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2.  Is expanding HPV vaccination programs to include school-aged boys likely to be value-for-money: a cost-utility analysis in a country with an existing school-girl program 
BMC Infectious Diseases  2014;14:351.
Similar to many developed countries, vaccination against human papillomavirus (HPV) is provided only to girls in New Zealand and coverage is relatively low (47% in school-aged girls for dose 3). Some jurisdictions have already extended HPV vaccination to school-aged boys. Thus, exploration of the cost-utility of adding boys’ vaccination is relevant. We modeled the incremental health gain and costs for extending the current girls-only program to boys, intensifying the current girls-only program to achieve 73% coverage, and extension of the intensive program to boys.
A Markov macro-simulation model, which accounted for herd immunity, was developed for an annual cohort of 12-year-olds in 2011 and included the future health states of: cervical cancer, pre-cancer (CIN I to III), genital warts, and three other HPV-related cancers. In each state, health sector costs, including additional health costs from extra life, and quality-adjusted life-years (QALYs) were accumulated. The model included New Zealand data on cancer incidence and survival, and other cause mortality (all by sex, age, ethnicity and deprivation).
At an assumed local willingness-to-pay threshold of US$29,600, vaccination of 12-year-old boys to achieve the current coverage for girls would not be cost-effective, at US$61,400/QALY gained (95% UI $29,700 to $112,000; OECD purchasing power parities) compared to the current girls-only program, with an assumed vaccine cost of US$59 (NZ$113). This was dominated though by the intensified girls-only program; US$17,400/QALY gained (95% UI: dominant to $46,100). Adding boys to this intensified program was also not cost-effective; US$128,000/QALY gained, 95% UI: $61,900 to $247,000).
Vaccination of boys was not found to be cost-effective, even for additional scenarios with very low vaccine or program administration costs – only when combined vaccine and administration costs were NZ$125 or lower per dose was vaccination of boys cost-effective.
These results suggest that adding boys to the girls-only HPV vaccination program in New Zealand is highly unlikely to be cost-effective. In order for vaccination of males to become cost-effective in New Zealand, vaccine would need to be supplied at very low prices and administration costs would need to be minimised.
PMCID: PMC4082618  PMID: 24965837
3.  Violent deaths of media workers associated with conflict in Iraq, 2003–2012 
PeerJ  2014;2:e390.
Background. The violent deaths of media workers is a critical issue worldwide, especially in areas of political and social instability. Such deaths can be a particular concern as they may undermine the development and functioning of an open and democratic society.
Method. Data on the violent deaths of media workers in Iraq for ten years (2003–2012) were systematically collated from five international databases. Analyses included time trends, weapons involved, nationality of the deceased, outcome for perpetrators and location of death.
Results. During this ten-year period, there were 199 violent deaths of media workers in Iraq. The annual number increased substantially after the invasion in 2003 (peaking at n = 47 in 2007) and then declined (n = 5 in 2012). The peak years (2006–2007) for these deaths matched the peak years for estimated violent deaths among civilians. Most of the media worker deaths (85%) were Iraqi nationals. Some were killed whilst on assignment in the field (39%) and 28% involved a preceding threat. Common perpetrators of the violence were: political groups (45%), and coalition forces (9%), but the source of the violence was often unknown (29%). None of the perpetrators have subsequently been prosecuted (as of April 2014). For each violent death of a media worker, an average of 3.1 other people were also killed in the same attack (range 0–100 other deaths).
Discussion. This analysis highlights the high number of homicides of media workers in Iraq in this conflict period, in addition to the apparently total level of impunity. One of the potential solutions may be establishing a functioning legal system that apprehends offenders and puts them on trial. The relatively high quality of data on violent deaths in this occupational group, suggests that it could act as one sentinel population within a broader surveillance system of societal violence in conflict zones.
PMCID: PMC4034609  PMID: 24883251
Media worker; Iraq; Epidemiology; Surveillance; Violent death
4.  Risk factors for death from pandemic influenza in 1918–1919: a case–control study 
Despite the persisting threat from future influenza pandemics, much is still unknown about the risk factors for death from such events, and especially for the 1918–1919 influenza pandemic.
