Strengthening community connection and personal well-being through volunteering in New Zealand.

Volunteering is a way for people to develop meaningful relationships within a social group and can lead to the building of social capital, from which both individuals and the wider group can benefit in the form of enhanced well-being. This study aimed to explore and describe the impact of volunteering on the volunteer coordinators and volunteers themselves in the eastern suburbs of Christchurch, New Zealand, an area particularly impacted by the devastating earthquakes in the period 2010/2011. Data were collected via semi-structured interviews with volunteer coordinators and volunteers (n = 35; 16 men, 19 women) from November 2018 to mid-January 2019. Thematic analysis of data highlighted a key theme of Creating and strengthening valued community connections, with subthemes of Personal growth, Community connections and Role of coordination. The key theme illustrated how formal volunteering created effort and opportunities towards the strengthening of personal and community connectedness. Our study demonstrates the importance of social connection for both individual and community well-being, emphasises the important role of "champions" in facilitating the building of bridging and bonding relationships between individuals and communities, and suggests a role for healthcare professionals to prescribe volunteering as a way to improve individual health and well-being outcomes.

Investigating the Association Between Child Television Viewing and Measured Child Adiposity Outcomes in a Large Nationally Representative Sample of New Zealanders: A Cross-Sectional Study.

BACKGROUND: This study investigates the association between television (TV) viewing and child adiposity and if parental education and child ethnicity moderate this association. METHOD: Cross-sectional, pooled (2013/2014-2016/2017) adult and child New Zealand Health Survey were matched resulting in 13,039 children (2-14 y) and parent dyads. Child TV viewing was estimated using self-reported time for each weekday and weekend. The height (in centimeters), weight (in kilograms), and waist circumference of parents and children were measured. Childhood body mass index and obesity were defined using the International Obesity Task Force cutoff values. Effect modification was assessed by interaction and then by stratifying regression analyses by parent education (low, moderate, and high) and child ethnicity (Asian, European/other, Maori, and Pacific). RESULTS: Overall, watching ≥2 hours TV on average per day in the past week, relative to <2 hours TV viewing, was associated with a higher odds of obesity (adjusted odds ratio = 1.291 [1.108-1.538]), higher body mass index z score (b = 0.123 [0.061-0.187]), and higher waist circumference (b = 0.546 [0.001-1.092]). Interactions considering this association by child ethnicity and parent education revealed little evidence of effect modification. CONCLUSION: While TV viewing was associated with child adiposity, the authors found little support for a moderating role of parental education and child ethnicity.

The good, the bad, and the environment: developing an area-based measure of access to health-promoting and health-constraining environments in New Zealand.

BACKGROUND: Accounting for the co-occurrence of multiple environmental influences is a more accurate reflection of population exposure than considering isolated influences, aiding in understanding the complex interactions between environments, behaviour and health. This study examines how environmental 'goods' such as green spaces and environmental 'bads' such as alcohol outlets co-occur to develop a nationwide area-level healthy location index (HLI) for New Zealand. METHODS: Nationwide data were collected, processed, and geocoded on a comprehensive range of environmental exposures. Health-constraining 'bads' were represented by: (i) fast-food outlets, (ii) takeaway outlets, (iii) dairy outlets and convenience stores, (iv) alcohol outlets, (v) and gaming venues. Health-promoting 'goods' were represented by: (i) green spaces, (ii) blue spaces, (iii) physical activity facilities, (iv) fruit and vegetable outlets, and (v) supermarkets. The HLI was developed based on ranked access to environmental domains. The HLI was then used to investigate socio-spatial patterning by area-level deprivation and rural/urban classification. RESULTS: Results showed environmental 'goods' and 'bads' co-occurred together and were patterned by area-level deprivation. The novel HLI shows that the most deprived areas of New Zealand often have the most environmental 'bads' and less access to environmental 'goods'. CONCLUSIONS: The index, that is now publicly available, is able to capture both inter-regional and local variations in accessibility to health-promoting and health-constraining environments and their combination. Results in this study further reinforce the need to embrace the multidimensional nature of neighbourhood and place not only when designing health-promoting places, but also when studying the effect of existing built environments on population health.

National movement patterns during the COVID-19 pandemic in New Zealand: the unexplored role of neighbourhood deprivation.

