Changes in awareness of cancer risk factors among adult New Zealanders (CAANZ): 2001 to 2015.

Behaviour change, specifically that which decreases cancer risk, is an essential element of cancer control. Little information is available about how awareness of risk factors may be changing over time. This study describes the awareness of cancer risk behaviours among adult New Zealanders in two cross-sectional studies conducted in 2001 and 2014/5.Telephone interviews were conducted in 2001 (n = 436) and 2014/5 (n = 1064). Participants were asked to recall things they can do to reduce their risk of cancer. They were then presented with a list of potential risk behaviours and asked if these could increase or decrease cancer risk.Most New Zealand adults could identify at least one action they could take to reduce their risk of cancer. However, when asked to provide specific examples, less than a third (in the 2014/5 sample) recalled key cancer risk reduction behaviours such as adequate sun protection, physical activity, healthy weight, limiting alcohol and a diet high in fruit. There had been some promising changes since the 2001 survey, however, with significant increases in awareness that adequate sun protection, avoiding sunbeds/solaria, healthy weight, limiting red meat and alcohol, and diets high in fruit and vegetables decrease the risk of developing cancer.

SunSmart Accreditation and Use of a Professional Policy Drafting Service: Both Positively and Independently Associated with High Sun Protective Hat Scores Derived from Primary School Policies.

BACKGROUND: The head and neck are exposed to the highest solar ultraviolet radiation levels and experience a disproportionate skin cancer burden. Sun protective hats can provide an effective barrier. Since early life exposure contributes to skin cancer risk, the World Health Organisation recommends prevention programmes in schools. The New Zealand SunSmart Schools programme is one example. Two criteria concern wearing hat outdoors: students are required to wear a hat providing protection for the face, neck, and ears; if a suitable hat is not worn, students must play in shaded areas. OBJECTIVES: To investigate two internationally relevant interventions as plausible statistical predictors of hat policy strength: (1) skin cancer primary prevention programme membership, (2) use of a professional policy drafting service. METHODS: Of 1,242 (62%) eligible schools participating in a 2017 national survey, 1,137 reported a sun protection policy and 842 were available for categorising and allocating protective scores (0-3). RESULTS: In multinomial (polytomous) logistic regression models of cross-sectional association, adjusted for school characteristics, SunSmart accredited schools and those utilising a policy drafting service were independently significantly more likely than their counterparts to obtain the most protective compared to the least protective hat score (respectively, RRR 6.48: 95% CI 3.66, 11.47; 7.47: 3.67, and 15.20). For the dichotomous shade measure, similar associations were found using adjusted logistic regression (OR 3.28: 95% CI 2.11, 5.09; 2.70: 1.54, 4.74). CONCLUSIONS: Our findings provide support for two plausible interventions that could potentially be implemented beneficially in primary schools via established infrastructure in any jurisdiction, internationally.

Sun protection practices in New Zealand secondary schools: a 2014 baseline study.

OBJECTIVE: Guided by the established primary school SunSmart programme, a survey of secondary schools' sun protection policies, planning, behavioural expectations, curriculum content and environment was undertaken in order to establish a baseline to inform advocacy and secondary level programme development. METHODS: All 448 principals of state or state integrated public secondary schools identified from the Ministry of Education database were mailed a hard copy questionnaire. School sun protection practices were assessed and a summative, non-weighted, 11-item Total Sun Protection Score (TSPS) was created. Associations between TSPS and socio-demographic factors, as well as school sun protection policy, were investigated using unadjusted and multiple linear regressions. RESULTS: Usable responses received from 211 of the 448 schools (47% participation) indicated reasonable representativeness of eligible schools, but under-representation of low socioeconomic decile institutions (p = 0.003) and those with the smallest roll size (p = 0.004). Only 50% of schools reported having a sun protection policy. The least attained TSPS components were outdoor event planning (17.1%), student breaks (16.6%), sun-protective clothing (8.5%) and shade provision (6.2%). The mean (SD) TSPS was 4.58 (2.06). In multivariable analysis, TSPS was statistically significantly positively associated with having a sun protection policy (p < 0.001) and the presence of primary level classes (p < 0.001) - the latter suggesting a possible influence of programme continuity, but negatively associated with integrated school status (p = 0.036). CONCLUSION: A standard SunSmart programme could be promoted to all schools, irrespective of socioeconomic decile, overall roll size, gender status or regional population density. Low attainment of some TSPS components indicates targeting priorities.

Screening for prostate cancer: what do general practitioners think?

