Cohort profile: Nga Kawekawe o Mate Korona | Impacts of COVID-19 in Aotearoa - a prospective, national cohort study of people with COVID-19 in New Zealand.

PURPOSE: The COVID-19 pandemic has had significant health, social and economic impacts around the world. We established a national, population-based longitudinal cohort to investigate the immediate and longer-term physical, psychological and economic impacts of COVID-19 on affected people in Aotearoa New Zealand (Aotearoa), with the resulting evidence to assist in designing appropriate health and well-being services for people with COVID-19. PARTICIPANTS: All people residing in Aotearoa aged 16 years or over, who had a confirmed or probable diagnosis of COVID-19 prior to December 2021, were invited to participate. Those living in dementia units were excluded. Participation involved taking part in one or more of four online surveys and/or in-depth interviews. The first wave of data collection took place from February to June 2022. FINDINGS TO DATE: By 30 November 2021, of 8735 people in Aotearoa aged 16+ who had COVID-19, 8712 were eligible for the study and 8012 had valid addresses so were able to be contacted to take part. A total of 990 people, including 161 Tangata Whenua (Maori, Indigenous peoples of Aotearoa) completed one or more surveys; in addition, 62 took part in in-depth interviews. Two hundred and seventeen people (20%) reported symptoms consistent with long COVID. Key areas of adverse impacts were experiences of stigma, mental distress, poor experiences of health services and barriers to healthcare, each being significantly more pronounced among disabled people and/or those with long COVID. FUTURE PLANS: Further data collection is planned to follow-up cohort participants. This cohort will be supplemented by the inclusion of a cohort of people with long COVID following Omicron infection. Future follow-ups will assess longitudinal changes to health and well-being impacts, including mental health, social, workplace/education and economic impacts of COVID-19.

The alcohol industry-A commercial determinant of poor health for Rainbow communities.

BACKGROUND: Alcohol use is an area of challenge for health promotion internationally. The alcohol industry operates as a key commercial determinant of health in that its actions contribute to alcohol misuse, resulting in a range of health and social harms to individuals, families and communities. Rainbow people (including those who identify as lesbian, gay, bisexual, transgender or gender diverse) are one group experiencing considerable harm from alcohol use. METHODS: Data from 24 focus groups involving 131 people held in six cities in New Zealand during 2018, were used to explore local understandings of the ways in which the alcohol industry operates as a commercial determinant of health for Rainbow communities. The focus group discussions were analysed thematically. RESULTS: Three key themes were identified. First, the alcohol industry was identified as present in the 'everyday', through targeted alcohol promotion to Rainbow people, and due to the centrality of bars to their social and cultural landscapes. Second, participants recognised the benefits of alcohol industry support for Rainbow communities. Last, an opposing view was articulated, with the alcohol industry and its commercial activities viewed negatively. CONCLUSIONS: These findings highlight that alcohol as a commodity and the alcohol industry are successfully and firmly embedded within Rainbow communities. Overall, given alcohol is widely regarded in a positive way, this is likely to create difficulties for health promotion efforts to reduce alcohol related harm in these communities.

Justifications for heavy alcohol use among gender and sexually diverse people.

A range of research reports that many gender and sexually diverse people drink alcohol at heavy levels. This study used 24 focus groups to explore shared understandings of alcohol use among gender and sexually diverse people living in New Zealand. An inductive, data-driven thematic analysis was employed to identify explanations for heavy drinking among gender and sexually diverse people. Three key explanations were articulated: alcohol is needed for socialising; drinking helps coping with stress; alcohol and drug treatment services are inadequate. These results demonstrate justifications for heavy drinking in certain contexts. This behaviour runs counter to public health approaches and messages that highlight low-risk levels of drinking or not drinking as desirable. Public health interventions should continue to address alcohol use at a whole population level but should be supplemented by policy and interventions that take into account the sociocultural contexts and structural conditions that encourage drinking among gender and sexually diverse people.

Enabling participation for disabled young people: study protocol.

