What impact would tobacco retailer proximity limit have on tobacco availability in New Zealand?

INTRODUCTION

One policy option to reduce the density of tobacco retailers is to restrict the distance retailers can be located to each other. This study examined the impacts of proximity limits of 150 m, 300 m and 450 m between tobacco retailers in New Zealand and if critical threshold reduction in tobacco retailers of 90%-95% would be achieved.

METHODS

Using a spatial modelling approach, tobacco retailers were randomly removed based on a minimum distance between retailers until there were zero retailers within each scenario's minimum distance. This was repeated for all three proximity limit scenarios and descriptive statistics are provided for each.

RESULTS

Implementation of 150 m, 300 m or 450 m distance restrictions between tobacco retailers would result in an average reduction in availability of 35%, 49% and 58%, respectively. On average, the current median distance to the closest retailer increases from 110 m to 377 m, to 568 m or to 718 m, respectively. The average median distance from a retailer to the closest school also increases across the three proximity limits, from 1017 m to 1087 m, to 1149 m or to 1231 m, respectively. Reduced clustering in deprived areas would be most apparent if a 450 m restriction policy was implemented.

CONCLUSIONS

A proximity limit of 450 m would reduce retailers by 58%, but would not reach proposed critical behaviour-change threshold of 90%-95% required to reduce smoking prevalence independently. There is a need for a combination of policies, which focus on promoting equity, to achieve this bold endgame goal.

Healthy grocery delivery in the usual care for adults recovering from an acute coronary event: protocol for a three-arm randomised controlled trial

INTRODUCTION

Coronary heart disease is a major contributor to the global burden of disease. Appropriate nutrition is a cornerstone of the prevention and treatment of coronary heart disease; however, barriers including cost and access to recommended foods limits long-term adherence for many. We are conducting, in adults with coronary heart disease, a randomised controlled trial comparing usual care with two dietary interventions in which usual care is augmented by 12 weeks free delivered groceries.

METHODS AND ANALYSIS

Three hundred adults recovering from an acute coronary event will be recruited from outpatient cardiovascular services in three regions of Aotearoa New Zealand. Participants will be randomly allocated to three arms: usual care (control group), usual care and the free delivery of foods high in dietary fibre or usual care and the free delivery of foods high in unsaturated fats. Interventions duration is 12 weeks, with a further 12 months follow-up. The primary outcome measures are change in low-density lipoprotein (LDL) cholesterol concentration following the intervention, and a cost-effectiveness analysis of healthcare access and social costs in the year after the intervention. A broad range of secondary outcome measures include other blood lipids, anthropometry, glycaemia, inflammatory markers, gut microbiome, dietary biomarkers, food acceptability, dietary change and the facilitators and barriers to dietary change. The trial will determine whether the free provision of groceries known to reduce cardiovascular risk within usual care will be clinically beneficial and justify the cost of doing so. Results may also provide an indication of the relative benefit of foods rich in dietary fibre or unsaturated fats in coronary heart disease management.

ETHICS AND DISSEMINATION

This trial, The Healthy Heart Study, has Health and Disability Ethics Committee approval (20/NTB/121), underwent Māori consultation, and has locality authority to be conducted in Canterbury, Otago and Southland.

TRIAL REGISTRATION NUMBER

ACTRN12620000689976, U1111-1250-1499.

Quality of life in people living with HIV in Aotearoa New Zealand: an exploratory cross-sectional study

Quality of life (QoL) in people living with HIV (PLHIV) is reportedly worse than in people without HIV, with many factors impacting on this. We aimed to investigate QoL in PLHIV in New Zealand (NZ). In-person interviews were conducted including socio-demographic, health, social connectedness, and stigma-related questions. QoL was measured using the 13-question PozQoL Scale - summed to give a score between 13 and 65. Univariate linear regression was used to investigate factors associated with differences in PozQoL scores. PLHIV (n = 188) of different ethnicities from throughout NZ participated. The mean age was 47 years; 65% were men; 61% were men who have sex with men; 61% had been living with HIV for ≥10 years. The mean summary PozQoL score was 47.16. Factors associated with a lower mean PozQol included no sex in the last 12 months (-9.03), inability to meet basic needs (-7.47), ever (-6.49) or recently (-5.03), experiencing stigma or discrimination, mental health condition (-5.74), HIV diagnosis <5 years (-5.48), poor health (-5.43), being unemployed (-5.02), not having support (-4.71), and greater internalised stigma (-2.81). Improving QoL will require investment in peer support and community welfare programmes to better support PLHIV, and stigma reduction campaigns targeting the broader community.

