriate interventions can be targeted.

The COVID Psychosocial Impacts Scale: A Reliable and Valid Tool to Examine the Psychosocial Impacts of the COVID-19 Pandemic.

This paper reports on the development and validation of the COVID Psychosocial Impacts Scale (CPIS), a self-report measure that comprehensively examines both positive and negative psychosocial impacts from the COVID-19 pandemic. This is the first part of the program of work in which the CPIS was administered and compared with a measure of psychological distress (Kessler Psychological Distress Scale, K-10) and wellbeing (World Health Organization Well-Being Index, WHO-5). The data were obtained online in 2020 and 2022 at two distinct time points to capture different exposures to the pandemic in the New Zealand population to a non-representative sample of 663 and 687 adults, respectively. Two hundred seventy-one participants took part in both surveys. Findings indicate a unidimensional structure within CPIS subscales and inter-relatedness among CPIS stress-related subscales. The scatter plots and correlation matrix indicate CPIS having a positive moderate correlation with K10 and a negative moderate correlation with WHO-5, indicative of construct validity. The paper outlines contextual factors surrounding CPIS development and makes suggestions for future iterations of CPIS. Further work will examine its psychometric properties across cultures.

Relationship between perceived and measured body size among Pacific 14-year-olds in Aotearoa|New Zealand: Findings from the Pacific Islands Families Study.

AIM: Pacific people carry a disproportionate burden of socio-cultural and economic determinants of health in Aotearoa | New Zealand (NZ), and 61.7% of Pacific children aged 0-14 years are overweight or obese. Yet Pacific children's self-perception of their body size is unknown. This population-based study aimed to investigate the concordance between measured and perceived body size in a cohort of Pacific 14-year-olds in NZ, and to assess how this relationship is influenced by their cultural orientation, socio-economic deprivation and degree of recreational internet use. METHODS: The Pacific Islands Families Study tracks a cohort of Pacific infants born in the year 2000 at Middlemore Hospital, South Auckland. This study is a nested cross-section of participants at the 14-year postpartum measurement wave. Following strict measurement protocols, body mass index was measured and categorised according to the World Health Organization classifications. Agreement and logistic regression analysis methods were employed. RESULTS: Of 834 participants with valid measures, 3 (0.4%) were measured as being underweight, 183 (21.9%) as normal, 235 (28.2%) as overweight and 413 (49.5%) as obese. Overall, 499 (59.8%) perceived their body size to have a lower classification than that when measured. Neither cultural orientation nor deprivation was significantly related to weight misconception but recreational internet use was, with higher use associated with increased misconception. CONCLUSIONS: Improving body size awareness together with the risk of higher recreational internet use is likely to be an important component in any population-based healthy weight intervention formulation for Pacific adolescents.

Examining the psychosocial impacts of the COVID-19 pandemic: an international cross-sectional study protocol.

INTRODUCTION: The COVID-19 pandemic exposed people to significant and prolonged stress. The psychosocial impacts of the pandemic have been well recognised and reported in high-income countries (HICs) but it is important to understand the unique challenges posed by COVID-19 in low- and middle-income countries (LMICs) where limited international comparisons have been undertaken. This protocol was therefore devised to study the psychosocial impacts of the COVID-19 pandemic in seven LMICs using scales that had been designed for or translated for this purpose. METHODS AND ANALYSIS: This cross-sectional study uses an online survey to administer a novel COVID Psychosocial Impacts Scale (CPIS) alongside established measures of psychological distress, post-traumatic stress, well-being and post-traumatic growth in the appropriate language. Participants will include adults aged 18 years and above, recruited from Indonesia, Iraq, Iran, Malaysia, Pakistan, Somalia and Turkey, with a pragmatic target sample size of 500 in each country.Data will be analysed descriptively on sociodemographic and study variables. In addition, CPIS will be analysed psychometrically (for reliability and validity) to assess the suitability of use in a given context. Finally, within-subjects and between-subjects analyses will be carried out using multi-level mixed-effect models to examine associations between key sociodemographic and study variables. ETHICS AND DISSEMINATION: Ethical approval was granted by the Human Ethics Committee, University of Otago, New Zealand (Ref. No. 21/102). In addition, international collaborators obtained local authorisation or ethical approval in their respective host universities before data collection commenced.Participants will give informed consent before taking part. Data will be collected and stored securely on the University of Otago, New Zealand Qualtrics platform using an auto-generated non-identifiable letter-number string. Data will be available on reasonable request. Findings will be disseminated by publications in scientific journals and/or conference presentations. TRIAL REGISTRATION NUMBER: NCT05052333.