A case–control study was performed to explore possible risk factors for death from pandemic influenza among New Zealand military personnel in the Northern Hemisphere in 1918–1919 (n = 218 cases, n = 221 controls). Data were compiled from a Roll-of-Honour dataset, a dataset of nearly all military personnel involved in the war and archived individual records.
In the fully adjusted multivariable model, the following were significantly associated with increased risk of death from pandemic influenza: age (25–29 years), pre-pandemic hospitalisations for a chronic condition (e.g. tuberculosis), relatively early year of military deployment, a relatively short time from enlistment to foreign service, and having a larger chest size (e.g. adjusted odds ratio for 90–99 cm versus <90 cm was 2·45; 95% CI=1·47–4·10). There were no significant associations in the fully adjusted model with military rank, occupational class at enlistment, and rurality at enlistment.
This is one of the first published case–control studies of mortality risk factors for the 1918–1919 influenza pandemic. Some of the findings are consistent with previous research on risk factors (such as chronic conditions and age groups), but others appear more novel (e.g., larger chest size). As all such historical analyses have limitations, there is a need for additional studies in other settings as archival World War One records become digitalised.
PMCID: PMC4181481  PMID: 24490663
1918–1919 Influenza pandemic; infectious disease; influenza; military; pandemic
5.  Obtaining Fruit and Vegetables for the Lowest Prices: Pricing Survey of Different Outlets and Geographical Analysis of Competition Effects 
PLoS ONE  2014;9(3):e89775.
Inadequate fruit and vegetable (F&V) consumption is an important dietary risk factor for disease internationally. High F&V prices can be a barrier to dietary intake and so to improve understanding of this topic we surveyed prices and potential competition between F&V outlet types.
Over a three week early autumn period in 2013, prices were collected bi-weekly for 18 commonly purchased F&Vs from farmers' markets (FM) selling local produce (n = 3), other F&V markets (OFVM) (n = 5), supermarkets that neighbored markets (n = 8), and more distant supermarkets (n = 8), (in urban Wellington and Christchurch areas of New Zealand). Prices from an online supermarket were also collected.
A total of 3120 prices were collected. Most F&Vs (13/18) were significantly cheaper at OFVMs than supermarkets. Over half of the F&Vs (10/18) were significantly cheaper at nearby compared to distant supermarkets, providing evidence of a moderate ‘halo effect’ in price reductions in supermarkets that neighbored markets. Weekend (vs midweek) prices were also significantly cheaper at nearby (vs distant) supermarkets, supporting evidence for a ‘halo effect’.
Ideal weekly ‘food basket’ prices for a two adult, two child family were: OFVMs (NZ$76), online supermarket ($113), nearby supermarkets ($124), distant supermarkets ($127), and FMs ($138). This represents a savings of $49 per week (US$26) by using OFVMs relative to (non-online) supermarkets. Similarly, a shift from non-online supermarkets to the online supermarket would generate a $13 saving.
In these locations general markets appear to be providing some substantially lower prices for fruit and vegetables than supermarkets. They also appear to be depressing prices in neighboring supermarkets. These results, when supplemented by other needed research, may help inform the case for interventions to improve access to fruit and vegetables, particularly for low-income populations.
PMCID: PMC3961225  PMID: 24651475
6.  Smoking close to others and butt littering at bus stops: pilot observational study 
PeerJ  2014;2:e272.
Background. Transportation settings such as bus stops and train station platforms are increasingly the target for new smokefree legislation. Relevant issues include secondhand smoke exposure, nuisance, litter, fire risks and the normalization of smoking. We therefore aimed to pilot study aspects of smoking behavior and butt disposal at bus stops.
Methods. Systematic observation of smoking and butt disposal by smokers at bus stops. The selection of 11 sites was a mix of convenience and purposeful (bus stops on main routes) in two New Zealand cities.
Results. During 27 h of observation, a total of 112 lit cigarettes were observed being smoked. Smoking occurred in the presence of: just adults (46%), both young people and adults (44%), just young people (6%) and alone (5%). An average of 6.3 adults and 3.8 young people were present at the bus stops while smoking occurred, at average minimum distances of 1.7 and 2.2 m respectively. In bus stops that included an enclosed shelter, 33% of the cigarettes were smoked inside the shelter with others present. Littering was the major form of cigarette disposal with 84% of cigarettes smoked being littered (95% CI; 77%–90%). Also, 4% of disposals were into vegetation, which may pose a fire risk.