Is the neighbourhood context important for a tobacco retailer proximity policy?

A spatial modelling approach was used to explore how a proximity limit (150 m, 300 m, and 450 m) between tobacco retailers may impact different neighbourhoods in New Zealand. Neighbourhoods were categorised into three density groups (0, 1-2, 3+ retailers). As the proximity limit increases, there is a progressive redistribution of neighbourhoods in the three density groups with, the 3+ density group incorporating fewer neighbourhoods and the 0 and 1-2 density groups conversely each consisting of more. The differing measures available at the neighbourhood level enabled our study to discern potential inequities. More directed policies targeting these inequities are needed.

Parental history of positive development and child behavior in next generation offspring: A two-cohort prospective intergenerational study

This study examined whether positive development (PD) in adolescence and young adulthood predicts offspring behavior in two Australasian intergenerational cohorts. The Australian Temperament Project Generation 3 Study assessed PD at age 19-28 (years 2002-2010) and behavior in 1165 infants (12-18 months; 608 girls) of 694 Australian-born parents (age 29-35; 2012-2019; 399 mothers). The Dunedin Multidisciplinary Health and Development Parenting Study assessed PD at age 15-18 (years 1987-1991) and behavior in 695 preschoolers (3-5 years; 349 girls) and their New Zealand born parents (age 21-46; 1994-2018; 363 mothers; 89% European ethnicity). In both cohorts, PD before parenthood predicted more positive offspring behavior (β_range  = .11-.16) and fewer behavior problems (β_range  = -.09 to -.11). Promoting strengths may secure a healthy start to life.

Could We See the End of Tobacco Being Sold in Bars and Pubs in New Zealand?

BACKGROUND

Disallowing the sale of tobacco wherever alcohol is consumed is one policy option to help achieve Smokefree 2025. This study aimed to investigate the prevalence of selling tobacco in New Zealand (NZ) on-license premises and explore attitudes toward the sale of tobacco.

METHODS

A sample of managers of on-license premises were asked by telephone about the importance of tobacco to their business, advantages and disadvantages of selling tobacco, and the impact of not being able to sell tobacco in the future. Logistic and linear regression analyses were used to investigate associations between on-license characteristics and selling status and importance scores, respectively.

RESULTS

Of on-license premises, 6.5% (95% CI: 5.3, 8.0) sold tobacco; 17.4% (95% CI: 14.0, 21.4) of hotels, 17.5% (95% CI: 13.8, 21.9) of taverns, and 1.3% (95% CI: 0.6, 3.2) of restaurants. Both retailer type and population density were associated with selling status. On-licenses were more likely to rate tobacco as "unimportant" (51.7%) to their business than "important" (30.0%), although premises where the closest tobacco retailer was at least 1 km away were associated with a higher score. Similar proportions of businesses were opposed to (45.7%) and supported (47.2%) the policy of removing all tobacco sales from on-license premises.

CONCLUSION

Few on-license premises in NZ sell tobacco. Most retailers would support transitioning out of selling tobacco before the 2025 Smokefree goal, and they believed ending sales of tobacco would not negatively affect their business. However, businesses and customers in rural areas may be more affected than others.

IMPLICATIONS

Many countries have tobacco-free goals, with several still developing their endgame strategies to achieve these goals. This study provides NZ and other jurisdictions with evidence useful in the development of such strategies. Having on-license alcohol retailers transition out of sales of tobacco would contribute to a reduction in tobacco availability. Moreover, the results of this study suggest that, in part due to declining tobacco sales and increased thefts, such a policy is likely to have the support of retailers. Policy developers should note, however, the potential for different impacts where the distance to the closest tobacco retailer is over 1 km or in rural areas.