AIM: To determine how general practitioners in New Zealand view screening for prostate cancer and the extent to which this is undertaken in general practice. METHOD: A questionnaire survey of a random sample of 500 general practitioners. RESULTS: Completed questionnaires were received from 317 of an eligible sample of 462. Approximately 50% believed digital rectal examination (DRE) and prostate specific antigen (PSA) were effective screening tests for prostate cancer and that asymptomatic men should be screened; 40% believed all men aged 50 years or more should be screened using either DRE or PSA. The majority of the general practitioners currently screen at least some of the men aged 50 years or more on their lists using DRE or PSA regardless of beliefs about the efficacy of the tests. The results also indicated that significantly more general practitioners in the age groups 50-59 years and 60 years and over believed asymptomatic patients should be screened with DRE or PSA. CONCLUSION: Despite the absence of evidence to support screening for prostate cancer using DRE or PSA and the increasing number of professional organisations releasing guidelines and statements to that effect, the majority of the general practitioners who participated in this survey are screening some of their patients aged 50 years or more using DRE and/or PSA.

General practice consultations involving pigmented naevi presented for assessment of malignancy.

AIM: To outline the initial general practice care of pigmented naevi presented for assessment of malignancy. METHOD: Fifty six general practitioners completed a brief record for each patient presenting a pigmented skin lesion for assessment of malignancy; records were maintained prospectively for periods over October 1988 to April 1989. 2614 records were received. RESULTS: Numbers of consultations increased sharply with age to peaks at 15-19 for men and 30-44 for women; at ages 20 44 the sex ratio was 1.9 (F/M). Lesions were usually typical (51%) or atypical (24%) moles. 22% of patients were biopsied by the practitioner and 8% were referred, to dermatologists (4%) or surgeons (4%). CONCLUSIONS: The age pattern of presentations is younger than is optimal. General practitioners' decisions and actions are of crucial importance in the effective functioning of melanoma early detection programmes.

Targeting early detection of malignant melanoma of the skin.

Incidence and mortality rates, and clinical stage at diagnosis were analysed for malignant melanoma of the skin in recent years to assist in identifying high risk groups. Over 12 years to 1985-6 age standardised melanoma mortality rates in the nonMaori population increased 90% among men and 16% among women. In most age groups the male death rate was twice the female rate. Almost half the deaths from melanoma in 1983-6 were in men aged 45 or older. Age standardised incidence rates, for each sex, continued to increase to 1983-4. Among older age groups melanomas were less likely to be localised at diagnosis. This fall in localisation occurred at much younger ages (about 40) among men than among women. Middle aged men and older men and women are important target groups for education about the early detection of melanoma.

Trends in nonmelanoma skin cancer mortality.

Nonmelanoma skin cancer mortality rates for recent decades show a biphasic pattern: from 1950-65 rates decreased; from 1966-86 rates increased. Age standardised mortality rates for 35-74 year old males increased from 1.6 (95% CI, 1.3-1.9) deaths per 100,000 person years in 1966-72 to 2.3 (95% CI, 2.0-2.5) deaths per 100,000 person years in 1980-86. Rates in women were lower but showed a similar percentage increase (46%), between these periods, to that observed for men (44%). The increased mortality from 1966 was presumably a result of increased ultraviolet exposure.

Primary malignant melanoma of skin in four regions of New Zealand.

AIMS: to describe the incidence and thickness of a representative collection of melanomas occurring in recent years in New Zealand. METHODS: all pathology reports of primary malignant melanoma of the skin, in defined periods in 1987-9, were collated for four regions of New Zealand. RESULTS: nonMaori incidence rates were 52 and 58 melanomas per 100,000 person years for men and women, respectively. These rates are much higher than the 24 per 100,000 person years for melanoma registrations in 1983-4. The age standardised invasive melanoma rate of 35 per 100,000 person years was higher than those of most Australian states and close to the rate for Queensland in 1986. Preinvasive melanomas comprised 26% of all melanomas. Of invasive melanomas, 58% in men and 55% in women were less than 0.76 mm in thickness; 7% of invasive melanomas in men and 5% in women were at least 3.5 mm thick. CONCLUSIONS: increasingly early detection of malignant melanomas in successive years is likely to have contributed to the recent increase in incidence, perhaps to a major degree, but an environmental cause cannot be excluded.

Factors affecting participation in mammography screening.

