John Broughton

New Zealand Drivers Study: a follow-up study of newly licensed drivers.

Background: Despite significant improvement since graduated licensing was introduced, traffic-related injury remains the leading cause of death and hospitalisation among young New Zealanders. Most research to date has used routinely collected crash data but has been limited in that these databases do not, and realistically cannot, include the level of detail required to ensure that learner driver policy and programmes are based on sound scientific evidence applicable to young drivers in the current New Zealand context. Objectives: To examine the driving-related experiences of newly licensed drivers to identify factors associated with increased or decreased risk of negative traffic outcomes. Design: Multistage prospective cohort study. Setting: New Zealand. Participants: Newly licensed drivers. Variables: Exposures: background demographic details, pre-licence driving, previous crashes, driving intentions, motivations for driving and licensing, sensation seeking, aggression, impulsivity, quality and quantity of driving experience, driving supervision, driving behaviour, alcohol and other drug use, compliance with New Zealand’s graduated driver licensing scheme, driver training/education, cell phone use, and sleep. Outcomes: crash, conviction, infringements, risky driving. Data sources: Exposures: participants and their parents. Outcomes: participants and official records. Bias: On the basis of a pilot study, participation and attrition bias are likely to be minimal. A comparison of baseline data for those followed and those not followed will be undertaken. Information bias will be minimised by standardised questionnaires. Information on potential confounders is to be collected and controlled for in analyses. Study size: 5000 (including 1500 Māori). Statistical Methods: Survival analysis, logistic or Poisson regression, generalised estimating equations.

The mortality and cancer experience of New Zealand Vietnam war veterans: a cohort study.

Objectives The aim was to observe the patterns of mortality and cancer incidence in New Zealand Vietnam veterans. The objectives were to assess whether the patterns of disease observed were consistent with those associated with military service in Vietnam, and similar to the patterns identified in other groups of Vietnam veterans. Design A historical cohort study. Setting Veterans, identified from service records, with Vietnam service between 1964 and 1972. Participants Of the 3322 survivors of Vietnam service, we followed up 2783 (84%). Outcome measures Standardised mortality and incidence ratios (SMRs and SIRs, respectively) were calculated based on the number of deaths and cancer registrations observed, those expected being based on New Zealand national rates. Results All cause mortality was significantly reduced (SMR 0.85, 95% CI 0.77 to 0.94) and cancer incidence non-significantly increased (SIR 1.06, 95% CI 0.97 to 1.16). The risk of mortality from cancers of the head and neck (SMR 2.20, 95% CI 1.09 to 3.93); oral cavity pharynx and larynx (SMR 2.13, 95% CI 1.06 to 3.81) and the incidence of chronic lymphatic leukaemia (CLL) (SIR 1.91, 95% CI 1.04 to 3.20) were, however, significantly increased. Other lymphohaematopoietic disorders, specifically multiple myeloma and Hodgkin disease, showed non-significant mortality excesses, reflected by a similar increase in incidence. Conclusions Service in the Vietnam war was associated with defoliant herbicide exposure, including 2,4,5-trichlorophenoxyacetic acid, 2,4-dichlorophenoxyacetic acid, picloram and cacodylic acid. Subsequent reviews of mechanistic, animal and epidemiological evidence led to certain conditions being deemed compensable. The pattern of mortality and cancer incidence is not at odds with the list of compensable conditions and consistent with that found in Australian veterans serving in the same area of Vietnam, but also consistent with smoking and the healthy soldier effect. In common with the Australian experience, this is the only veterans group to show a significant excess of CLL.

The oral health of Indigenous children: A review of four nations

This review of the oral health of children in Australia, New Zealand, Canada and the USA demonstrates that significant oral health inequalities exist in each nation. Despite traditionally low levels of disease in Indigenous communities, dental caries is now highly prevalent and of increased severity among Indigenous children in comparison to their non‐Indigenous counterparts. Early childhood caries is particularly prevalent. The high level of dental disease experience at an early age is associated with increased rates of general anaesthesia and greater risk of dental caries in later life. The rates and severity of dental caries experienced by young Indigenous children are even more alarming when we consider that dental caries is essentially a preventable disease. The success of specific preventive programmes is encouraging; these approaches should be further evaluated and implemented as part of broader health promotion programmes for Indigenous children and families in order to decrease current oral health disparities.

Suicide among New Zealand Maori: is history repeating itself?

Suicide rates for New Zealanders identified as Maori were analysed for the period 1957‐91 and compared with those for non‐Maori people. Overall, Maori men had about half the risk of suicide of non‐Maori men, and Maori women one‐third the risk of non‐Maori women. Nevertheless, there was a sharp increase in suicide rates for Maori aged 15–24 years during the period studied, with rates for the 1987–91 time period of 35.2/100,000 for men and 6.0/100,000 for women. These were similar to the high suicide rates of young non‐Maori New Zealanders. Suicide among Maori in pre‐European times appears to have been embedded in traditional culture and may have occurred particularly among bereaved women; today the pattern is one of high rates in young men who are likely to have been from their culture.