BACKGROUND: The COVID-19 pandemic has asked unprecedented questions of governments around the world. Policy responses have disrupted usual patterns of movement in society, locally and globally, with resultant impacts on national economies and human well-being. These interventions have primarily centred on enforcing lockdowns and introducing social distancing recommendations, leading to questions of trust and competency around the role of institutions and the administrative apparatus of state. This study demonstrates the unequal societal impacts in population movement during a national 'lockdown'. METHODS: We use nationwide mobile phone movement data to quantify the effect of an enforced lockdown on population mobility by neighbourhood deprivation using an ecological study design. We then derive a mobility index using anonymised aggregated population counts for each neighbourhood (2253 Census Statistical Areas; mean population n=2086) of national hourly mobile phone location data (7.45 million records, 1 March 2020-20 July 2020) for New Zealand (NZ). RESULTS: Curtailing movement has highlighted and exacerbated underlying social and spatial inequalities. Our analysis reveals the unequal movements during 'lockdown' by neighbourhood socioeconomic status in NZ. CONCLUSION: In understanding inequalities in neighbourhood movements, we are contributing critical new evidence to the policy debate about the impact(s) and efficacy of national, regional or local lockdowns which have sparked such controversy.

Spatial-temporal patterns of childhood immunization in New Zealand (2006-2017): an improving pattern but not for all?

BACKGROUND: Declining childhood immunization represents a serious public health problem globally and in New Zealand. To guide efforts to increase immunization coverage, this study monitors nationwide change in immunization coverage since the introduction of the National Immunisation Register (NIR) in 2005 and spatiotemporal patterns of immunization coverage from 2006 to 2017. METHODS: The study population consisted of 4 482 499 individual immunization records that were obtained from the NIR (2005-2017). Data on yearly and average immunization coverage in census area units (CAUs) in New Zealand were calculated by milestone age (6/8/12/18/24/60/144 months). Data for 2005 were excluded due to missing records in the introductory period of the NIR. We analyzed spatial and spatiotemporal patterns using Gi* and SaTScan methods. RESULTS: Immunization coverage improved since the introduction of the NIR in 2005, reaching a peak in 2014 and 2015 with a slight decrease in 2016 and 2017. Well and insufficiently immunized areas were identified with spatial autocorrelation analyses highlighting several hot- and cold-spots. Comparison of CAUs with neighbouring CAUs allowed for the identification of places where immunization coverage was significantly higher or lower than expected, over both time and space. CONCLUSION: We provide the first spatiotemporal analysis of childhood immunization in New Zealand that utilizes a large sample of over 4.4 million individual immunization records. Our spatial analyses enable policymakers to understand the development of childhood immunization coverage and make more effective prevention strategies in New Zealand.

Transport changes and COVID-19: From present impacts to future possibilities.

Changes in people's movement and travel behaviour have been apparent in many places during the COVID-19 pandemic, with differences seen at a range of spatial scales. These changes, occurring as a result of the COVID-19 'natural experiment', have afforded us an opportunity to reimagine how we might move in our day-to-day travels, offering a hopeful glimpse of possibilities for future policy and planning around transport. The nature and scale of changes in movement and transport resulting from the pandemic have shown we can shift travel behaviour with strong policy responses, which is especially important in the concurrent climate change crisis.

A geospatial analysis of Type 2 Diabetes Mellitus and the food environment in urban New Zealand.

The aim of this research is to analyse the spatial epidemiology of Type 2 Diabetes Mellitus (T2DM) and investigate associations with the built environment in urban New Zealand. Data on T2DM was sourced from the New Zealand Virtual Diabetes Register (2016), and data on environmental variables sourced from the Ministry for Primary Industries and Territorial Authorities (2013-2016). Novel measures of the built environment using an enhanced two-step floating catchment area model were established using data on fast food outlets, takeaways, dairy/convenience stores, supermarkets and fruit/vegetable stores. Rates of T2DM per 1000 population and standardised morbidity ratios were computed and visualised for all urban areas. Getis Ord was used to assess spatial clustering, and Bayesian modelling was used to understand associations between T2DM and environmental variables. Results indicate that T2DM is influenced by demographic factors, spatially clustered and associated with accessibility to environmental exposures. Health-promoting resources, such as fruit/vegetable stores, were shown to have a consistently protective effect on T2DM while those considered detrimental to health showed varying, and largely insignificant, associations. This is the first study in New Zealand to spatially quantify the effects of multiple environmental exposures on population level T2DM for all urban areas using a geospatial approach. It has implications for both policy and future research efforts as a deeper knowledge of local environments forms a basis on which to better understand spatial associations between the built environment and health, as well as formulate policy directed toward environmental influences on chronic health conditions.