AIMS: To assess factors influencing attendance or nonattendance at the first round of a population based mammography screening programme, in New Zealand. METHOD: Representative samples of women who responded to an invitation to attend screening, and women who did not respond, were interviewed by telephone, by an interviewer independent of the screening programme. The response rates in those identified were 98% for attenders and 86% for nonattenders, giving final samples of 191 and 174 respectively. However, more nonattenders could not be contacted or had no known phone number. RESULTS: Reasons given for attendance were primarily the need for reassurance, to detect breast cancer early, and the fact that the programme was free, a pilot programme, or recommended by their family doctor. Seventeen percent of attenders had been influenced by positive reports from other women. Of the nonattenders, 7% were ineligible for mammography, 20% did not attend because of practical difficulties and convenience, and 20% expressed concern or fear of the procedure or were influenced by negative reports from other women. Attenders and nonattenders did not differ in regard to age, education, income, socioeconomic status, degree of worry when the invitation was received, or physical distance from their home to the screening centre, although nonattenders estimated the travel would take considerably longer than did attenders. Ninety percent of attenders intend to come to the second round of screening. Forty three percent of nonattenders intend to participate at future rounds of screening, this figure being 80% in those who did not attend because of logistic or convenience reasons, and 27% for those who did not attend because of fear or negative reports. CONCLUSIONS: The main reasons given for nonattendance are approximately equally divided between practical difficulty, and negative attitude towards the process. Most of those who did not attend for reasons of convenience intend to participate at future rounds, so that overall almost half of nonattenders intend to participate at future rounds. Therefore we recommend that invitations for future screening rounds should be sent to women who do not participate in the first round of population based screening.

New Zealand hospital records insufficient for vitamin K study.

AIMS: To assess the availability and completeness of existing hospital records, required for a proposed case-control study of vitamin K administration to neonates and childhood cancer. METHODS: We surveyed 44 hospitals, to see whether they had kept records for children born during 1962-87. Additionally, we sought the neonatal records of 44 Dunedin-born people who would be in the proposed study if it went ahead. We abstracted details of vitamin K administration from the records found. RESULTS: There were 36 responses to our survey (82%). For two-thirds of the hospitals, neonatal records were not available for all of the period 1962-87. The commonest reason for unavailability of records was that they had been destroyed. Neonatal records could be found for 34 (77%) of those born in Dunedin. Although 30 records indicated that vitamin K had been given, only 17 gave the route of administration. CONCLUSIONS: Our proposed study is not feasible because of the poor availability of records and the lack of details recorded. We support the introduction of regulations requiring hospitals to retain health information for a specified time, and we argue that the minimum period for hospitals should be longer than has been proposed.

The lifetime occurrence of sexually transmitted diseases among a cohort aged 21.

AIMS: To determine the lifetime occurrence of sexually transmitted diseases (STDs) among a cohort aged 21. METHODS: Participants were interviewed at aged 21 as part of a multidisciplinary health and development study. Questions on STDs and sexual behaviour were presented by computer. RESULTS: Of the cohort members known to be alive, 92% responded. Among the sexually experienced 8.6% of the men and 17.3% of the women reported ever having had an STD. Genital warts and chlamydial infection were the commonest STDs among the men, and chlamydial infection, genital warts, and genital herpes among the women. General practice was the commonest place for treatment, and only a minority of people were treated at sexual health clinics. The risk of having an STD increased steeply with the lifetime number of sexual partners. CONCLUSIONS: STDs are common problems among young New Zealanders, especially women. The rate was as high as the US. Prevention should be directed at increasing the use of condoms, but education aimed at reducing the number of sexual partners and delaying the onset of sexual involvement should be considered seriously. A more coordinated approach to treatment is required to take into account the diversity of settings where STDs are treated. Surveillance of STDs needs to be extended, as currently the only data are from sexual health clinics.

Breast cancer surgery in New Zealand: consensus or variation?

AIMS: To explore how patients with early breast cancer are managed surgically in New Zealand. METHODS: A questionnaire was mailed to 195 surgeons registered as general surgeons. RESULTS: Replies were received from 112 of the 186 currently working surgeons (60%), of whom 76 indicated that they treated patients with breast disease. Six per cent indicated that they treated > 50 newly diagnosed breast cancer patients in 1994. A minority, 29%, had formal protocols documented for the surgical management of breast cancer patients in their unit. One-third would make the decision about treatment themselves, two-thirds would involve other specialties. Almost all would offer the patient a choice of treatment when this was appropriate. Only 9% would recommend mastectomy for a T1/2NO tumour located in the upper outer breast quadrant. There were no significant differences between surgeons when divided by regional health authority, type of hospital and numbers of patients treated annually. CONCLUSIONS: There appears to be agreement amongst surgeons regarding the preferred form of surgical treatment of patients with stage I or II disease. The results indicate that the surgical treatment of early stage disease is consistent with published guidelines.