Conclusions. This pilot study is limited by its small size and various methodological aspects but it appears to be a first attempt to provide observational evidence around smoking at bus stops. The issues described could be considered by policy makers who are investigating national smokefree laws or by-laws covering transportation settings.
PMCID: PMC3940480  PMID: 24688851
Smoking; Tobacco control; Transportation; Observational study
7.  Taxes on Sugar-Sweetened Beverages to Curb Future Obesity and Diabetes Epidemics 
PLoS Medicine  2014;11(1):e1001583.
In a linked Perspective, Tony Blakely and colleagues discuss the real-world implications of this type of modeling study.
Please see later in the article for the Editors' Summary
PMCID: PMC3883634  PMID: 24409103
8.  Optimising locational access of deprived populations to farmers’ markets at a national scale: one route to improved fruit and vegetable consumption? 
PeerJ  2013;1:e94.
Background. Evidence suggests that improved locational access to farmers’ markets increases fruit and vegetable (FV) consumption, particularly for low-income groups. Therefore, we modelled potential alternative distributions of farmers’ markets in one country (New Zealand) to explore the potential impact for deprived populations and an indigenous population (Māori).
Methods. Data were collected on current farmers’ markets (n = 48), population distributions, area deprivation, and roads. Geographic analyses were performed to optimize market locations for the most deprived populations.
Results. We found that, currently, farmers’ markets provided fairly poor access for the total population: 7% within 12.5 km (15 min driving time); 5% within 5 km; and 3% within 2 km. Modelling the optimal distribution of the 48 markets substantially improved access for the most deprived groups: 9% (vs 2% currently) within 12.5 km; 5% (vs 1%) within 5 km; and 3% (vs 1%) within 2 km. Access for Māori also improved: 22% (vs 7%) within 12.5 km; 12% (vs 4%) within 5 km; and 6% (vs 2%) within 2 km. Smaller pro-equity results arose from optimising the locations of the 18 least pro-equity markets or adding 10 new markets.
Conclusion. These results highlight the potential for improving farmers’ market locations to increase accessibility for groups with low FV consumption. Given that such markets are easily established and relocated, local governments could consider these results to inform decisions, including subsidies for using government land and facilities. Such results can also inform central governments planning around voucher schemes for such markets and exempting them from taxes (e.g., VAT/GST).
PMCID: PMC3709110  PMID: 23862107
Farmers’ market; Fruit and vegetable intake; Geography; Equity
9.  Foods and Dietary Patterns That Are Healthy, Low-Cost, and Environmentally Sustainable: A Case Study of Optimization Modeling for New Zealand 
PLoS ONE  2013;8(3):e59648.
Global health challenges include non-communicable disease burdens, ensuring food security in the context of rising food prices, and environmental constraints around food production, e.g., greenhouse gas [GHG] emissions. We therefore aimed to consider optimized solutions to the mix of food items in daily diets for a developed country population: New Zealand (NZ).
We conducted scenario development and linear programming to model 16 diets (some with uncertainty). Data inputs included nutrients in foods, food prices, food wastage and food-specific GHG emissions.
This study identified daily dietary patterns that met key nutrient requirements for as little as a median of NZ$ 3.17 per day (US$ 2.41/d) (95% simulation interval [SI] = NZ$ 2.86 to 3.50/d). Diets that included “more familiar meals” for New Zealanders, increased the cost. The optimized diets also had low GHG emission profiles compared with the estimate for the ‘typical NZ diet’ e.g., 1.62 kg CO2e/d for one scenario (95%SI = 1.39 to 1.85 kg CO2e) compared with 10.1 kg CO2e/d, respectively. All of the optimized low-cost and low-GHG dietary patterns had likely health advantages over the current NZ dietary pattern, i.e., lower cardiovascular disease and cancer risk.