Adolescents and oral health service utilization in Canterbury, New Zealand: A geospatial cross-sectional study.

OBJECTIVE: Non-utilization of dental care during adolescence can result in poorer oral health and subsequently higher expenditures on dental services. This study examined the geospatial and epidemiological factors associated with utilization of the publicly funded Adolescent Oral Health Services (AOHS) in Canterbury, Aotearoa New Zealand (NZ). METHODS: A secondary analysis of prospectively collected routine data from AOHS visits of adolescents in school Year 9 (13-14 years) for the financial year 2019-2020. Geographic information systems examined distance from home to dental practices. Multilevel mixed-effects Poisson regression models investigated associations between geospatial, demographic and clinical factors and non-utilization of dental services. Models were adjusted for sex, ethnicity, area-level deprivation, rural/urban classification, previous caries experience and the distance from home address to dental practice referred. RESULTS: Dental practices were concentrated in large urban areas and in the least deprived neighbourhoods, with several service area gaps identified. Rural areas and the most deprived areas of Christchurch City had the highest non-utilization rates. After adjustment, adolescents residing in the most deprived areas had a higher risk of non-utilization (adjusted risk ratio [aRR] = 1.38; 95% CI 1.26-1.51) compared to adolescents in the least deprived areas. Adolescents in remote areas also had an increased risk of non-utilization (aRR = 1.36; 95% CI 1.20-1.54) compared to adolescents in urban core areas. Finally, Maori (aRR = 1.37; 95% CI 1.29-1.46) and Pasifika (aRR = 1.46; 95% CI 1.35-1.59) adolescents had significantly higher risks of non-utilization compared to their NZ European counterparts. CONCLUSION: Inequitable utilization of dental services exists among adolescents in Canterbury, NZ, and is associated with Maori, Pasifika and those living in rural and most deprived areas. Adolescents at the greatest oral health risk are geographically underserved by current oral health services. The current health system should also explore the possibility of partnering with Maori and Pasifika communities to provide services within culturally appropriate settings.

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.

The pattern of association between early childhood caries and body mass index in pre-school children within Aotearoa | New Zealand: a national cross-sectional study.

OBJECTIVES: The relationship between childhood anthropometric measurements and dental caries has an inconsistent evidence-base. This study investigated dental caries experience and body mass index (BMI) measurements of children aged 4 years in a national cohort, after accounting for key confounding variables. METHODS: A near whole-population cross-sectional study of children who had a health and developmental assessment, as part of the nationwide B4 School Check screening program, conducted in Aotearoa | New Zealand (ANZ) between 1 July 2010 and 30 June 2021 was studied. The extracted database included 582 820 children, of whom 572 523 (98.2%) had valid BMI and oral health records. Dental caries experience was derived from the 'lift the lip' oral health screening, and measured height and weight were used to calculate sex-specific BMI-for-age z-scores (BMIz). Analyses were adjusted for age, sex, ethnicity and area-level deprivation. Modified Poisson regression models using 2-degree fractional polynomial curves for BMIz were employed. RESULTS: In the extracted sample, the median age was 4.3 years (interquartile range: 4.1-4.5 years), 283 565 (48.7%) were female, 135 734 (23.4%) and 74 237 (12.8%) were identified as Maori and Pacific, respectively, and 140 931 (24.4%) lived in the most deprived areas of ANZ. Overall, 81 926 (14.2%) had dental caries identified. In unadjusted analyses, a significant J-shaped association was observed between dental caries experience and BMIz. However, in the adjusted analysis, a significant flattened S-shaped association was found; those with lower BMIz had lower predicted probabilities of dental caries experience. Large differences in predicted probabilities were observed between different sex, ethnicity and area-level deprivation groups. CONCLUSIONS: This study found significant non-linear associations between dental caries experience and BMI in 4-year-old children. However, the inclusion of confounders importantly changed the shape of this non-linear association. Sex, ethnicity and area-level deprivation inequalities had a greater impact on dental caries experience than BMI.