BACKGROUND: Participation in community life is vital for health and wellbeing, promoting a sense of belonging, networks of social support and opportunities for physical activity. Disabled young people have lower levels of mobility and participation in recreational activities (physical, social and cultural), education and employment, than their peers without disabilities. This has implications for their health and wellbeing and life course opportunities. Previous research on the participation levels of disabled young people has primarily relied on parent/caregiver reports and been oriented to home and school environments. This study investigates how physical and social environmental factors cohere to support or restrict the everyday mobility and participation of disabled young people. METHODS/DESIGN: The study is located in Auckland, Aotearoa/New Zealand (NZ). Participants comprise 35 young people aged 12-25 years with mobility, vision or hearing impairments. A mixed-methods research design combines objective (global positioning systems, accelerometers, geographical information systems) and self-report measures (travel diaries, and questionnaires) to assess young people's mobility and levels of participation in leisure/educational and employment activities with in-depth interviews exploring their everyday experiences of inclusion/exclusion, and factors enabling or constraining community participation. Parents/caregivers and disability sector key informant viewpoints on the community participation of disabled young people have also been gathered through in-depth interviews. Follow-up workshops with young people and parents/caregivers will identify pathways to increase participation and challenge current disabling practices. DISCUSSION: This study looks beyond barriers in the physical environment to the interplay of personal, social and physical factors that enable or constrain the community participation of disabled young people. In keeping with the study's overarching goal of increasing opportunities for effective community participation and full citizenship of disabled young people, research methods were applied flexibily - negotiated and adapted to maximise each young person's participation in light of their abilities and preferences.

Social and built-environment factors related to children's independent mobility: The importance of neighbourhood cohesion and connectedness.

This study examines aspects of neighbourhood social environments (namely, neighbourhood safety, cohesion and connection) and child-specific built environment attributes in relation to children's independent mobility. The results suggest that children aged 8-13 years with parents who perceive their neighbourhood as more cohesive and more connected, and are located closer to school, engaged in higher levels of independently mobile trips. The qualitative component of this research revealed that for NZ European, Maori, Samoan and other Pacific parents, 'people danger' was the most common concern for letting their children go out alone, whereas for Asian and Indian parents, 'traffic danger' was the most common reason for their concern.

Neighbourhoods for Active Kids: study protocol for a cross-sectional examination of neighbourhood features and children's physical activity, active travel, independent mobility and body size.

INTRODUCTION: New Zealand children's physical activity, including independent mobility and active travel, has declined markedly over recent decades. The Neighbourhoods for Active Kids (NfAK) study examines how neighbourhood built environments are associated with the independent mobility, active travel, physical activity and neighbourhood experiences of children aged 9-12 years in primary and intermediate schools across Auckland, New Zealand's largest city. METHODS AND ANALYSIS: Child-specific indices of walkability, destination accessibility and traffic exposure will be constructed to measure the built environment in 8 neighbourhoods in Auckland. Interactive online-mapping software will be used to measure children's independent mobility and transport mode to destinations and to derive measures of neighbourhood use and perceptions. Physical activity will be measured using 7-day accelerometry. Height, weight and waist circumference will be objectively measured. Parent telephone interviews will collect sociodemographic information and parent neighbourhood perceptions. Interviews with school representative will capture supports and barriers for healthy activity and nutrition behaviours at the school level. Multilevel modelling approaches will be used to understand how differing built environment variables are associated with activity, neighbourhood experiences and health outcomes. DISCUSSION: We anticipate that children who reside in neighbourhoods considered highly walkable will be more physically active, accumulate more independent mobility and active travel, and be more likely to have a healthy body size. This research is timely as cities throughout New Zealand develop and implement plans to improve the liveability of intensifying urban neighbourhoods. Results will be disseminated to participants, local government agencies and through conventional academic avenues.

Mental health promotion for gay, lesbian, bisexual, transgender and intersex New Zealanders.

INTRODUCTION: A number of studies have identified that gay, lesbian, bisexual, transgender, and intersex (GLBTI) people have poorer mental health than the general population. This article describes current mental health promotion and service provision for GLBTI people in New Zealand, and the views of stakeholders on current service delivery and concerns facing the sector. METHODS: An email survey of service providers gathered descriptive data about mental health promotion and services provided for GLBTI people. Data obtained from interviews with key informants and online submissions completed by GLBTI individuals were analysed thematically. FINDINGS: Five organisations provide clear, specific and utilised services and programmes to some or all of the GLBTI populations. Twelve GLBTI-focused mental health promotion resources are identified. The analysis of data from key informants and GLBTI respondents identified factors affecting mental health for these populations occurring at three levels-macro-social environment, social acceptance and connection, and services and support. CONCLUSION: While GLBTI individuals have the same basic mental health promotion and service provision needs as members of the general population, they have additional unique issues. To enhance the mental health of GLBTI New Zealanders, a number of actions are recommended, including building sector capacity, allocating sufficient funding, ensuring adequate research and information is available, and reducing stigma, enhancing young people's safety, and supporting practitioners through training and resources. An important role for government, alongside GLBTI input, for improving mental health is noted.