Investigating spatial variation and change (2006-2017) in childhood immunisation coverage in New Zealand.

BACKGROUND: Immunisation is a safe and effective way of protecting children and adults against harmful diseases. However, immunisation coverage of children is declining in some parts of New Zealand. AIM: Use a nationwide sample to first, examine the socioeconomic and demographic determinants of immunisation coverage and spatial variation in these determinants. Second, it investigates change in immunisation coverage in New Zealand over time. METHODS: Individual immunisation records were obtained from the National Immunisation Register (NIR) (2005-2017; 4,482,499 events). We calculated the average immunisation coverage by year and milestone age for census area units (CAU) and then examined the immunisation coverage by selected socioeconomic and demographic determinants. Finally, local variations in the association between immunisation coverage and selected determinants were investigated using geographically weighted regression. RESULTS: Findings showed a decrease of immunisation rates in recent years in CAUs with high immunisation coverage in the least deprived areas and increasing immunisation rates in more deprived areas. Nearly all explanatory variables exhibited a spatial variation in their association with immunisation coverage. For instance, the strongest negative effect of area-level deprivation is observed in the northern part of the South Island, the central-southern part of the North Island, around Auckland, and in Northland. CONCLUSION: Our findings show that childhood immunisation coverage varies by socioeconomic and demographic factors across CAUs. We also identify important spatial variation and changes over time in recent years. This evidence can be used to improve immunisation related policy in New Zealand.

Pathways to urban health and well-being: measuring and modelling of community services' in a medium size city.

Social and natural capital are fundamental to people's wellbeing, often within the context of local community. Developing communities and linking people together provide benefits in terms of mental well-being, physical activity and other associated health outcomes. The research presented here was carried out in Christchurch - Otautahi, New Zealand, a city currently re-building, after a series of devastating earthquakes in 2010 and 2011. Poor mental health has been shown to be a significant post-earthquake problem, and social connection has been postulated as part of a solution. By curating a disparate set of community services, activities and facilities, organised into a Geographic Information Systems (GIS) database, we created i) an accessibility analysis of 11 health and well-being services, ii) a mobility scenario analysis focusing on 4 general well-being services and iii) a location-allocation model focusing on 3 primary health care and welfare location optimisation. Our results demonstrate that overall, the majority of neighbourhoods in Christchurch benefit from a high level of accessibility to almost all the services; but with an urban-rural gradient (the further away from the centre, the less services are available, as is expected). The noticeable exception to this trend, is that the more deprived eastern suburbs have poorer accessibility, suggesting social inequity in accessibility. The findings presented here show the potential of optimisation modelling and database curation for urban and community facility planning purposes.

Spatial Lifecourse Epidemiology Reporting Standards (ISLE-ReSt) statement.

Spatial lifecourse epidemiology is an interdisciplinary field that utilizes advanced spatial, location-based, and artificial intelligence technologies to investigate the long-term effects of environmental, behavioural, psychosocial, and biological factors on health-related states and events and the underlying mechanisms. With the growing number of studies reporting findings from this field and the critical need for public health and policy decisions to be based on the strongest science possible, transparency and clarity in reporting in spatial lifecourse epidemiologic studies is essential. A task force supported by the International Initiative on Spatial Lifecourse Epidemiology (ISLE) identified a need for guidance in this area and developed a Spatial Lifecourse Epidemiology Reporting Standards (ISLE-ReSt) Statement. The aim is to provide a checklist of recommendations to improve and make more consistent reporting of spatial lifecourse epidemiologic studies. The STrengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement for cohort studies was identified as an appropriate starting point to provide initial items to consider for inclusion. Reporting standards for spatial data and methods were then integrated to form a single comprehensive checklist of reporting recommendations. The strength of our approach has been our international and multidisciplinary team of content experts and contributors who represent a wide range of relevant scientific conventions, and our adherence to international norms for the development of reporting guidelines. As spatial, location-based, and artificial intelligence technologies used in spatial lifecourse epidemiology continue to evolve at a rapid pace, it will be necessary to revisit and adapt the ISLE-ReSt at least every 2-3 years from its release.