Palliative and end of life care in undergraduate medical education: a survey of New Zealand medical schools

BACKGROUND

In New Zealand, 34% of deaths occur in the hospital setting where junior doctors are at the frontline of patient care. The death rate in New Zealand is expected to double by 2068 due to the aging population, but many studies report that graduates feel unprepared to care for people near the end of life and find this to be one of the most stressful parts of their work. International guidelines recommend that palliative and end of life care should be a mandatory component of undergraduate medical education, yet teaching varies widely and remains optional in many countries. Little is known about how medical students in New Zealand learn about this important area of clinical practice. The purpose of this study was to investigate the organisation, structure and provision of formal teaching, assessment and clinical learning opportunities in palliative and end of life care for undergraduate medical students in New Zealand.

METHODS

Quantitative descriptive, cross-sectional survey of module conveners in New Zealand medical schools.

RESULTS

Palliative and end of life care is included in undergraduate teaching in all medical schools. However, there are gaps in content, minimal formal assessment and limited contact with specialist palliative care services. Lack of teaching staff and pressure on curriculum time are the main barriers to further curriculum development.

CONCLUSIONS

This article reports the findings of the first national survey of formal teaching, assessment and clinical learning opportunities in palliative and end of life care in undergraduate medical education in New Zealand. There has been significant progress towards integrating this content into the curriculum, although further development is needed to address barriers and maximise learning opportunities to ensure graduates are as well prepared as possible.

Vaccine mandates in the time of Omicron

Nil.

Erythemal ultraviolet radiation exposure of high school rowers in Aotearoa/New Zealand

Athletes who compete in outdoor sports can receive potentially harmful levels of solar ultraviolet radiation (UVR). Rowing is a popular outdoor sport that takes place during the peak UVR season. Using electronic dosimeters attached to the shoulder strap of the rower's uniform, this study aimed to quantify the real-time solar UVR exposure experienced by high school rowers during competition. We measured personal UVR exposure (PE) during the time spent on the water in order to compete in a single rowing-race (race-time), when rowing administrators are responsible for athletes' wellbeing. Data collection took place in Aotearoa (New Zealand) at Lake Ruataniwha (44.28°S, 170.07°E), during two consecutive rowing seasons (December-February 2018-19 and 2019-20). Analysis of dosimeter data generated from 56 race-times over five regattas revealed a median personal UVR exposure (PE) of 1.15 standard erythemal dose (SED), where 1 SED is defined as an effective radiant exposure of 100 Jm^-2. Mean race-time was 46 min. Over two-thirds of race-times (69.6%) exceeded the Australian Radiation Protection and Nuclear Safety Agency recommendation of 1 SED being considered safe for most people in a day. An exposure of 1.5-3.0 SED produces perceptible erythema for people with light coloured skin and the lower parameter of 1.5 SED was exceeded in 14 (25.0%) of the race-times. By regatta, the median SED/h ranged from 0.96-2.40 and the median percentage of total concurrent ambient UVR ranged from 17 to 31%. Our results indicate that rowing is a high UVR sport and that races outside of peak UVR times also warrant the use of sun protection even when the UVI < 3. Given that acute and cumulative UVR exposure are recognised risk factors in the development of ocular diseases and skin cancers later in life, risk management guidelines for competitive school rowing will be incomplete until a long-term approach to well-being is considered and comprehensive sun protection measures adopted.

Preparing nurses for palliative and end of life care: A survey of New Zealand nursing schools

BACKGROUND

Nurses play a vital role in the care of people with advanced life-limiting illnesses, so palliative and end of life care is an essential skill nurses need to learn. Despite numerous reports in the international literature about educational developments in this area, there are widespread inconsistencies in undergraduate education, and graduates continue to report feeling unprepared for this part of their work. Little is known about how New Zealand nursing students learn about this important area of clinical practice.

OBJECTIVES

To obtain information about teaching content, organisation, delivery, assessment and clinical learning opportunities in palliative and end of life care in undergraduate nurse education in New Zealand.

DESIGN

Quantitative descriptive cross sectional study.

SETTINGS

Tertiary education institutions that provide the Bachelor of Nursing programme in New Zealand.

PARTICIPANTS

Academic leads and course coordinators.

METHODS

National online survey.

RESULTS

A total of 13/18 (72%) educational institutions completed the survey. All integrate palliative and end of life care in their teaching with an identified coordinator at 12 (92%) institutions. Between 1 and 10 h of formal teaching is provided at 11 (85%) institutions where lectures and tutorials are most comon. Clinical placements with specialist palliative care providers are scarce and limited to senior students as elective placements. Assessment of student learning in palliative and end of life care is carried out at seven (54%) institutions, and formally evaluated at 12 (92%). Lack of teaching time and clinical placements with palliative care providers are barriers to increased learning opportunities in palliative and end of life care.

