Racism and Health Among Aotearoa New Zealand Young People Aged 15-24 years: Analysis of Multiple National Surveys.

PURPOSE: This Aotearoa New Zealand-based study addresses a gap in literature focusing on individual experiences of racism among adolescents and young adults and its links to health. METHODS: This cross-sectional study uses data from multiple instances of the New Zealand Health Survey (2002/03, 2006/07, 2011/12, 2016/17) and General Social Survey (2008-2016) restricted to participants aged 15-24 years. Prevalence of reported experiences of racism are estimated. Meta-analytic techniques to pool data and multiple regression analyses are used to examine associations between experiences of racism and outcomes measures (mental and physical health, general health and well-being, life satisfaction, inability to access health care, and identity). The study used an ethical co-design process between university researchers and a rangatahi Maori (Maori young people) partnership group. RESULTS: Racism was higher among Maori, Pacific, and Asian young people compared to European young people. Racism was associated with all negative health and well-being measures examined for young people, including negative mental and physical health measures (12-Item Short Form Survey, Kessler Psychological Distress Scale), lower self-rated health, negative life satisfaction, higher unmet need for primary care, and identity measures (feelings of not belonging in New Zealand, less able to express their identity). DISCUSSION: The results of this study are concerning. Non-European young people disproportionately bear the burden of racism in Aotearoa New Zealand with a potentially substantial impact on their health and well-being. This is a breach of Indigenous (for Maori) and other international human rights and should be motivation to act to eliminate racism in all its forms.

Asian Rainbow Youth in New Zealand: Protective Factors.

PURPOSE: To explore the impacts of double minority status (ethnic and sexual/gender minority) and protective factors associated with the emotional wellbeing and mental health of Asian Rainbow (sexual/gender minority) youth in New Zealand. METHODS: The data were extracted from the Youth19 Rangatahi survey, which surveyed 7,374 students from 45 mainstream secondary schools. The comparison groups were Asian non-Rainbow youth and Pakeha (New Zealand European) Rainbow youth. A secondary analysis was performed examining the associations between postulated protective factors and the emotional wellbeing and mental health outcomes of Asian Rainbow youth. RESULTS: Asian Rainbow youth had higher odds of depressive symptoms, anxiety, and suicidal thoughts and attempts and lower odds of good emotional wellbeing compared to Asian non-Rainbow youth. However, Asian Rainbow youth had lower odds of anxiety compared to Pakeha Rainbow youth. Among Asian Rainbow youth, family acceptance and feeling safe at school were associated with higher odds of good emotional wellbeing, and lower odds of depressive symptoms, anxiety, and suicidal thoughts. Several other protective factors were also associated with 1 or more (but not all) of the emotional wellbeing and mental health indicators. DISCUSSION: This study suggests that family acceptance and feeling safe at school may serve as important buffers mitigating risks of adverse emotional wellbeing experienced by Asian Rainbow youth.

Dying well in Aotearoa New Zealand for ethnic minority communities: a time for reclamation?

Despite technological advances and a disproportionate increase in health expenditure at the end-of-life, most New Zealanders die in hospital or in aged residential care. This counters the aspirations espoused by Te Whatu Ora (Health New Zealand) for all New Zealanders "to live well, age well and die well in their homes and communities." Furthermore, despite reported inequities in end-of-life care experienced by ethnic minority communities (EMCs) overseas, and increasing proportions of people identifying with Asian, Middle Eastern, Latin American and African ethnicities in Aotearoa New Zealand, local data, research and policies addressing healthcare needs of EMCs at end-of-life are scant. Acknowledging this invisibility, we reflect on and discuss the current discourses on death and dying, the complex experiences at end-of-life for EMCs, including concepts of a "good death", the impact of recent existential crises (e.g., COVID-19 pandemic, climate change) on death awareness, and the global rise to reclaim dying as an important part of living. We argue for the need: a) to partner with ethnic communities to co-design culturally safe end-of-life health services, and b) to adopt a "compassionate communities" public health approach that can support people of EMCs at the end-of-life to die well.

Rural and Ethnic Disparities in Out-of-hospital Care and Transport Pathways After Road Traffic Trauma in New Zealand.