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.

Carer distress among community living older adults with complex needs in the pre- and post-COVID-19 era: a national population study.

Carer distress is one important negative impact of caregiving and likely exacerbated by the novel coronavirus disease 2019 (COVID-19) pandemic, yet little population-based epidemiological information exists. Using national data from repeated standardized comprehensive geriatric needs assessments, this study aims to: describe the pattern of caregiver distress among those providing informal care to community-living adults aged ≥ 65 years with complex needs in New Zealand over time; estimate the COVID-19 effect on this temporal pattern; and, investigate relationships between participants' sociodemographic and selected health measures on caregiver distress. Fractional polynomial regression and multivariable multilevel mixed-effects models were employed. Overall, 231,277 assessments from 144,358 participants were analysed. At first assessment, average age was 82.0 years (range 65-107 years), and 85,676 (59.4%) were female. Carer distress prevalence increased from 35.1% on 5 July 2012 to a peak of 48.5% on 21 March 2020, when the New Zealand Government announced a national lock-down. However, the population attributional fraction associated with the COVID-19 period was small, estimated at 0.56% (95% CI 0.35%, 0.77%). Carer distress is common and has rapidly increased in recent years. While significant, the COVID-19 impact has been relatively small. Policies and services providing efficacious on-going strategies to support caregivers deserves specific attention.

An eight country cross-sectional study of the psychosocial effects of COVID-19 induced quarantine and/or isolation during the pandemic.

Forced quarantine and nationwide lockdowns have been a primary response by many jurisdictions in their attempt at COVID-19 elimination or containment, yet the associated mental health burden is not fully understood. Using an eight country cross-sectional design, this study investigates the association between COVID-19 induced quarantine and/or isolation on probable generalized anxiety disorder (GAD) and major depressive episode (MDE) psychological outcomes approximately eight months after the pandemic was declared. Overall, 9027 adults participated, and 2937 (32.5%) were indicated with GAD and/or MDE. Reported quarantine and/or isolation was common, with 1199 (13.8%) confined for travel or health requirements, 566 (6.5%) for being close contact, 720 (8.3%) for having COVID-19 symptoms, and 457 (5.3%) for being COVID-19 positive. Compared to those not quarantining or isolating, the adjusted estimated relative risks of GAD and/or MDE associated with quarantine and/or isolation was significant (p < 0.001), ranging from 1.24 (95% confidence interval [CI]: 1.07, 1.43) for travel/health to 1.37 (95% CI 1.19, 1.59) for COVID-19 symptom isolation reasons. While almost universally employed, quarantine and/or isolation is associated with a heavy mental health toll. Preventive strategies are needed, such as minimizing time-limits imposed and providing clear rationale and information, together with additional treatment and rehabilitation resources.

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.

Understanding the contextual and cultural influences on women's modern contraceptive use in East Uganda: A qualitative study.