A survey of urban and rural participants in the Otago-Southland pilot breast cancer screening programme.

AIMS: By surveying participants in a pilot breast cancer screening programme, to measure satisfaction with the screening service, to provide feedback for programme staff, to obtain an indication of future participation, and to collect information about costs to women. METHODS: A self administered questionnaire was posted to representative samples of urban and rural women (total 474) who had participated in the Otago-Southland pilot breast cancer screening programme in its first year of operation. RESULTS: There was a 93% response rate to the survey, after one reminder letter. Although some demographic characteristics of urban and rural women differed, their opinions about the screening programme were similar. Satisfaction with the service is extremely high, with 94% of respondents planning to participate again in two years. CONCLUSIONS: The Otago-Southland pilot programme provides a service which is regarded as satisfactory by the great majority of participants.

Once is enough--why some women do not continue to participate in a breast cancer screening programme.

AIM: To assess the reasons why many women who have been screened once in a breast screening programme decline an invitation for further screening. METHODS: Telephone interview survey of a sample of such women; for questions relating to their experience of previous mammography, comparison to data on a representative sample of first screen attendees. The subjects were women who had attended the first round of the Otago-Southland breast cancer screening programme in 1991-1994, who were eligible for re-screening but had been rescreened; age range 50-62. RESULTS: From programme records, 86% of women who were eligible for a second screen accepted it. Of the women not recorded as having had a second screen, some had attended for a second screen; some had not been invited until they had become age ineligible and some had received no invitation for re-screening. Of women who had received and declined an invitation for re-screening (n = 81), the major reason (46%) was their previous mammogram being painful. Other factors contributing were illness in themselves or their spouse, practical difficulties arranging time and negative experiences with staff in the previous mammography, although these related to relatively few women. A few women thought mammography would be of no benefit, and a few thought re-screening was unnecessary because their first mammography had been normal, or because they practise self-examination. CONCLUSIONS: Ensuring that all women eligible for further screening do get invited could substantially increase the re-screening rate. Even women who have declined previous invitations should be offered further invitations, as a substantial proportion with to be screened. Flexible and convenient appointment times are the main modifiable logistic issue. The major factor influencing non-participation with further screening is a painful experience of mammography. Innovative approaches, either to reduce the pain or to reduce the impact of the pain on the woman's attitude to re-screening, should be trialed.

The general practitioner's role in breast cancer screening: a survey in Otago-Southland.

AIMS: To study the experience of general practitioners in Otago and Southland with the existing breast cancer screening programme and the reviews on future programmes. METHODS: A questionnaire was sent to all 210 general practitioners in Otago and Southland in June 1996. RESULTS: The response rate was 71%. All the 141 respondents except one encouraged eligible women to take part in the programme; this was done mainly during individual doctor-patient consultations, by pamphlets and posters, and in the work of the practice nurse. Ten percent of practitioners had a practice-based recall system for breast cancer screening. Seventy-five percent of general practitioners currently provide a list of eligible women to the programme, and of these, 52% check the list to exclude ineligible women. Only 24% of practitioners supplying a patient list to the programme reported that a patient had ever requested that their name be excluded from the list. Twenty-five percent of general practitioners providing lists had a notice in the waiting room stating that. Of those who did not provide lists, concerns about logistics, ethical issues and cost were raised, although 40% of these general practitioners intended to provide lists in the future. In a future programme, 57% of general practitioners felt they should be paid for supplying lists defined by age only and 82% felt they should be paid for supplying a list of women eligible by both age and medical history. Most general practitioners felt that general practitioner lists were the preferred source for invitations to the breast screening programme and that general practitioners had an important part in any future programme. Screening at the ages 50-64 (as currently proposed) is supported by 95% of general practitioners; in addition, 64% supported screening at ages 65-69. Only a minority of general practitioners supported screening at ages 40-49 or ages 70-74. Most general practitioners would offer screening to women under age 50 with either a strong or a weak family history, or even with a past history of a fibroadenoma. CONCLUSIONS: These results show that almost all general practitioners support breast cancer screening programmes and feel that they have an important role in future programmes. The majority support extension of the programme to ages 65-69, but not to ages 40-49. The majority support screening women with individual risk factors at ages under 50, although their responses show that better information on the importance of different risk factors is required.

Comparison of fatalities from work related motor vehicle traffic incidents in Australia, New Zealand, and the United States.