Introduction: The out-of-hospital emergency medical service (EMS) care responses and the transport pathways to hospital play a vital role in patient survival following injury and are the first component of a well-functioning, optimised system of trauma care. Despite longstanding challenges in delivering equitable healthcare services in the health system of Aotearoa-New Zealand (NZ), little is known about inequities in EMS-delivered care and transport pathways to hospital-level care. Methods: This population-level cohort study on out-of-hospital care, based on national EMS data, included trauma patients <85 years in age who were injured in a road traffic crash (RTC). In this study we examined the combined relationship between ethnicity and geographical location of injury in EMS out-of-hospital care and transport pathways following RTCs in Aotearoa-NZ. Analyses were stratified by geographical location of injury (rural and urban) and combined ethnicity-geographical location (rural Maori, rural non-Maori, urban Maori, and urban non-Maori). Results: In a two-year period, there were 746 eligible patients; of these, 692 were transported to hospital. Indigenous Maori comprised 28% (196) of vehicle occupants attended by EMS, while 47% (324) of patients' injuries occurred in a rural location. The EMS transport pathways to hospital for rural patients were slower to reach first hospital (total in slowest tertile of time 44% vs 7%, P ≥ 0.001) and longer to reach definitive care (direct transport, 77% vs 87%, P = 0.001) compared to urban patients. Maori patients injured in a rural location were comparatively less likely than rural non-Maori to be triaged to priority transport pathways (fastest dispatch triage, 92% vs 97%, respectively, P = 0.05); slower to reach first hospital (total in slowest tertile of time, 55% vs 41%, P = 0.02); and had less access to specialist trauma care (reached tertiary trauma hospital, 51% vs 73%, P = 0.02). Conclusion: Among RTC patients attended and transported by EMS in NZ, there was variability in out-of-hospital EMS transport pathways through to specialist trauma care, strongly patterned by location of incident and ethnicity. These findings, mirroring other health disparities for Maori, provide an equity-focused evidence base to guide clinical and policy decision makers to optimize the delivery of EMS care and reduce disparities associated with out-of-hospital EMS care.

Maori and Pacific families' experiences and perspectives of cardiovascular care; A qualitative study.

OBJECTIVE: This study aimed to understand the reasons behind evidence-practice gaps and inequities in cardiovascular care for Maori and Pacific people, as evidenced by the experiences and perspectives of patients and their families. METHODS: The research was guided by Maori and Pacific worldviews, incorporating Kaupapa Maori Theory and Pacific conceptual frameworks and research methodologies. Template analysis was used to analyse interview data from 61 Maori and Pacific people who had experienced a cardiovascular disease (CVD) risk assessment, acute coronary syndrome, and/or heart failure. RESULTS: The range of experiences relating to participants' heart health journeys are presented in five main themes: Context, Mana (maintaining control and dignity), Condition, People and Journey. CONCLUSIONS: Maori and Pacific people want to take charge of their heart health but face challenges. Participants described important obligations to family, community and tikanga (the culturally correct way of doing things). Participants described times when health care undermined existing responsibilities, their dignity and/or their mana, and they felt excluded from treatment as a result. IMPLICATIONS FOR PUBLIC HEALTH: Good reciprocal communication, stemming from a high-quality relationship is essential for successful outcomes. A workforce that is representative of the population it serves and is culturally safe lays the foundation for excellence in care.

Symptoms and Engagement in Anti-social Behavior 10 Years After Mild Traumatic Brain Injury Within a Community Civilian Sample: A Prospective Cohort Study With Age-Sex Matched Control Group.

OBJECTIVE: To determine if there are longer-term effects on symptoms, health status, mood, and behavior 10 years after a mild traumatic brain injury (mTBI). DESIGN: Prospective cohort study. SETTING: Community-based, civilian sample. PARTICIPANTS: Adults aged ≥16 years at follow-up who experienced an mTBI 10 years ago, and an age and sex-matched non-injured control group. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: mTBI cases and controls were asked to complete self-report assessments of functioning (WHO Disability Assessment Schedule Version 2), symptoms (Rivermead Post-Concussion Symptom Questionnaire), health status (100-point scale), alcohol (Alcohol Use Disorders Identification Test) and substance use (Alcohol, Smoking and Substance Involvement Screening Test), and whether they had engaged in any anti-social behaviors over the past 12 months. RESULTS: Data were analyzed for 368 participants (184 mTBI cases and 184 age-sex matched controls). Just over a third of mTBI cases (64, 34.8%) reported that they were still affected by their index mTBI 10 years later. After adjusting for education and ethnicity, the mTBI group had statistically higher overall symptom burden (F=22.32, P<.001, ηp2=0.07) compared with controls. This difference remained after excluding those who experienced a recurrent TBI. The mTBI group were more than 3 times as likely to have engaged in anti-social behavior during the previous 12 months (F=5.89, P=.02). There were no group differences in health status, functioning, or problematic alcohol or substance use 10 years post-injury. CONCLUSIONS: This study provides evidence of potential longer-term associations between mTBI, post-concussion symptoms, and anti-social behavior which warrants further evaluation. Future research should also examine if longer-term effects may be preventable with access to early rehabilitation post-injury.