We identified optimal foods and dietary patterns that would lower the risk of non-communicable diseases at low cost and with low greenhouse gas emission profiles. These results could help guide central and local government decisions around which foods to focus policies on. That is which foods are most suitable for: food taxes (additions and exemptions); healthy food vouchers and subsidies; and for increased use by public institutions involved in food preparation.
PMCID: PMC3609827  PMID: 23544082
10.  The Feasibility of Achieving Low-Sodium Intake in Diets That Are Also Nutritious, Low-Cost, and Have Familiar Meal Components 
PLoS ONE  2013;8(3):e58539.
Given the importance of high sodium diets as a risk factor for disease burden (ranked 11th in importance in the Global Burden of Disease Study 2010), we aimed to determine the feasibility of low-sodium diets that were also low-cost, nutritious and (for some scenarios) included familiar meals.
The mathematical technique of “linear programming” was used to model eight optimized daily diets (some with uncertainty), including some diets that contained “familiar meals” for New Zealanders or were Mediterranean-, Asian- and Pacific-style diets. Data inputs included nutrients in foods, food prices and food wastage.
Using nutrient recommendations for men and a cost constraint of
These results provide some reassurance for the feasibility of substantially reducing population sodium intake given currently available low-cost foods and while maintaining some level of familiar meals. Policy makers could consider ways to promote such optimized diets and foods, including regulations on maximum salt levels in processed foods, and taxes on alternative foods that are high in salt, sugar and saturated fat.
PMCID: PMC3591307  PMID: 23505532
Addiction (Abingdon, England)  2012;107(1):197-205.
To describe some of the variability across the world in levels of quit smoking attempts and use of various forms of cessation support.
Use of the International Tobacco Control Policy Evaluation Project surveys of smokers, using the 2007 survey wave (or later, where necessary).
Australia, Canada, China, France, Germany, Ireland, Malaysia, Mexico, Netherlands, New Zealand, South Korea, Thailand, UK, Uruguay and USA.
Self-report on use of cessation aids and on visits to health professionals and provision of cessation advice during the visits.
Prevalence of quit attempts in the last year varied from under 20% to over 50% across countries. Similarly, smokers varied greatly in reporting of visiting health professionals in the last year (< 20% to over 70%), and among those who did, provision of advice to quit also varied greatly. There was also marked variability in the levels and types of help reported. Use of medication was generally more common than use of behavioural support, except where medications are not readily available.
There is wide variation across countries in rates of attempts to stop smoking and use of assistance with higher overall use of medication than behavioural support. There is also wide variation in the provision of brief advice to stop by health professionals.
PMCID: PMC3237953  PMID: 21883605
BMC Public Health  2012;12:782.
There is increasing interest in ending the tobacco epidemic and in applying ‘endgame’ solutions to achieve that goal at national levels. We explored the understanding of, and reactions to, a tobacco-free vision and an endgame approach to tobacco control among New Zealand smokers and non-smokers.
We recruited participants in four focus groups held in June 2009: Māori (indigenous people) smokers (n=7); non-Māori smokers (n=6); Māori non-smokers (n=7); and non-Māori non-smokers (n=4). Participants were from the city of Whanganui, New Zealand. We introduced to them the vision of a tobacco-free New Zealand and the concept of a semi-autonomous agency (Tobacco-Free Commission [TFC]) that would control the tobacco market as part of an endgame approach.
There was mostly strong support for the tobacco-free New Zealand vision among all groups of participants. The reason most commonly given for supporting the vision was to protect children from tobacco. Most participants stated that they understood the TFC concept and reacted positively to it. Nevertheless, rather than focusing on organisational or structural arrangements, participants tended to focus on supporting the specific measures which a future TFC might facilitate such as plain packaging of tobacco products. Various concerns were also raised around the TFC, particularly around the feasibility of its establishment.
We were able to successfully communicate a complex and novel supply-side focused tobacco control policy intervention to smokers and non-smokers. The findings add to the evidence from national surveys that there is public support, including from smokers, for achieving a tobacco-free vision and using regulatory and policy measures to achieve it. Support for such measures may be enhanced if they are clearly communicated and explained with a rationale which stresses protecting children and future generations from tobacco smoking.