OBJECTIVE: To compare the extent and characteristics of motor vehicle traffic incidents on public roads resulting in fatal occupational injuries in Australia, New Zealand (NZ), and the United States (US). DESIGN AND SETTING: Information came from separate data sources in Australia (1989--92), NZ (1985--98), and the US (1989--92). METHODS: Using data systems based on vital records, distributions and rates of fatal injuries resulting from motor vehicle traffic incidents were compared for the three countries. Common inclusion criteria and occupation and industry classifications were used to maximize comparability. RESULTS: Motor vehicle traffic incident related deaths accounted for 16% (NZ), 22% (US), and 31% (Australia) of all work related deaths during the years covered by the studies. Australia had a considerably higher crude rate (1.69 deaths/100,000 person years; 95% confidence interval (95% CI) 1.54 to 1.83) compared with both NZ (0.99; 95% CI 0.85 to 1.12) and the US (0.92; 95% CI 0.89 to 0.94). Industry distribution differences accounted for only a small proportion of this variation in rates. Case selection issues may have accounted for some of the remainder, particularly in NZ. In all three countries, male workers, older workers, and truck drivers were at higher risk. CONCLUSIONS: Motor vehicle traffic incidents are an important cause of work related death of workers in Australia, NZ, and the US. The absolute rates appear to differ between the three countries, but most of the incident characteristics were similar. Lack of detailed data and inconsistencies between the data sets limit the extent to which more in-depth comparisons could be made.

The use of quality of life data in clinical practice.

A large amount of quality of life (QoL) information has been and is being collected in the oncology setting but it is unclear how such data influence decisions about the management of individual patients. A questionnaire designed specifically for the study was mailed to 260 senior oncologists to investigate how QoL data are being used outside the context of cancer clinical trials; replies were received from 154 (59%). Approximately 80% believed QoL information should be collected prior to the commencement of treatment, but less than 50% actually did so. Similarly, less than 50% assessed QoL as a method of monitoring the responses to treatment even when the treatment goal was palliation. The barriers to collecting such data were time and resource constraints, perceived lack of an appropriate instrument and a belief that QoL assessments were unnecessary. Other than making a subjective assessment based on examination and history, 73 (47%) used either standardized questionnaires or a system derived in their unit to assess the QoL of their patients. Given an appropriate instrument the majority believed that QoL data could be collected on a routine basis. The main barriers to collecting QoL data are logistic and the challenge remains to develop a method of collecting and analysing QoL information in a manner which enhances decision making.

Otago Women's Health Survey 30-month follow-up. I: Onset patterns of non-psychotic psychiatric disorder.

Women who showed new psychiatric morbidity after a 30-month follow-up of a random community sample of New Zealand women were compared with those who were free of psychiatric disorder at follow-up. There were 25 new cases among the 215 women who were originally not psychiatric cases and who were re-interviewed. Using the weighted back population data to obtain prevalence figures for the general population, 6.9% became new cases over the two and a half years. Those who developed psychiatric disorder initially showed more psychiatric symptoms at a subdiagnostic level. Baseline factors that preceded the onset of psychiatric disorder were being separated or divorced, coming from a large family, having poor social networks, living alone, having few social role responsibilities such as paid employment or motherhood, and having poor physical health. An additional cross-sectional association at follow-up was poor financial security. Good social networks were closely linked with the number of a woman's social roles and appeared to protect her against the onset of psychiatric disorder. Consistent with the initial cross-sectional study, the follow-up data provide no support for marriage and child-care being risk factors for female psychiatric disorder. However, in New Zealand, these factors indicate social integration and are associated with superior mental health.

Otago Women's Health Survey 30-month follow-up. II: Remission patterns of non-psychotic psychiatric disorder.

The follow-up phase of a random community sample of New Zealand women contrasted the social, demographic, and clinical characteristics of those women whose initial psychiatric disorder had remitted with those who continued to describe significant psychiatric morbidity, two-and-a-half years later. Of 272 women studied at baseline and reinterviewed, 57 had originally been psychiatric cases. Twenty-five of those women (44%) were still cases at follow-up. Using figures that statistically reconstructed the original population from the stratified sample, the remission rate in the parent population was 61% over the two-and-a-half years (an average of 24% per annum). Women less likely to experience remission of their psychiatric disorder were of mid-age (45-64 years), with poor finances and with poor social relationships at the initial assessment. Although the age finding replicates a previous report from an Epidemiological Catchment Area study, it is not clear whether it is a universal relationship, true for all cultures. The alterations in social roles faced by women after child-rearing is a possible explanation, at least for New Zealand.