CONCLUSIONS

This article provides comprehensive information about palliative and end of life care teaching in undergraduate nurse education in New Zealand. Teaching on this subject is not a mandatory requirement so there are inconsistencies in the teaching provided between educational institutions, and significant barriers to development. Mandatory competencies need to be introduced to ensure graduates have the knowledge, skills and attitudes required to provide optimal care for people near the end of life.

New Zealand medical students' views of euthanasia/assisted dying across different year levels

BACKGROUND

Previous studies report a majority of the general public support euthanasia/assisted dying (EAD), while a majority of doctors are opposed. In considering policy decisions about EAD, some may discount the views of doctors because they take them to be based on personal values or tradition, rather than reasons that the general public might share. One way to explore this notion is to examine whether medical students' views change during their medical education. The objective of this study was to learn how New Zealand medical students view EAD and whether students at different year levels have different views.

METHODS

An on-line survey of undergraduate medical students was conducted asking whether they supported a law change to allow EAD. Quantitative data was analysed using unadjusted and multiple logistic regression. Thematic analysis was conducted with the qualitative data.

RESULTS

A total of 326 students replied to the survey. The overall response rate was 28%. 65% of 2nd year students were supportive of EAD, compared to 39% in 5th year. The odds of 5th year students supporting a law change compared to 2nd year was 0.30 (95% CI: 0.15-0.60). The predominant themes found in the qualitative results indicate that medical students support or oppose EAD for reasons similar to those found in the wider debate, and that their views are influenced by a range of factors. However, several at all year levels cited an aspect of medical school as having influenced their views. This was mentioned by participants who were supportive of, opposed to, or unsure about EAD, but it was the type of influence most often mentioned by those who were opposed.

CONCLUSIONS

The quantitative findings show students at the end of 5th year were less likely to support EAD than students at the end of 2nd year. We suggest that this difference is most likely due to their time in medical education. This suggests that the lower support found among doctors is in part related to medical education and medical work rather than age, personality, or social context. The qualitative findings indicate that this is not related to a particular educational experience at Otago Medical School but a range.

Childhood disadvantage and adolescent socioemotional wellbeing as predictors of future parenting behaviour

INTRODUCTION

In extending work on early life antecedents of parenting, we investigate associations between childhood family history of disadvantage, adolescent socioemotional wellbeing, and age at first parenthood and subsequent parenting behaviour.

METHODS

Parent-child interactions were recorded when participants in the longitudinal Dunedin Multidisciplinary Health and Development Study (New Zealand) had a three-year-old child. Data were available for 358 mothers and 321 fathers, aged between 17.7 and 41.5 at the time of their child's birth. Associations between parenting and antecedent data on socioeconomic disadvantage, adolescent wellbeing and mental health, as well as current adult mental health and age at parenting, were tested for using structural equation modelling.

RESULTS

Family disadvantage in childhood and lower adolescent wellbeing was associated with less positive future parenting, but only adult (not adolescent) anxiety/depression symptoms were directly associated with parenting behaviour. Childhood family disadvantage was associated with further disadvantage across the life course that included less positive parenting of the next generation. In contrast, socioemotional wellbeing during adolescence and later age of onset of parenting were associated with more positive parenting.

CONCLUSIONS

Reducing childhood disadvantage and improving socioemotional wellbeing during childhood and adolescence is likely to have intergenerational benefits through better parenting of the next generation.

Cancer Information Seeking Among Adult New Zealanders: a National Cross-Sectional Study