PMCID: PMC3505727  PMID: 22974338
Objective. To establish the trends in prevalence, and correlates, of roll-your-own (RYO) use in Canada, USA, UK and Australia, 2002–2008. Methods. Participants were 19,456 cigarette smokers interviewed during the longitudinal International Tobacco Control (ITC) Four-Country Survey in Canada, USA, UK, and Australia. Results. “Predominant” RYO use (i.e., >50% of cigarettes smoked) increased significantly in the UK and USA as a proportion of all cigarette use (both P < .001) and in all countries as a proportion of any RYO use (all P < .010). Younger, financially stressed smokers are disproportionately contributing to “some” use (i.e., ≤50% of cigarettes smoked). Relative cost was the major reason given for using RYO, and predominant RYO use is consistently and significantly associated with low income. Conclusions. RYO market trends reflect the price advantages accruing to RYO (a product of favourable taxation regimes in some jurisdictions reinforced by the enhanced control over the amount of tobacco used), especially following the impact of the Global Financial Crisis; the availability of competing low-cost alternatives to RYO; accessibility of duty-free RYO tobacco; and tobacco industry niche marketing strategies. If policy makers want to ensure that the RYO option does not inhibit the fight to end the tobacco epidemic, especially amongst the disadvantaged, they need to reduce the price advantage, target additional health messages at (young) RYO users, and challenge niche marketing of RYO by the industry.
PMCID: PMC3361236  PMID: 22666277
Emerging Infectious Diseases  2012;18(2):226-233.
Food safety measures that lower incidence of campylobacteriosis might also prevent Guillain-Barré syndrome.
PMCID: PMC3310455  PMID: 22304786
Guillain-Barré syndrome; Campylobacter infection; camplyobacteriosis; food safety; poultry; government regulations; public health surveillance; epidemiology; New Zealand
Emerging Infectious Diseases  2012;18(1):71-77.
The persistent excess in adverse outcomes by ethnicity highlights the need for improved public health responses.
Evidence suggests that indigenous populations have suffered disproportionately from past influenza pandemics. To examine any such patterns for Māori in New Zealand, we searched the literature and performed new analyses by using additional datasets. The Māori death rate in the 1918 pandemic (4,230/100,000 population) was 7.3× the European rate. In the 1957 pandemic, the Māori death rate (40/100,000) was 6.2× the European rate. In the 2009 pandemic, the Māori rate was higher than the European rate (rate ratio 2.6, 95% confidence interval 1.3–5.3). These findings suggest some decline in pandemic-related ethnic inequalities in death rates over the past century. Nevertheless, the persistent excess in adverse outcomes for Māori, and for Pacific persons residing in New Zealand, highlights the need for improved public health responses.
PMCID: PMC3310086  PMID: 22257434
influenza pandemic; virus; historical; Maori; Pacific
Nicotine & Tobacco Research  2010;12(Suppl 1):S78-S84.
We aimed to describe use of a national quitline service and the variation in its use by smoker characteristics (particularly ethnicity and deprivation). The setting was New Zealand (NZ), which takes proactive measures to attract disadvantaged smokers to this service.
The NZ arm of the International Tobacco Control Policy Evaluation Survey (ITC Project) utilizes the New Zealand Health Survey (a national sample) from which we surveyed adult smokers in two waves (N = 1,376 and N = 923) 1 year apart.
Quitline use in the last 12 months rose from 8.1% (95% CI = 6.3%–9.8%) in Wave 1 to 11.2% (95% CI = 8.4%–14.0%) at Wave 2. Māori (the indigenous people of NZ) were significantly more likely to call the Quitline than were European/other smokers. Relatively higher call rates also occurred among those reporting higher deprivation, financial stress, a past mental health disorder, a past drug-related disorder, and higher psychological distress (Kessler 10-item index). Independent associations in the multivariate analyses of Quitline use were being Māori, reporting financial stress, and ever having been diagnosed with a mental health disorder.
This national Quitline service is successfully stimulating disproportionately more calls by Māori smokers and those with some measures of disadvantage. It may therefore be contributing to reducing health inequalities. It appears possible to target quitlines to reach those smokers in greatest need.