Unmet need for contraception, defined as the percentage of women who are sexually active and want to avoid, space or limit pregnancies, but are not using a method of contraception, stands at 28.4% of all married women in Uganda. An understanding of women's contraceptive behaviours, and the motivations that drive these, are key to tackling unmet need, by way of designing, implementing and improving family planning programs to effectively meet the needs of different population groups. This qualitative study sought to understand women's contraceptive use and identify strategies to strengthen contraceptive uptake among women in the Busoga region of east Uganda (chosen due to its low contraceptive prevalence of 31.3% and high unmet need of 36.5% among married women of reproductive age). Six focus group discussions were conducted with single and married women across different age groups (18-24, 25-34, and ≥ 35 years), living in three urban and three rural districts. Thematic analyses of the data highlighted three major themes pertaining to the complex, multi-level nature of contributors to unmet need and women's use of contraception in the Busoga region. Within a largely patriarchal society, women had to navigate many obstacles. Some of these included: fears about contraceptive side effects; partner opposition, community beliefs and stigma that dissuaded contraceptive use; traditional gender and socio-cultural norms that dictated women's fertility choices; and service delivery limitations. Changing community narratives about family planning through testimonies from satisfied users, increasing male acceptance of contraception, and encouraging joint-decision making on matters of reproductive health are strategic focal areas for family planning initiatives to effectively tackle the problem of unmet need among women, and make contraceptives more accessible to women in Uganda.

Patterns of Suicide Ideation Across Eight Countries in Four Continents During the COVID-19 Pandemic Era: Repeated Cross-sectional Study.

BACKGROUND: The COVID-19 pandemic and countries' response measures have had a globally significant mental health impact. This mental health burden has also been fueled by an infodemic: an information overload that includes misinformation and disinformation. Suicide, the worst mental health outcome, is a serious public health problem that can be prevented with timely, evidence-based, and often low-cost interventions. Suicide ideation, one important risk factor for suicide, is thus important to measure and monitor, as are the factors that may impact on it. OBJECTIVE: This investigation had 2 primary aims: (1) to estimate and compare country-specific prevalence of suicide ideation at 2 different time points, overall and by gender and age groups, and (2) to investigate the influence of sociodemographic and infodemic variables on suicide ideation. METHODS: A repeated, online, 8-country (Canada, the United States, England, Switzerland, Belgium, Hong Kong, Philippines, and New Zealand), cross-sectional study was undertaken with adults aged ≥18 years, with measurement wave 1 conducted from May 29, 2020 to June 12, 2020 and measurement wave 2 conducted November 6-18, 2021. Self-reported suicide ideation was derived from item 9 of the Patient Health Questionnaire-9 (PHQ-9). Age-standardized suicide ideation rates were reported, a binomial regression model was used to estimate suicide ideation indication rates for each country and measurement wave, and logistic regression models were then employed to relate sociodemographic, pandemic, and infodemic variables to suicide ideation. RESULTS: The final sample totaled 17,833 adults: 8806 (49.4%) from measurement wave 1 and 9027 (50.6%) from wave 2. Overall, 24.2% (2131/8806) and 27.5% (2486/9027) of participants reported suicide ideation at measurement waves 1 and 2, respectively, a difference that was significant (P<.001). Considerable variability was observed in suicide ideation age-standardized rates between countries, ranging from 15.6% in Belgium (wave 1) to 42.9% in Hong Kong (wave 2). Frequent social media usage was associated with increased suicide ideation at wave 2 (adjusted odds ratio [AOR] 1.47, 95% CI 1.25-1.72; P<.001) but not wave 1 (AOR 1.11, 95% CI 0.96-1.23; P=.16). However, having a weaker sense of coherence (SOC; AOR 3.80, 95% CI 3.18-4.55 at wave 1 and AOR 4.39, 95% CI 3.66-5.27 at wave 2; both P<.001) had the largest overall effect size. CONCLUSIONS: Suicide ideation is prevalent and significantly increasing over time in this COVID-19 pandemic era, with considerable variability between countries. Younger adults and those residing in Hong Kong carried disproportionately higher rates. Social media appears to have an increasingly detrimental association with suicide ideation, although having a stronger SOC had a larger protective effect. Policies and promotion of SOC, together with disseminating health information that explicitly tackles the infodemic's misinformation and disinformation, may importantly reduce the rising mental health morbidity and mortality triggered by this pandemic.