Organisations seeking to establish themselves as leading cancer information sources for the public need to understand patterns and motivators for information seeking. This study describes cancer information seeking among New Zealanders through a national cross-sectional survey conducted in 2014/15 with a population-based sample of adults (18 years and over). Participants were asked if they had sought information about cancer during the past 12 months, the type of information they sought, what prompted them to look for information and ways of getting information they found helpful. Telephone interviews were completed by 1064 participants (588 females, 476 males, 64% response rate). Of these, 33.8% of females and 23.3% of males (total, 29.2%) had searched for information about cancer over the past year. A search was most frequently prompted by a cancer diagnosis of a family member or friend (43.3%), a desire to educate themselves (17.5%), experience of potential symptoms or a positive screening test (9.4%), family history of cancer (8.9%) or the respondent's own cancer diagnosis (7.7%). Across the cancer control spectrum, the information sought was most commonly about treatment and survival (20.2%), symptoms/early detection (17.2%) or risk factors (14.2%), although many were general or non-specific queries (50.0%). The internet was most commonly identified as a helpful source of information (71.7%), followed by health professionals (35.8%), and reading material (e.g. books, pamphlets) (14.7%).This study provides a snapshot of cancer information seeking in New Zealand, providing valuable knowledge to help shape resource delivery to better meet the diverse needs of information seekers and address potential unmet needs, where information seeking is less prevalent.

Cancer Mortality, Early Detection and Treatment among Adult New Zealanders: Changes in Perceptions between 2001 and 2014/5

Background:

Beliefs about cancer risk and experience of early detection and treatment can impact on willingness to engage with these initiatives. This study describes changes in perceptions of cancer mortality, early detection and treatment among adult New Zealanders (NZ) between two cross-sectional studies conducted in 2001 and 2014/5.

Methods:

Data was collected via telephone interviews conducted by trained interviewers in 2001 (231 females and 207 males, 64% response rate) and 2014/5 (588 females and 476 males, 64% response rate). Participants were asked to identify the most common three causes of cancer mortality among women and then men. They were also asked to note their agreement or otherwise with statements about early detection and treatment of cancer.

Results:

There was an increase in proportions of men who correctly identified prostate cancer as one of the top three causes of cancer mortality among men, and also an increase among women who correctly identified bowel cancer as one of the top three. Most participants agreed that there were benefits from early detection for cancer outcomes. Over time, there was a significant decline in proportions which felt that most cancer treatment is “so terrible it is worse than death” and that alternative therapy has an “equal or better chance of curing cancer.”

Conclusion:

Internationally, there is little information available about changes in cancer perceptions over time, these findings suggest some changes in perceptions of treatment and awareness of types of cancer with the highest mortality in NZ, which should support timely engagement with early detection and treatment services.

Cancer Awareness in Aotearoa New Zealand (CAANZ), 2001 and 2015: Study Protocols

Population cancer awareness is of interest worldwide, as efforts are made to reduce cancer incidence via changes in risk and protective behaviours. To date, few studies have described changes in awareness over time, despite significant investment in raising awareness about various cancer types and risk behaviours. This paper describes the Cancer Awareness in Aotearoa New Zealand (CAANZ) survey, a cross-sectional telephone survey of adult New Zealanders conducted in 2014/2015 (CAANZ15, n = 1064) and its comparison with a similar 2001 study (CAANZ01, n = 438). Both aimed to describe current cancer awareness among a national sample of New Zealand (NZ) adults, with additional aims for CAANZ15 being to explore emerging issues in information provision and supportive care. Follow-up studies are challenged by changes in communication technologies and, in turn, potential issues in sampling. However, given the value of information about changing awareness, pragmatic steps were taken in CAANZ15 to maximise the response rate and comparability of the surveys. A response rate of 64 % was achieved for both samples. When compared to the adult NZ population, the CAANZ15 sample tended to be older, of higher socioeconomic status and under-representative of people with Pacific, Asian or, to a lesser extent, Māori (the indigenous population of NZ) ethnicity. To compensate for possible disproportionate age-by-ethnicity (Māori/non-Māori) groups in the sample, poststratification weighting was adopted. While caution will need to be exercised in drawing conclusions from comparisons made between these two cohorts, the dearth of such studies means that insights gained should be useful for guiding reflection on future cancer control directions and the generation of new hypotheses.

Knowledge of Evidence-Based Cancer Risk Factors Remains Low Among New Zealand Adults: Findings from Two Cross-Sectional Studies, 2001 and 2015

Objective:

Cancer risk reduction messages are a part of cancer control efforts around the world. The complex reality is that risk factors differ for different types of cancer, making clear communication of desired behavioural changes more difficult. This study aims to describe awareness of risk factors for breast, bowel, cervical, prostate and lung cancer and cutaneous melanoma among New Zealanders in 2014/15 and identify changes in awareness since 2001.