Impact of an injury hospital admission on childhood academic performance: a Welsh population-based data linkage study.

BACKGROUND: While injuries can impact on children's educational achievements (with threats to their development and employment prospects), these risks are poorly quantified. This population-based longitudinal study investigated the impact of an injury-related hospital admission on Welsh children's academic performance. METHODS: The Secure Anonymised Information Linkage databank, 55 587 children residing in Wales from 2006 to 2016 who had an injury hospital admission (58.2% males; 16.8% born in most deprived Wales area; 80.1% one injury hospital admission) were linked to data from the Wales Electronic Cohort for Children. The primary outcome was the Core Subject Indicator reflecting educational achievement at key stages 2 (school years 3-6), 3 (school years 7-9) and 4 (school years 10-11). Covariates in models included demographic, birth, injury and school characteristics. RESULTS: Educational achievement of children was negatively associated with: pedestrian injuries (adjusted risk ratio, (95% CIs)) (0.87, (0.83 to 0.92)), cyclist (0.96, (0.94 to 0.99)), high fall (0.96, (0.94 to 0.97)), fire/flames/smoke (0.85, (0.73 to 0.99)), cutting/piercing object (0.96, (0.93 to 0.99)), intentional self-harm (0.86, (0.82 to 0.91)), minor traumatic brain injury (0.92, (0.86 to 0.99)), contusion/open wound (0.93, (0.91 to 0.95)), fracture of vertebral column (0.78, (0.64 to 0.95)), fracture of femur (0.88, (0.84 to 0.93)), internal abdomen/pelvic haemorrhage (0.82, (0.69 to 0.97)), superficial injury (0.94, (0.92 to 0.97)), young maternal age (<18 years: 0.91, (0.88 to 0.94); 19-24 years: 0.94, (0.93 to 0.96)); area based socioeconomic status (0.98, (0.97 to 0.98)); moving to a more deprived area (0.95, (0.93 to 0.97)); requiring special educational needs (0.46, (0.44 to 0.47)). Positive associations were: being female (1.04, (1.03 to 1.06)); larger pupil school sizes and maternal age 30+ years. CONCLUSION: This study highlights the importance on a child's education of preventing injuries and implementing intervention programmes that support injured children. Greater attention is needed on equity-focused educational support and social policies addressing needs of children at risk of underachievement, including those from families experiencing poverty. VIBES-JUNIOR STUDY PROTOCOL: http://dx.doi.org/10.1136/bmjopen-2018-024755.

Manifold child, family and social variables are associated with injury among New Zealand preschool children.

AIM: Approaches to understanding child injury tend to focus on short-term proximal influences. Previous analyses have found higher rates of injury among Maori and Pacific children in Aotearoa New Zealand (NZ). This study aimed to investigate how combinations of situations and multiple events act across the life-course to either protect preschool children from, or place them at risk of, repeated injuries requiring medical attention. METHODS: Longitudinal data were used to identify parent-reported injuries requiring medical attention among 6114 preschool NZ children. The environments experienced by children with multiple and/or severe injury were explored using multivariable analyses. RESULTS: Eight percent of children (n=505) experienced 1-3 injuries with at least one hospitalisation or ≥4 injuries (high injury group) from birth to 4.5 years of age. After accounting for antenatal, sociodemographic and psychosocial variables, children of Maori mothers (OR=0.7, 95% CI 0.5 to 0.97) and children of Asian mothers (OR=0.5, 95% CI 0.3 to 0.7) were less likely to be in the high injury group than children of European mothers. After adjusting for maternal ethnicity and child variables (gender, temperament, level of activity and behaviour difficulties), cumulative exposure to factors in four domains was associated with injury category: maternal, family, social and service use. CONCLUSION: This study identified social and economic opportunities to lower rates of injury among preschool children, that might reduce associated direct and indirect costs. Our findings in relation to ethnicity go against the standard public rhetoric and provide support for shifting the apportioning of blame for child injury from individuals to wider environmental exposures for which public health and societal solutions are required.