PMCID: PMC2981469  PMID: 20889485
BMC Public Health  2011;11:598.
Although the association between smoking status and poorer mental health has been well documented, the association between quit status and psychological distress is less clear. The aim of the present study is to investigate the association of smoking status and quit status with psychological distress.
Data for this study is from a single year of the Survey of Families, Income and Employment (SoFIE) conducted in New Zealand (2004/05) (n = 18,525 respondents). Smoking status and quit status were treated as exposure variables, and psychological distress (Kessler-10) was treated as the outcome variable. Logistic regression analyses were performed to determine the association of smoking with psychological distress in the whole adult population and quit status with psychological distress in the ex- and current-smoking population.
Current smokers had higher rates of high and very high psychological distress compared to never smokers (adjusted odds ratio (aOR) = 1.45; 95% CI: 1.24-1.69). Unsuccessful quitters had much higher levels of high to very high levels of psychological distress (16%) than any other group. Moreover, compared to long-term ex-smokers, unsuccessful quitters had a much higher odds of high to very high levels of psychological distress (aOR = 1.73; 95% CI: 1.36-2.21).
These findings suggest that the significant association between smoking and psychological distress might be partly explained by increased levels of psychological distress among current smokers who made a quit attempt in the last year. This issue needs further study as it has implications for optimising the design of quitting support.
PMCID: PMC3160992  PMID: 21798059
smoking status; quit status; psychological distress; socioeconomic status
BMC Public Health  2011;11:580.
Tobacco control strategies have mainly targeted reducing demand. Supply-side focused measures, though less familiar, deserve consideration, particularly to achieve 'endgame' tobacco control aims (e.g. achieving close to zero smoking prevalence). We explored attitudes towards supply-side focused 'endgame' tobacco control approaches and how they can be best communicated with senior policymakers, journalists, and public health practitioners.
We identified five supply-side focused approaches which could potentially lead to the tobacco endgame: two structural models and three discrete actions. The structural models were: (i) a Nicotine Authority to coordinate tobacco control activities and regulate the nicotine/tobacco market for public health aims; and (ii) a Tobacco Supply Agency acting as a monopoly purchaser of tobacco products and controlling the tobacco supply for public health aims. The actions were: (a) allocating progressively reducing tobacco product import quotas (the 'sinking lid') until importation and commercial sale of tobacco products ceased; (b) making tobacco companies responsible for reducing smoking prevalence with stringent financial penalties if targets were missed; and (c) new laws to facilitate litigation against tobacco companies. These approaches were presented as means to achieve a tobacco free New Zealand by 2020 to 19 senior policymakers, journalists, and public health physicians in two focus groups and eight interviews, and their reactions sought.
The tobacco-free vision was widely supported. Participants engaged fully with the proposed tobacco control approaches, which were viewed as interesting or even intriguing. Most supported increasing the focus on supply-side measures. Views differed greatly about the desirability, feasibility and likely effectiveness of each approach. Participants identified a range of potential barriers to implementation and challenges to successfully advocating and communicating these approaches. The current framing of tobacco as a risky but legal commodity was noted as an important potential barrier to implementing endgame approaches.
Endgame tobacco control approaches were considered to be viable policy options. Further policy analysis, research and public discussion are needed to develop endgame approaches. A significant change in the public framing of tobacco may be a prerequisite for implementing endgame solutions.
PMCID: PMC3160990  PMID: 21774829
Emerging Infectious Diseases  2011;17(6):1007-1015.
A population-level food safety response successfully reduced disease incidence.
Beginning in the 1980s, New Zealand experienced rising annual rates of campylobacteriosis that peaked in 2006. We analyzed notification, hospitalization, and other data to explore the 2007–2008 drop in campylobacteriosis incidence. Source attribution techniques based on genotyping of Campylobacter jejuni isolates from patients and environmental sources were also used to examine the decline. In 2008, the annual campylobacteriosis notification rate was 161.5/100,000 population, representing a 54% decline compared with the average annual rate of 353.8/100,000 for 2002–2006. A similar decline was seen for hospitalizations. Source attribution findings demonstrated a 74% (95% credible interval 49%–94%) reduction in the number of cases attributed to poultry. These reductions coincided with the introduction of a range of voluntary and regulatory interventions to reduce Campylobacter spp. contamination of poultry. The apparent success of these interventions may inform approaches other countries could consider to help control foodborne campylobacteriosis.