Methods:

Two national telephone surveys, the first (CAANZ01) conducted in 2001, included 438 adults (231 females and 207 males, 64% response rate). The second, conducted in 2014/15 (CAANZ15), included 1064 adults (588 females and 476 males, 64% response rate).

Results:

In 2014/5, most participants could identify evidence-based risk factors for lung cancer and melanoma. In contrast, many participants were unable to name any risk factors (evidence-based or otherwise) for bowel (34.8%), breast (48.8%), cervical (53.9%) and prostate cancer (60.9%). Between 2001 and 2014/5 there were increases in the proportion of individuals identifying sunbeds as increasing melanoma risk, and alcohol consumption and family history as increasing risk for bowel and breast cancer.

Conclusions:

Effective communication of risk information for specific cancers remains a challenge for cancer control. Although some positive changes in awareness over the 14 year period were observed, there remains substantial room for progressing awareness of evidence-based risk factors.

The outcomes of patients returned to general practitioner after being declined hip and knee replacement

AIM

To determine the outcome of patients waitlisted for hip and knee replacement surgery who were returned to GP due to resource constraints.

METHODS

Prospectively gathered data of all patients returned to GP was analysed, including demographics, clinical prioritisation scores and patient-reported scores. Subsequent outcome was collected from departmental records and the National Joint Registry.

RESULTS

Between November 2013 and December 2015, 374 patients were returned to GP care. At minimum 12-month follow-up, 215 (57.5%) had undergone or had certainty for surgery, 36 patients (9.6%) had been re-referred and again declined surgery and 123 (32.9%) remained in GP care. The factors influencing the likelihood of a patient subsequently qualifying for surgery were need for hip rather than knee replacement, time from initial FSA and initial NZOA score. The mean waiting time for those patients who underwent publicly-funded surgery was 14.7 months.

CONCLUSION

Returning patients to GP delays treatment rather than reducing the need for surgery. This delay results in waste, added costs to the patient, healthcare system and society, and may reduce the benefit of surgery. There needs to be a significant increase in capacity to meet this demand.

New Zealand adolescents' discouragement of smoking among their peers

OBJECTIVE

This study examines the extent to which young people are acting as 'agents of change' in discouraging smoking among their peers.

METHODS

This study used data from a survey of 2,919 New Zealand secondary school students who participated in the 2014 national Youth In-depth Survey. Relevant questions were used to assess the extent to which students engaged in behaviours to discourage or promote smoking among their peers.

RESULTS

About half of all students reported some form of behaviour discouraging others from smoking, while only one in ten reported encouraging smoking. Discouragement was associated with non-smoking or lower levels of smoking, having more friends who smoked, and exposure to more health promotion messages about not smoking. Māori and Pacific young people also reported more discouraging behaviours.

CONCLUSIONS

The results highlight the positive impact that young people can have on discouraging smoking among their peers. Implications for public health: The findings of this study point to encouraging and training young people as 'agents of change' to spread the smokefree message.

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.

Wahakura Versus Bassinet for Safe Infant Sleep: A Randomized Trial

OBJECTIVES

To compare an indigenous sleep device (wahakura) for infants at high risk for sudden unexpected death with a bassinet, for measures of infant sleep position, head covering, breastfeeding, bed-sharing, and maternal sleep and fatigue.

METHODS

A total of 200 mainly Māori pregnant women were recruited from deprived areas of New Zealand. They were randomized to receive a bassinet or wahakura and asked to sleep the infant in this device from birth. Questionnaires at 1, 3, and 6 months and an overnight infrared video in the home at 1 month were completed.

RESULTS

An intention-to-treat and an "as-used" analysis of questionnaires showed no group differences at 1, 3, and 6 months in infant-adult direct bed-sharing (7% vs 12%, P = .24 at 1 month), and at the 6-month interview, the wahakura group reported twice the level of full breastfeeding (22.5% vs 10.7%, P = .04). Maternal sleep and fatigue were not significantly different between groups. Video identified no increase in head covering, prone/side sleep position, or bed-sharing in the wahakura group, either from intention-to-treat analysis, or when analyzed for actual sleep location.

CONCLUSION

There were no significant differences in infant risk behaviors in wahakura compared with bassinets and there were other advantages, including an increase in sustained breastfeeding. This suggests wahakura are relatively safe and can be promoted as an alternative to infant-adult bed-sharing. Policies that encourage utilization are likely to be helpful in high-risk populations.