Ethnic differences of the care pathway following an out-of-hospital cardiac event: A systematic review.

AIM: This systematic review aimed to determine to what extent and why the care pathways for acute cardiac events in the community might differ for minoritised ethnic populations compared to non-minoritised populations. It also sought to identify the barriers and enablers that could influence variations in access to care for minoritised populations. METHODS: A multi-database search was conducted for articles published between 1 January 2000 and 1 January 2023. A combination of MeSH terms and keywords was used. Inclusion criteria for papers were published in English, adult population, the primary health condition was an acute cardiac event, and the primary outcomes were disaggregated by ethnicity or race. A narrative review of extracted data was performed, and findings were reported according to the PRISMA 2020 guidelines. RESULTS: Of the 3552 articles identified using the search strategy, 40 were deemed eligible for the review. Studies identified a range of variables in the care pathway that differed by ethnicity or race. These could be grouped as time to care, transportation, event related-variables, EMS interactions and symptoms. A meta-analysis was not performed due to heterogeneity across the studies. CONCLUSION: The extent and reasons for differences in cardiac care pathways are considerable. There are several remediable barriers and enablers that require attention to achieve equitable access to care for minoritised populations.

Reasons for Ethnic Disparities in the Prehospital Care Pathway Following an Out-of-Hospital Cardiac Event: Protocol of a Systematic Review.

BACKGROUND: Substantial inequities in cardiovascular disease occur between and within countries, driving much of the current burden of global health inequities. Despite well-established treatment protocols and clinical interventions, the extent to which the prehospital care pathway for people who have experienced an out-of-hospital cardiac event (OHCE) varies by ethnicity and race is inconsistently documented. Timely access to care in this context is important for good outcomes. Therefore, identifying any barriers and enablers that influence timely prehospital care can inform equity-focused interventions. OBJECTIVE: This systematic review aims to answer the question: Among adults who experience an OHCE, to what extent and why might the care pathways in the community and outcomes differ for minoritized ethnic populations compared to nonminoritized populations? In addition, we will investigate the barriers and enablers that could influence variations in the access to care for minoritized ethnic populations. METHODS: This review will use Kaupapa Maori theory to underpin the process and analysis, thus prioritizing Indigenous knowledge and experiences. A comprehensive search of the CINAHL, Embase, MEDLINE (OVID), PubMed, Scopus, Google Scholar, and Cochrane Library databases will be done using Medical Subject Headings terms themed to the 3 domains of context, health condition, and setting. All identified articles will be managed using an Endnote library. To be included in the research, papers must be published in English; have adult study populations; have an acute, nontraumatic cardiac condition as the primary health condition of interest; and be in the prehospital setting. Studies must also include comparisons by ethnicity or race to be eligible. Those studies considered suitable for inclusion will be critically appraised by multiple authors using the Mixed Methods Appraisal Tool and CONSIDER (Consolidated Criteria for Strengthening the Reporting of Health Research Involving Indigenous Peoples) framework. Risk of bias will be assessed using the Graphic Appraisal Tool for Epidemiology. Disagreements on inclusion or exclusion will be settled by a discussion with all reviewers. Data extraction will be done independently by 2 authors and collated in a Microsoft Excel spreadsheet. The outcomes of interest will include (1) symptom recognition, (2) patient decision-making, (3) health care professional decision-making, (4) the provision of cardiopulmonary resuscitation, (5) access to automated external defibrillator, and (6) witnessed status. Data will be extracted and categorized under key domains. A narrative review of these domains will be conducted using Indigenous data sovereignty approaches as a guide. Findings will be reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. RESULTS: Our research is in progress. We anticipate the systematic review will be completed and submitted for publication in October 2023. CONCLUSIONS: The review findings will inform researchers and health care professionals on the experience of minoritized populations when accessing the OHCE care pathway. TRIAL REGISTRATION: PROSPERO CRD42022279082; https://tinyurl.com/bdf6s4h2. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/40557.

An intersectional approach to exploring lived realities and harnessing the creativity of ethnic minority youth for health gains: protocol for a multiphase mixed method study.