Area-level deprivation, childhood dental ambulatory sensitive hospitalizations and community water fluoridation: evidence from New Zealand.

BACKGROUND: We examined the association between area-level deprivation and dental ambulatory sensitive hospitalizations (ASH) and considered the moderating effect of community water fluoridation (CWF). The hypothesis was that higher levels of deprivation are associated with higher dental ASH rates and that CWF will moderate this association such that children living in the most deprived areas have greater health gain from CWF. METHODS: Dental ASH conditions (dental caries and diseases of pulp/periapical tissues), age, gender and home address identifier (meshblock) were extracted from pooled cross-sectional data (Q3, 2011 to Q2, 2017) on children aged 0-4 and 5-12 years from the National Minimum Dataset, New Zealand (NZ) Ministry of Health. CWF was obtained for 2011 and 2016 from the NZ Institute of Environmental Science and Research. Dental ASH rates for children aged 0-4 and 5-12 years (/1000) were calculated for census area units (CAUs). Multilevel negative binomial models investigated associations between area-level deprivation, dental ASH rate and moderation by CWF status. RESULTS: Relative to CWF (2011 and 2016), no CWF (2011 and 2016) was associated with increased dental ASH rates in children aged 0-4 [incidence rate ratio (IRR) = 1.171 (95% confidence interval 1.064, 1.288)] and aged 5-12 years [IRR = 1.181 (1.084, 1.286)]. An interaction between area-level deprivation and CWF showed that the association between CWF and dental ASH rates was greatest within the most deprived quintile of children aged 0-4 years [IRR = 1.316 (1.052, 1.645)]. CONCLUSIONS: CWF was associated with a reduced dental ASH rate for children aged 0-4 and 5-12 years. Children living in the most deprived areas showed the greatest effect of CWF on dental ASH rates, indicating that the greater health gain from CWF occurred for those with the highest socio-economic disadvantage. Variation in CWF contributes to structural inequities in oral-health outcomes for children.

Why is the rate of annual road fatalities increasing? A unit record analysis of New Zealand data (2010-2017).

INTRODUCTION: Recent increases in road crashes have reversed New Zealand's formerly declining crash rates to produce annual fatal and serious injury counts that are 49% higher than the lowest rates achieved in 2013. METHOD: We model twenty-one factors in fatal and serious injury crashes, four years before and after 2013 using logistic regression. Three major factors are significantly different in the period after 2013, when crash rates increased: (1) alcohol as a cause, (2) learner licence holders, and (3) a regional effect for Auckland. Newly defined speed zones are a more common setting for crashes in the period of upturn but there is no coinciding elevated likelihood of 'speed as a causal factor'. Three factors related to road safety were less common: aged under 25-years old, fatigue, and not wearing a seatbelt. RESULTS: Results are compared to rates of prosecutions for alcohol-related driving offences over this period. It is possible that New Zealand's successful road safety initiatives of the past have been undermined by reduced levels of enforcement and an unexpected outcome from the graduated driving licence system.

Investigating the prevalence of non-fluoride toothpaste use in adults and children using nationally representative data from New Zealand: a cross-sectional study.

Introduction Despite improvements in oral health outcomes in New Zealand over the last number of decades, there are still high levels of preventable tooth decay in adults and children. We investigate the prevalence and spatial variation of non-fluoride toothpaste use in a nationally representative sample of adults and children in New Zealand.Method Individual-level self-reported data were sourced from the New Zealand Health Survey (2017/18). Both child (n = 4,723) and adult (n = 13,869) data were used. Data included sociodemographic (for example, age), socioeconomic (for example, area-level deprivation) and dental-related (for example, type of toothpaste used) variables.Results Overall, 6.8% of adults and 6.4% of children use non-fluoride toothpaste. When split by deprivation, the highest prevalence of non-fluoride toothpaste use for children and adults was in the moderate to least deprived areas, while the lowest prevalence was in the most deprived areas. When disaggregated by ethnicity, the Asian population had the highest prevalence of non-fluoride toothpaste use for both adults and children compared to Maori, Pacific and European/Other. There was little difference in prevalence by rural/urban classification; however, prevalence varied geographically across the study area.Conclusion This is the first study that uses a nationally representative sample of adults and children to show variation in the use of non-fluoride toothpaste in New Zealand.