Kids in the city study: research design and methodology.

BACKGROUND: Physical activity is essential for optimal physical and psychological health but substantial declines in children's activity levels have occurred in New Zealand and internationally. Children's independent mobility (i.e., outdoor play and traveling to destinations unsupervised), an integral component of physical activity in childhood, has also declined radically in recent decades. Safety-conscious parenting practices, car reliance and auto-centric urban design have converged to produce children living increasingly sedentary lives. This research investigates how urban neighborhood environments can support or enable or restrict children's independent mobility, thereby influencing physical activity accumulation and participation in daily life. METHODS/DESIGN: The study is located in six Auckland, New Zealand neighborhoods, diverse in terms of urban design attributes, particularly residential density. Participants comprise 160 children aged 9-11 years and their parents/caregivers. Objective measures (global positioning systems, accelerometers, geographical information systems, observational audits) assessed children's independent mobility and physical activity, neighborhood infrastructure, and streetscape attributes. Parent and child neighborhood perceptions and experiences were assessed using qualitative research methods. DISCUSSION: This study is one of the first internationally to examine the association of specific urban design attributes with child independent mobility. Using robust, appropriate, and best practice objective measures, this study provides robust epidemiological information regarding the relationships between the built environment and health outcomes for this population.

Towards quality Pacific services: the development of a service self-evaluation tool for Pacific addiction services in New Zealand.

OBJECTIVES: To describe the development and use of a quality improvement service self-evaluation tool within Pacific addiction services in New Zealand. METHODS: The study involved two phases: (i) a development phase; and (ii) a testing phase. In Phase I, a preliminary tool was developed and piloted with two Pacific addiction drugs services. It was modified to reduce the number of statements, aligning the statements with the National Sector Standards and incorporating Pacific concepts, themes and motifs that underlie the practices of Pacific providers. In Phase II the resulting tool, named Potalanoa, was then tested in four Pacific addiction treatment services. All services provided feedback on the user acceptability and feasibility of the tool, usefulness and adaptability of the tool to specific service settings. RESULTS: The participating services generally found the evaluation tool to be understandable, acceptable and useful. Each service provider demonstrated varied use or implementation strategies for Potalanoa with a general consensus that incorporating the evaluation process within existing team meetings would be ideal. The involvement of all staff within a group setting was also found to be an essential part of the process and a trained facilitator helped with the flow of discussion. CONCLUSIONS: The study found that there is a need for an evaluation tool for the provision of quality services. For Pacific services it was important that the tool recognize and capture the Pacific approaches utilized in their service delivery. Overall the tool was found to be acceptable and feasible to use, assisted services to identify areas of achievement and to prioritize areas requiring improvement and was adaptable to 'real world' Pacific addiction treatment settings in New Zealand.

Children admitted to hospital following unintentional injury: perspectives of health service providers in Aotearoa/New Zealand.

BACKGROUND: Unintentional injuries are the leading cause of death and hospitalisation among New Zealand children, with indigenous Maori and ethnic minority Pacific children significantly over represented in these statistics. International research has shown that many children hospitalised for injury, as well as their families experience high levels of stress, and ethnic disparities in the quality of trauma care are not uncommon. The research on which this paper is based sought to identify key issues and concerns for New Zealand's multi-ethnic community following hospitalisation for childhood injury in order to inform efforts to improve the quality of trauma services. This paper reports on service providers' perspectives complementing previously published research on the experiences of families of injured children. METHODS: A qualitative research design involving eleven in-depth individual interviews and three focus groups was used to elicit the views of 21 purposefully selected service provider key informants from a range of professional backgrounds involved in the care and support of injured children and their families in Auckland, New Zealand. Interviews were transcribed and data were analysed using thematic analysis. RESULTS: Key issues identified by service providers included limited ability to meet the needs of children with mild injuries, particularly their emotional needs; lack of psychological support for families; some issues related to Maori and Pacific family support services; lack of accessible and comprehensive information for children and families; poor staff continuity and coordination; and poor coordination of hospital and community services, including inadequacies in follow-up plans. There was considerable agreement between these issues and those identified by the participant families. CONCLUSIONS: The identified issues and barriers indicate the need for interventions for service improvement at systemic, provider and patient levels. Of particular relevance are strategies that enable families to have better access to information, including culturally appropriate oral and written sources; improve communication amongst staff and between staff and families; and carefully developed discharge plans that provide care continuity across boundaries between hospital and community settings. Maori and Pacific family support services are important and need better resourcing and support from an organisational culture responsive to the needs of these populations.