BACKGROUND: Understanding the diversity and multiplicity of identities experienced by youth in Aotearoa (Te reo Maori name of the country) New Zealand (NZ) is vital to promoting their wellbeing. Ethnic minority youth (EMY) in NZ (defined as those identifying with Asian, Middle Eastern, Latin American and African ethnic origins) have been historically under-studied and under-counted, despite reporting high levels of discrimination, a major determinant of mental health and wellbeing and potentially a proxy for other inequities. In this paper, we describe the protocol for a multi-year study that examines, using an intersectional approach, how multiple marginalised identities impact mental and emotional wellbeing of EMY. METHODS: This is a multiphase, multi-method study designed to capture the diversity of lived realities of EMY who self-identify with one or more additional marginalised intersecting identity (the population referred here as EMYi). Phase 1 (Descriptive study) will involve secondary analyses of national surveys to examine the prevalence and relationships between discrimination and wellbeing of EMYi. Phase 2 (Study on public discourse) will analyse data from media narratives, complemented by interviews with stakeholders to explore discourses around EMYi. Phase 3 (Study on lived experience) will examine lived experiences of EMYi to discuss challenges and sources of resilience, and how these are influenced by public discourse. Phase 4 (Co-design phase) will use a creative approach that is youth-centered and participatory, and will involve EMYi, creative mentors and health service, policy and community stakeholders as research partners and advisors. It will employ participatory generative creative methods to explore strengths-based solutions to discriminatory experiences. DISCUSSION: This study will explore the implications of public discourse, racism and multiple forms of marginalisation on the wellbeing of EMYi. It is expected to provide evidence on the impacts of marginalisation on their mental and emotional wellbeing and inform responsive health practice and policy. Using established research tools and innovative creative means, it will enable EMYi to propose their own strength-based solutions. Further, population-based empirical research on intersectionality and health is still nascent, and even more scarce in relation to youth. This study will present the possibility of expanding its applicability in public health research focused on under-served communities.

Use of public sector diabetes eye services in New Zealand 2006-2019: Analysis of national routinely collected datasets.

OBJECTIVE: To assess diabetes eye service use in New Zealand among people aged ≥15 years by estimating service attendance, biennial screening rate, and disparities in the use of screening and treatment services. METHODS: We obtained Ministry of Health data from the National Non-Admitted Patient Collection on diabetes eye service events between 1 July 2006 and 31 December 2019 and sociodemographic and mortality data from the Virtual Diabetes Register and linked these using a unique patient identifier (encrypted National Health Index). We 1) summarized attendance at retinal screening and ophthalmology services, 2) calculated biennial and triennial screening rate, 3) summarized treatment with laser and anti-VEGF and used log-binomial regression to examine associations of all of these with age group, ethnicity, and area-level deprivation. RESULTS: In total, 245,844 people aged ≥15 years had at least one diabetes eye service appointment attended or scheduled; half of these (n = 125,821, 51.2%) attended only retinal screening, one-sixth attended only ophthalmology (n = 35,883, 14.6%) and one-third attended both (n = 78,300, 31.8%). The biennial retinal screening rate was 62.1%, with large regional variation (73.9% in Southern District to 29.2% in West Coast). Compared with NZ Europeans, Maori were approximately twice as likely to never receive diabetes eye care or to access ophthalmology when referred from retinal screening, 9% relatively less likely to receive biennial screening and received the fewest anti-VEGF injections when treatment was commenced. Disparities in service access were also present for Pacific Peoples compared to NZ Europeans, younger and older age groups compared to those aged 50-59 years and those living in areas with higher deprivation. CONCLUSIONS: Access to diabetes eye care is suboptimal, with substantial disparity between age groups, ethnicity groups, area level deprivation quintile and across districts. Efforts to improve access to and quality of diabetes eye care services must include strengthening data collection and monitoring.

Atypical symptom reporting after mild traumatic brain injury.