Obesity risk in women of childbearing age in New Zealand: a nationally representative cross-sectional study.

OBJECTIVES: To investigate risk factors for women with obesity of childbearing age. METHODS: A cross-sectional survey of New Zealand women (15-49 years) with measured height and weight was used [unweighted (n = 3625) and weighted analytical sample (n = 1,098,372)] alongside sociodemographic-, behavioural- and environmental-level predictors. Multilevel logistic regression weighted for non-response of height and weight data was used. RESULTS: Meeting physical activity guidelines (AOR (adjusted odds ratio) 0.66, 95% CI 0.54-0.80), Asian (AOR 0.15, 95% CI 0.10-0.23) and European/other ethnicity (AOR 0.46, 95% CI 0.36-0.58) and an increased availability of public greenspace (Q4 AOR 0.55, 95% CI 0.41-0.75) were related to decreased obesity risk. Older age (45-49 years AOR 3.01, 95% CI 2.17-4.16), Pacific ethnicity (AOR 2.81, 95% CI 1.87-4.22), residing in deprived areas (AOR 1.65, 95% CI 1.16-2.35) or secondary urban areas (AOR 1.49, 95% CI 1.03-2.18) were related to increased obesity risk. When examined by rural/urban classification, private greenspace was only related to increased obesity risk in main urban areas. CONCLUSIONS: This study highlights factors including but not limited to public greenspace, which inform obesity interventions for women of childbearing age in New Zealand.

The approaches to measuring the potential spatial access to urban health services revisited: distance types and aggregation-error issues.

BACKGROUND: The potential spatial access to urban health services is an important issue in health geography, spatial epidemiology and public health. Computing geographical accessibility measures for residential areas (e.g. census tracts) depends on a type of distance, a method of aggregation, and a measure of accessibility. The aim of this paper is to compare discrepancies in results for the geographical accessibility of health services computed using six distance types (Euclidean and Manhattan distances; shortest network time on foot, by bicycle, by public transit, and by car), four aggregation methods, and fourteen accessibility measures. METHODS: To explore variations in results according to the six types of distance and the aggregation methods, correlation analyses are performed. To measure how the assessment of potential spatial access varies according to three parameters (type of distance, aggregation method, and accessibility measure), sensitivity analysis (SA) and uncertainty analysis (UA) are conducted. RESULTS: First, independently of the type of distance used except for shortest network time by public transit, the results are globally similar (correlation >0.90). However, important local variations in correlation between Cartesian and the four shortest network time distances are observed, notably in suburban areas where Cartesian distances are less precise. Second, the choice of the aggregation method is also important: compared with the most accurate aggregation method, accessibility measures computed from census tract centroids, though not inaccurate, yield important measurement errors for 10% of census tracts. Third, the SA results show that the evaluation of potential geographic access may vary a great deal depending on the accessibility measure and, to a lesser degree, the type of distance and aggregation method. Fourth, the UA results clearly indicate areas of strong uncertainty in suburban areas, whereas central neighbourhoods show lower levels of uncertainty. CONCLUSION: In order to accurately assess potential geographic access to health services in urban areas, it is particularly important to choose a precise type of distance and aggregation method. Then, depending on the research objectives, the choices of the type of network distance (according to the mode of transportation) and of a number of accessibility measures should be carefully considered and adequately justified.

New Zealand Healthline call data used to measure the effect of travel time on the use of the emergency department.

Telephone triage is a health tool increasingly used to connect geographically distant populations. Such services are also utilised to address issues of Emergency Department (ED) overuse. New Zealand's tele-triage service, Healthline, has existed since 2001 but is yet to be the focus of analysis. This research sought to understand the role that travel time to ED had upon Healthline users' compliance with telephone advice. Additionally, the role of deprivation in Healthline (as a determinant of caller behaviour) was examined. Travel time to ED was found to influence the impact of Healthline advice upon callers but this was not confounded by deprivation. Those living closest to the ED were more likely to attend when advised to, and less likely to stay away if told to avoid the ED. Different time brackets showed stronger trends, suggesting that callers at varying distances from EDs may be more or less influenced by both travel time and Healthline advice.