Experiences of whanau/families when injured children are admitted to hospital: a multi-ethnic qualitative study from Aotearoa/New Zealand.

OBJECTIVES: Several quantitative studies in the international literature have described disparities in the provision of and access to health services for a variety of health conditions among 'minority' populations. This New Zealand qualitative study aimed to explore and describe the experiences of indigenous Maori and Pacific families (both minority populations) and Pakeha (New Zealand European) families when their children were admitted to hospital for an unintended injury. DESIGN: Twenty-three children (eight Máori, eight Pacific and seven Pákeha) who were admitted to hospital following an injury were selected using maximum variation sampling from a trauma database and snowball sampling. In-depth individual and group interviews undertaken with the child's whanau/family explored the issues they encountered in the hospital setting. The data were analysed by key ideas and coded into main themes. Each strand was analysed separately by lead researchers of the same ethnic group prior to a comparative synthesis of the overall findings. RESULTS: While many families praised the dedication of the staff, the interviews revealed important concerns regarding their encounters with hospitals and related health and support services. These could be broadly characterised as (a) inadequate communication and information; (b) difficulties negotiating an environment perceived as foreign; (c) the stress of conflicting demands placed on families; and (d) issues relating to ethnicity and cultural miscommunication. Of note, many Maori and Pacific whanau/families felt particularly alienated within the hospital setting and did not appear to see themselves as being entitled to high-quality information or services. CONCLUSION: The findings have important implications for the structure, professional and institutional practices in the delivery of health services. The research also indicates the need for wider societal policies that increase Maori and Pacific whanau/families' sense of entitlement to the full range of available support services, and reduce alienation within public institutions such as hospitals.

New Zealand Pacific peoples' drinking style: too much or nothing at all?

AIMS: To describe the alcohol consumption patterns and related harms of some Pacific peoples (Samoan, Cook Islands Maori, Tongan, Niuean, Fijian, and Tokelauan) living in Aotearoa (New Zealand), and to draw comparisons with measures from the general New Zealand population. METHODS: The Pacific Drugs and Alcohol Consumption Survey (PDACS) was carried out with 1103 randomly selected Pacific peoples aged between 13 and 65 years old who were resident in households throughout New Zealand. The survey used computer-assisted telephone interviewing (CATI) and computer assisted cell-phone interviewing (CACI). The interviews were carried out in 2002/03. We descriptively compare findings from the PDACS with those from the 2000 National Alcohol Survey (NAS). RESULTS: Fifty-seven percent of Pacific peoples were drinkers (males 61%, females 51%), compared with 85% of the general New Zealand population (males 88%, females 83%). The average annual consumption of absolute alcohol was 21 litres for Pacific drinkers (males 28 litres, females 14 litres) compared with 11 litres for general New Zealand population drinkers (males 16 litres, females 7 litres). The typical occasional quantity consumed by Pacific drinkers was eight drinks (males: nine drinks, females: five drinks) compared with four drinks for drinkers in the general New Zealand population (males: five drinks, females: around four drinks). Thirty-three percent of Pacific drinkers consumed enough to feel drunk at least weekly (males 41%, females 25%) compared with 9% of drinker in the general New Zealand population (males 13%, females 6%). Eighteen percent of Pacific males and 10% of Pacific females reported being physically assaulted by someone who had been drinking compared with 8% and 5% of national males and females respectively. Twenty-three percent of Pacific males and 16% of Pacific females got drunk when there was an important reason to stay sober, compared with 8% and 5% of general New Zealand males and females respectively. Nineteen percent of Pacific males and 21% of Pacific females reported being involved in a serious argument after they had been drinking compared with 12% and 8% of general New Zealand males and females respectively. CONCLUSIONS: The proportion of Pacific drinkers is less than the proportion of drinkers in the general New Zealand population. However, Pacific drinkers consume larger annual volumes and typical occasion amounts of absolute alcohol than drinkers in the general New Zealand population. Pacific peoples drinking patterns appear to be more harmful with greater proportions of Pacific peoples reporting violence and injury from other peoples' drinking, and greater proportions of Pacific drinkers reporting problems from violence and serious arguments as a result of their own drinking compared with the general New Zealand population and general New Zealand population drinkers.