OBJECTIVE: Early reporting of atypical symptoms following a mild traumatic brain injury (mTBI) may be an early indicator of poor prognosis. This study aimed to determine the percentage of people reporting atypical symptoms 1-month post-mTBI and explore links to recovery 12 months later in a community-dwelling mTBI sample. METHODS: Adult participants (>16 years) who had experienced a mTBI were identified from a longitudinal incidence study (BIONIC). At 1-month post-injury, 260 participants completed the Rivermead Post-Concussion Symptoms Questionnaire (typical symptoms) plus four atypical symptom items (hemiplegia, difficulty swallowing, digestion problems and difficulties with fine motor tasks). At 12 months post-injury, 73.9% (n = 193) rated their overall recovery on a 100-point scale. An ordinal regression explored the association between atypical symptoms at 1 month and recovery at 12 months post-injury (low = 0-80, moderate = 81-99 and complete recovery = 100), whilst controlling for age, sex, rehabilitation received, ethnicity, mental and physical comorbidities and additional injuries sustained at the time of injury. RESULTS: At 1-month post-injury <1% of participants reported hemiplegia, 5.4% difficulty swallowing, 10% digestion problems and 15.4% difficulties with fine motor tasks. The ordinal regression model revealed atypical symptoms were not significant predictors of self-rated recovery at 12 months. Older age at injury and higher typical symptoms at 1 month were independently associated with poorer recovery at 12 months, p < 0.01. CONCLUSION: Atypical symptoms on initial presentation were not linked to global self-reported recovery at 12 months. Age at injury and typical symptoms are stronger early indicators of longer-term prognosis. Further research is needed to determine if atypical symptoms predict other outcomes following mTBI.

A health sector response to the commercial determinants of health.

AIM: To develop and apply a theoretical framework to assess the rigour of a district health organisation's response to the commercial determinants of health (CDoH). METHODS: The multi-method study incorporated literature reviews of CDoH strategies and ways in which organisations can respond; policy document review; and 12 qualitative, semi-structured, key informant interviews. RESULTS: A theoretical framework was developed summarising CDoH and potential responses. The organisation has relevant policies, including those concerning corporate relationships and conflict of interest; however, there are opportunities to strengthen policy content and processes. Key themes were identified based on key informants' perceptions: 1) disconnect between community impacts of harmful commodities and awareness/action on CDoH drivers of these impacts; 2) power imbalance between harmful commodity industries and communities; and 3) need for a robust, values-based, Tiriti-aligned response to CDoH. CONCLUSIONS: The health sector has an important role to play in redressing the power imbalance between harmful commodity industries and communities. Responses include: raising awareness about CDoH; strengthening policies related to interactions with corporations, and in particular considering alignment of values; supporting community actions; and advocating for legislative changes which restrict the power of harmful industries and support healthy environments and communities.

Identification of clinically relevant cohorts of people with heart failure from electronic health data in Aotearoa: potential, pitfalls and a plan.

Heart failure (HF) is associated with high morbidity and mortality and contributes to substantial burden of disease, significant inequities and high healthcare cost globally as well as in Aotearoa. Management of chronic HF is driven by HF phenotype, defined by left ventricular ejection fraction (EF), as only those with reduced ejection fraction (HFrEF) have been shown to experience reduced mortality and morbidity with long-term pharmacotherapy. To ensure appropriate and equitable implementation of HF management we need to be able to identify clinically relevant cohorts of patients with HF, in particular, those with HFrEF. The ideal HF registry would incorporate and link HF diagnoses and phenotype from primary and secondary care with echocardiography and pharmacotherapy data. In this article we consider several options for identifying such cohorts from electronic health data in Aotearoa, as well as the potential and pitfalls of these options. Given the urgent need to identify people with HF according to EF phenotype, the options for identifying them from electronic health data, and the opportunities presented by health system reform, including a focus on digital solutions, we recommend the following four actions, with oversight from a national HF working group: 1) Establish a HF registry based on random and representative sampling of HF admissions; 2) investigate obtaining HF diagnosis and EF-phenotype from primary care-coded data; 3) amalgamate national echocardiography data; and 4) investigate options to enable the systematic collection of HF diagnosis and EF-phenotype from outpatient attendances. Future work will need to consider reliability and concordance of data across sources. The case for urgent action in Aotearoa is compounded by the stark inequities in the burden of HF, the likely contribution of health service factors to these inequities and the legislative requirement under the Pae Ora (Healthy Futures) Act 2022 that "the health sector should be equitable, which includes ensuring Maori and other population groups - (i) have access to services in proportion to their health needs; and (ii) receive equitable levels of service; and (iii) achieve equitable health outcomes".

Aspiring toward Pae Ora: Values and strengths-based child safety messaging in Aotearoa/New Zealand.