Rationing of hip and knee replacement: effect on the severity of patient-reported symptoms and the demand for surgery in Otago

AIM

A key Government health target has been to increase access to elective surgery. Despite this, there is a growing concern about unmet demand and increasing numbers of patients are being declined elective surgery. This study aims to determine whether there has been an increase in the severity of osteoarthritis of the hip and knee in patients undergoing publicly-funded elective total joint replacement (TJR) and any increase in demand for TJR in Otago.

METHOD

Demographic details and preoperative patient reported outcome scores (Oxford hip or knee score (OHS,OKS) and a reduced Western Ontario and McMaster Osteoarthritis Index (WOMAC) score (RWS) were collected prospectively in an historical cohort of patients undergoing total hip and knee replacement (THR, TKR) between 2006-2010. These were compared with all patients undergoing THR and TKR in the 12-month period commencing 1 November 2013, and all patients waitlisted during this period but returned to GP due to capacity issues. An estimate of current demand was made by adding all waitlisted public patients from the 12-month period to surgical numbers from private and those funded by ACC.

RESULTS

In the 2006-2010 group of 613 patients, the mean OHS was 13.6 (SD 6.7) and OKS 15.4 (SD 6.5) and RWS 30.5 (SD 8.0). Three hundred and sixty-seven patients who underwent surgery in 2013/4 had significantly poorer scores (OHS 9.9 (SD 4.9), OKS 10.6 (SD 3.8), RWS 34.8 (SD 6.7)). The scores of 194 patients returned to GP in 2013/4 were the same as the historical surgical group (OHS13.0 (SD 6.2, OKS 15.2 (SD 5.9), RWS 30.8 (SD 8.4)). Six hundred and eight patients were wait-listed for public surgery and 356 joints were performed in private or under ACC in the 12-month period. The current intervention rate in Otago is 371/100,000 per year, while the demand has risen from 417/100000 in 2010-12 to 494/100,000 per year. In 2014, the shortfall was 241 joints per year.

CONCLUSION

Patients undergoing primary elective total hip and knee replacement in Otago in 2014 are more severely disabled than between 2006-2010. Patients currently being returned to GP would have qualified for publicly funded surgery during that period. The demand for elective TJR in Otago has increased by 19% since 2012.

Nondaily, Low-Rate Daily, and High-Rate Daily Smoking in Young Adults: A 17-Year Follow-Up

INTRODUCTION

While overall tobacco consumption is declining in many countries, patterns of low-frequency smoking-such as nondaily and low-rate daily smoking-appear to be increasing. We aimed firstly to describe differences in demographic, smoking- and quitting-related characteristics between nondaily and daily smokers in young adults; secondly, to determine the proportion of low-frequency smokers who transition to a higher rate of smoking by age 38 and factors associated with this.

METHODS

We assessed a cohort of individuals born in Dunedin, New Zealand, in 1972-1973, at regular intervals from age 21 to age 38 years. Smokers were categorized as either nondaily, low-rate daily (ie, defined as five or less cigarettes per day) or high-rate daily smokers (six or more cigarettes per day). Descriptive statistics, linear and logistic regression were used.

RESULTS

Nondaily smokers at age 21 tended to self-identify as nonsmokers. Both nondaily smokers and low-rate daily smokers reported higher readiness and confidence in quitting compared to high-rate daily smokers. Around 40% of the age 21 low-rate daily smokers reported smoking daily at age 38, compared to 13% of the nondaily smokers and 4% of the nonsmokers. Nondaily smoking at age 21 was associated with increased odds of being a daily smoker by age 38 (OR: 3.6; 95% CI = 1.7% to 7.8%) compared to nonsmokers.

CONCLUSIONS

Different patterns of smoking are associated with differences in readiness to quit and confidence in quitting ability. For a considerable proportion of smokers, low-frequency smoking in young adulthood develops into daily smoking by adulthood.

IMPLICATIONS

Low-frequency smoking, including nondaily smoking, in early adulthood is a significant risk factor for being a daily smoker in the long-term. Cessation interventions should be tailored to low-frequency smokers, taking into account differences between them and heavier smokers in terms of smoking motivation and quitting-related cognitions.