Living in areas with different levels of earthquake damage and association with risk of cardiovascular disease: a cohort-linkage study.

BACKGROUND: Cardiovascular disease rates are known to increase immediately after a severe earthquake. However, less is known about the magnitude of this increase over time in relation to the amount of housing damage. We assessed the effect of area housing damage from a major earthquake sequence in Christchurch, Canterbury province, New Zealand, on cardiovascular disease-related hospital admissions and deaths. METHODS: For this cohort-linkage study, we used linked administrative datasets from the Statistics New Zealand Integrated Data Infrastructure to identify individuals aged 45 years or older living in Christchurch from the date of the first earthquake on Sept 4, 2010. Individuals were assigned the average damage level for their residential meshblock (small neighbourhood generally comprising 10-50 dwellings) using the insurance-assessed residential building damage costs obtained from the Earthquake Commission as a proportion of property value. We calculated the rates of cardiovascular disease-related hospital admissions (including myocardial infarction) and cardiovascular disease-related mortality and rate ratios (adjusted for age, sex, ethnicity, small-area deprivation index, and personal income) by level of housing damage in the first year and the 4 subsequent years after the earthquake. The rate ratio association between earthquake housing damage and cardiovascular event was examined by Poisson regression, and linear test of trends across damage categories was done by regression modeling. FINDINGS: We identified 179 000 residents living in the earthquake-affected region of Christchurch, of whom 148 000 had complete data. For the first 3 months after the Feb 22, 2011 earthquake, the Poisson regression-adjusted rate ratio (RR) for cardiovascular disease-related hospital admissions for residents from areas that were most damaged (compared with residents from the least damaged areas) was 1·12 (95% CI 0·96-1·32; test for linear trend p=0·239). In the first year after the earthquake sequence, for residents from areas that were most damaged (vs the least damaged areas), Poisson regression-adjusted RRs were 1·10 (1·01-1·21; test for linear trend p=0·068) for cardiovascular disease-related hospital admissions, 1·22 (1·00-1·48; p=0·036) for myocardial infarction-related hospital admissions, and 1·25 (1·06-1·47; p=0·105) for cardiovascular disease-related mortality, corresponding to an excess of 66 (95% CI 7-125) cardiovascular disease-related hospital admissions, including 29 (0-53) additional myocardial infarction-related hospital admissions and 46 (13-73) additional deaths from cardiovascular disease. In the 4 subsequent years, we found no evidence of an association of these outcomes with earthquake damage. INTERPRETATION: Rates of cardiovascular disease and myocardial infarction were increased in people living in areas with more severely damaged homes in the first year after a major earthquake. Policy responses to reduce the effect of earthquake damage on cardiovascular disease could include pre-earthquake measures to minimise building damage, early wellbeing interventions within the first year to address post-earthquake stress, and enhanced provision of cardiovascular disease prevention and treatment services. FUNDING: Healthier Lives National Science Challenge and Natural Hazards Research Platform, Ministry of Business, Innovation and Employment.

Spatio-temporal variation of mood and anxiety symptom treatments in Christchurch in the context of the 2010/11 Canterbury earthquake sequence.

This article explores the spatio-temporal variation of mood and anxiety treatments in the context of a severe earthquake sequence. The aim was to examine a possible earthquake exposure effect, identify populations at risk and areas with particularly large mood and anxiety treatment rate increases or decreases in the affected Christchurch urban area. A significantly stronger increase of mood and anxiety treatments among residents in Christchurch compared to others in New Zealand have been found, as well as children and elderly identified as especially vulnerable. Spatio-temporal cluster analysis and Bayesian spatio-temporal modelling revealed little changes in mood and anxiety treatment patterns for most parts of the city, whereas areas in the less affected north and northwest showed the strongest increases in risk. This effect may be linked to inner-city mobility activity as a consequence of the earthquakes, but also different levels of community cohesion after the disaster, which merit further research.