On-going inequities in rates of fatal and non-fatal injury between tamariki Maori (Indigenous children) and non-Maori children in Aotearoa (New Zealand) are unacceptable and highlight breaches by the Crown in their obligations to Maori, outlined in Te Tiriti o Waitangi (The Treaty of Waitangi). Safekids Aotearoa, a national organisation tasked with reducing unintentional injuries to children (0-14 years), is shifting the focus of its programmes and resources to better align with Te Tiriti o Waitangi and to honour Maori knowledge, ideas and principles to eliminate inequity and support the pursuit of Pae Ora: Maori health aspirations for flourishing whanau (families) and tamariki. We provide an overview of Te Tiriti o Waitangi and its relevance to child injury prevention and the Te Tiriti-led response by Safekids Aotearoa, particularly around approaches to developing values and strengths-based safety messages. In doing so, we challenge and counter pervasive barriers to achieving equity and Pae Ora and describe how identifying and incorporating shared Maori values in a Te Tiriti-led agenda supports the work, ethos, programmes and relationships of Safekids Aotearoa in its journey toward equitable outcomes and Pae Ora for all. We highlight the importance of embedding prevention efforts and advocacy within a holistic framework of tamariki and whanau well-being embracing capability and strengths-based approaches.

What are the gaps in cardiovascular risk assessment and management in primary care for Maori and Pacific people in Aotearoa New Zealand? Protocol for a systematic review.

INTRODUCTION: In New Zealand, significant inequities exist between Maori and Pacific peoples compared with non-Maori, non-Pacific peoples in cardiovascular disease (CVD) risk factors, hospitalisations and management rates. This review will quantify and qualify already-reported gaps in CVD risk assessment and management in primary care for Maori and Pacific peoples compared with non-Maori/non-Pacific peoples in New Zealand. METHODS AND ANALYSIS: We will conduct a systematic search of the following electronic databases and websites from 1 January 2000 to 31 December 2021: MEDLINE (OVID), EMBASE, Scopus, CINAHL Plus, NZresearch.org, National Library Catalogue (Te Puna), Index New Zealand (INNZ), Australia/New Zealand Reference Centre. In addition, we will search relevant websites such as the Ministry of Health and research organisations. Data sources will include published peer reviewed articles, reports and theses employing qualitative, quantitative and mixed methods.Two reviewers will independently screen the titles and abstracts of the citations and grade each as eligible, not eligible or might be eligible. Two reviewers will read each full report, with one medically qualified reviewer reading all reports and two other reviewers reading half each. The final list of included citations will be compiled from the results of the full report reading and agreed on by three reviewers. Data abstracted will include authors, title, year, study characteristics and participant characteristics. Data analysis and interpretation will involve critical inquiry and a strength-based approach that is inclusive of Maori and Pacific values. This means that critical appraisal includes an assessment of quality from an Indigenous perspective. ETHICS AND DISSEMINATION: Ethical approval is not required. The findings will be published in a peer-reviewed journal and shared with stakeholders. This review contributes to a larger project which creates a Quality-Improvement Equity Roadmap to reduce barriers to Maori and Pacific peoples accessing evidence-based CVD care.

Factors predicting forgone healthcare among Asian adolescents in New Zealand: unmasking variations in aggregate data.

AIM: To examine the relationship between social support, safety, healthcare experience and forgone healthcare for Asian secondary school students in New Zealand by unmasking variations in aggregate Asian data. METHODS: The study population included 1,911 Asians (1,272 East Asians and 604 South Asians) from the Youth19 survey. The reference group included 3,053 Pakeha. RESULTS: We found disparities in family socioeconomic status (SES), social support, safety in school and neighbourhood, healthcare experience and forgone healthcare between East Asians and South Asians compared to Pakeha. One in five Asians (20%) reported forgone healthcare. Compared to their Pakeha peers (18%), Asian students (AOR=1.18, CI=1.04-1.33) and East Asian students (AOR=1.24, CI=1.06-1.45) were more likely to experience forgone healthcare, but South Asian students were not (AOR=1.05, CI=0.86-1.28). Important unique predictors of forgone healthcare for both East and South Asian students were: being discriminated against by health professionals due to ethnicity, not having a family member to talk about their worries with, and unfair treatment by teachers. Other unique predictors varied: lower community and family SES, not getting enough quality time with family, and being bullied at school were significant predictors for East Asian students; low perceived neighbourhood safety was a predictor for South Asian students. CONCLUSIONS: A complicated picture underlies the seemingly positive findings for the overall Asian group. We highlight the importance of disaggregating Asian youth data into East Asian and South Asian, to identify disparities in risk/protective factors and better inform targeted interventions.