PMCID: PMC3358198  PMID: 21749761
bacteria; foodborne infections; Campylobacter; epidemiology; surveillance; poultry; food supply; bacterial typing; research; New Zealand
BMC Research Notes  2011;4:111.
An innovative approach to learning public health by using feature-length commercial movies was piloted in the fourth year of a medical degree. We aimed to explore how students responded to this approach and the relative effectiveness of two promotional strategies. Firstly we placed DVDs of 15 movies (with public health-related content) in the medical school library. Then alternating groups of students (total n = 82 students) were exposed to either a brief promotional intervention or a more intensive intervention involving a class presentation. The response rates were 99% at baseline and 85% at follow-up.
The level and strength of support for using movies in public health training increased after exposure to the public health module with significantly more students "strongly agreeing". Student behaviour, in terms of movies viewed or accessed from the library, also suggested student interest. While there were no statistically significant differences in median viewing or library access rates between the two intervention groups, the distribution of viewing patterns was shifted favourably. Those exposed to the more intensive intervention (class presentation) were significantly more likely to have reported watching at least one movie (97% vs. 81%; p = 0.033) or to having accessed at least one movie from the library (100% vs. 70%, p = 0.0001).
This pilot study found that the students had very positive attitudes towards viewing public health-related commercial movies. Movie access rates from the library were also favourable.
PMCID: PMC3090335  PMID: 21473773
BMC Public Health  2010;10:797.
Governments use law to constrain aspects of private activities for purposes of protecting health and social wellbeing. Policymakers have a range of perceptions and beliefs about what is public or private. An understanding of the possible drivers of policymaker decisions about where government can or should intervene for health is important, as one way to better guide appropriate policy formation. Our aim was to identify obstacles to, and opportunities for, government smokefree regulation of private and public spaces to protect children. In particular, to seek policymaker opinions on the regulation of smoking in homes, cars and public parks and playgrounds in a country with incomplete smokefree laws (New Zealand).
Case study, using structured interviews to ask policymakers (62 politicians and senior officials) about their opinions on new smokefree legislation for public and private places. Supplementary data was obtained from the Factiva media database, on the views of New Zealand local authority councillors about policies for smokefree outdoor public places.
Overall, interviewees thought that government regulation of smoking in private places was impractical and unwise. However, there were some differences on what was defined as 'private', particularly for cars. Even in public parks, smoking was seen by some as a 'personal' decision, and unlikely to be amenable to regulation. Most participants believed that educative, supportive and community-based measures were better and more practical means of reducing smoking in private places, compared to regulation.
The constrained view of the role of regulation of smoking in public and private domains may be in keeping with current political discourse in New Zealand and similar Anglo-American countries. Policy and advocacy options to promote additional smokefree measures include providing a better voice for childrens' views, increasing information to policymakers about the harms to children from secondhand smoke and the example of adult smoking, and changing the culture for smoking around children.
PMCID: PMC3022865  PMID: 21194440
Nicotine & Tobacco Research  2009;11(12):1467-1473.
The aim of this study was to examine knowledge and attitudes to lower harm alternatives to cigarettes among New Zealand (NZ) smokers.
The NZ arm of the International Tobacco Control Policy Evaluation Survey (ITC Project) utilizes the NZ Health Survey (a national sample). From this sample, we surveyed adult smokers (N = 1,376).
Knowledge about smokeless tobacco was poor, with only 16% regarding such products as less harmful than ordinary cigarettes. Only 7% considered such products to be “a lot less” harmful. When participants were asked to assume that these products were much less harmful than cigarettes, 34% of smokers stated that they would be interested in trying smokeless tobacco products, with another 11% saying “maybe” or “don't know.” In the multivariate analysis, Māori smokers were significantly more interested in trying smokeless products than Europeans in all 3 models considered (e.g., Model 1: adjusted odds ratio [AOR] = 1.71, 95% CI = 1.23–2.37). There was also significantly increased interest for those concerned about the impact of smoking on health and quality of life in the future (AOR = 1.44, 95% CI = 1.17–1.78). But interest did not vary significantly by 2 measures of socioeconomic status and varied inconsistently by 2 measures of financial stress.
The finding that one third of smokers said that they would be interested in trying smokeless products suggests that these products could have a role as part of a tobacco epidemic endgame that phases out smoked tobacco. Differences in interest level by ethnic group may be relevant to stimulating further work in this area (e.g., among those health workers concerned for smokers with the highest need to quit).
PMCID: PMC2904262  PMID: 19828433
Emerging Infectious Diseases  2010;16(12):1931-1937.
TOC summary: Crowding and ventilation problems contributed to an increased risk of death.
We describe the epidemiology and risk factors for death in an outbreak of pandemic influenza on a troop ship. Mortality and descriptive data for military personnel on His Majesty’s New Zealand Transport troop ship Tahiti in July 1918 were analyzed, along with archival information. Mortality risk was increased among persons 25–34 years of age. Accommodations in cabins rather than sleeping in hammocks in other areas were also associated with increased mortality risk (rate ratio 4.28, 95% confidence interval 2.69–6.81). Assignment to a particular military unit, the field artillery (probably housed in cabins), also made a significant difference (adjusted odds ratio in logistic regression 3.04, 95% confidence interval 1.59–5.82). There were no significant differences by assigned rurality (rural residence) or socioeconomic status. Results suggest that the virulent nature of the 1918 influenza strain, a crowded environment, and inadequate isolation measures contributed to the high influenza mortality rate onboard this ship.
PMCID: PMC3294590  PMID: 21122224
Influenza; pandemic; viruses; New Zealand; infectious disease outbreak; troop ship; mortality; risk factors; military; historical review
Injury Prevention  2007;13(5):304-306.
To examine the content and trends of safety‐related consumer information in magazine vehicle advertisements, as a case study within the worldwide marketing of vehicles.
Content analysis of popular current affairs magazines in New Zealand for the 5‐year period 2001–2005 was undertaken (n  =  514 advertisements), supplemented with vehicle data from official websites.
Safety information in advertisements for light passenger vehicles was relatively uncommon with only 27% mentioning one or more of nine key safety features examined (average: 1.7 out of nine features in this 27%). Also included were potentially hazardous features of: speed imagery (in 29% of advertisements), power references (14%), and acceleration data (4%). The speed and power aspects became relatively more common over the 5‐year period (p < 0.05 for trend).
To enhance informed consumer choice and improve injury prevention, governments should consider regulating the content of vehicle advertisements and vehicle marketing – as already occurs with many other consumer products.
PMCID: PMC2610613  PMID: 17916885
BMC Public Health  2010;10:498.
Some countries have started to extend indoor smokefree laws to cover cars and various outdoor settings. However, policy-modifiable factors around smoker support for these new laws are not well described.
The New Zealand (NZ) arm of the International Tobacco Control Policy Evaluation Survey (ITC Project) derives its sample from the NZ Health Survey (a national sample). From this sample we surveyed adult smokers (n = 1376).
For the six settings considered, 59% of smokers supported at least three new completely smokefree areas. Only 2% favoured smoking being allowed in all the six new settings. Support among Maori, Pacific and Asian smokers relative to European smokers was elevated in multivariate analyses, but confidence intervals often included 1.0.
Also in the multivariate analyses, "strong support" by smokers for new smokefree area laws was associated with greater knowledge of the second-hand smoke (SHS) hazard, and with behaviours to reduce SHS exposure towards others. Strong support was also associated with reporting having smokefree cars (aOR = 1.68, 95% CI = 1.21 - 2.34); and support for tobacco control regulatory measures by government (aOR = 1.63, 95% CI = 1.32 - 2.01). There was also stronger support by smokers with a form of financial stress (not spending on household essentials).
Smokers from a range of population groups can show majority support for new outdoor and smokefree car laws. Some of these findings are consistent with the use of public health strategies to support new smokefree laws, such as enhancing public knowledge of the second-hand smoke hazard.
PMCID: PMC2933722  PMID: 20718985

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