NEW ZEALAND DRIVERS STUDY: DEVELOPING A METHODOLOGY FOR CONDUCTING A FOLLOW-UP STUDY OF NEWLY LICENSED DRIVERS

PROBLEM In recent years, there has been a significant reduction in traffic crash injury among young people, but they continue to be overrepresented in the traffic crash statistics. To improve this situation, sound scientific evidence is needed to develop effective policies and programs. METHOD The aim of the proposed study is to provide this evidence by examining early driving and driving-related experiences of newly licensed drivers as they progress through the learner-, restricted-, and full-license stages of the graduated licensing system and to determine the impact of these experiences on subsequent negative traffic-related outcomes (risky driving behavior, injury traffic crashes, noninjury traffic crashes, infringements, convictions). Given the size and complexity of the proposed study, a comprehensive pilot study was undertaken to determine the feasibility of conducting a New Zealand-wide cohort study of newly licensed drivers. RESULTS This article describes the pilot study process and the methodology that has been developed for the New Zealand-wide study.

Unlicensed driving among urban and rural Maori drivers: New Zealand drivers study

Objective: To determine the extent and type of self-reported unlicensed car driving and reasons given for driving before getting a license among Māori drivers in urban and rural areas of New Zealand. Method: Participants included 824 people of self-identified Māori ethnicity. The ages ranged from 15 to 65 years, with the majority of participants aged 15 (37%), 16 (21%), or 17 (14%) years at the time of recruitment. Participants were recruited after passing the car drivers learner license theory test at a driver licensing agency or a learner license course or by the participant responding to a postcard placed at licensing agencies nationwide. All participants completed a self-administered questionnaire that included items for a wide range of personal, driving, and licensing-related variables. The cohort was not randomly selected but included as many eligible participants as possible, with recruitment taking place in urban and rural areas of both the North and South Islands of New Zealand. Results: Unlicensed car driving experience was common, especially among rural participants (urban: 65%, rural: 83%). The nature and extent of driving experience and reasons for driving unlicensed were remarkably similar for urban and rural drivers, Females (47%) were more likely than males (37%) to report previous experience of a serious traffic crash. Being stopped by the police for driving unlicensed was not common (24% urban, 17% rural), but for those who had been stopped, the consequences varied by residential location. Conclusions: Driving before obtaining a drivers license was common practice and the amount of driving extensive, for both rural and urban drivers. Furthermore, contrary to common perceptions in New Zealand, the need and opportunities for driving were similar, irrespective of place of residence. This suggests that similar issues may need to be addressed by both urban and rural Māori community road safety providers.

Reducing disease burden and health inequalities arising from chronic disease among indigenous children: an early childhood caries intervention in Aotearoa/New Zealand

BackgroundMaaori are the Indigenous people of New Zealand and do not enjoy the same oral health status as the non-Indigenous majority. To overcome oral health disparities, the life course approach affords a valid foundation on which to develop a process that will contribute to the protection of the oral health of young infants. The key to this process is the support that could be provided to the parents or care givers of Maaori infants during the pregnancy of the mother and the early years of the child. This study seeks to determine whether implementing a kaupapa Maaori (Maaori philosophical viewpoint) in an early childhood caries (ECC) intervention reduces dental disease burden among Maaori children. The intervention consists of four approaches to prevent early childhood caries: dental care provided during pregnancy, fluoride varnish application to the teeth of children, motivational interviewing, and anticipatory guidance.Methods/designThe participants are Maaori women who are expecting a child and who reside within the Maaori tribal area of Waikato-Tainui.This randomised-control trial will be undertaken utilising the principles of kaupapa Maaori research, which encompasses Maaori leadership, Maaori relationships, Maaori customary practices, etiquette and protocol. Participants will be monitored through clinical and self-reported information collected throughout the ECC intervention. Self-report information will be collected in a baseline questionnaire during pregnancy and when children are aged 24 and 36 months. Clinical oral health data will be collected during standardised examinations at ages 24 and 36 months by calibrated dental professionals. All participants receive the ECC intervention benefits, with the intervention delayed by 24 months for participants who are randomised to the control-delayed arm.DiscussionThe development and evaluation of oral health interventions may produce evidence that supports the application of the principles of kaupapa Maaori research in the research processes. This study will assess an ECC intervention which could provide a meaningful approach for Maaori for the protection and maintenance of oral health for Maaori children and their family, thus reducing oral health disparities.Trial registrationAustralia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12611000111976.

Self-reported racism and experience of toothache among pregnant Aboriginal Australians: the role of perceived stress, sense of control, and social support

OBJECTIVES We hypothesized that the psychosocial factors perceived stress and sense of personal control mediated the relationship between self-reported racism and experience of toothache. We hypothesized that social support moderated this relationship. METHODS Data from 365 pregnant Aboriginal Australian women were used to evaluate experience of toothache, socio-demographic factors, psychosocial factors, general health, risk behaviors, and self-reported racism exposure. Hierarchical logistic regression models estimated odds ratios (ORs) and 95 percent confidence intervals (CIs) for experience of toothache. Perceived stress and sense of personal control were examined as mediators of the association between self-reported racism and experience of toothache. Social support was examined as a moderator. RESULTS Self-reported racism persisted as a risk indicator for experience of toothache (OR 1.99, 95 percent CI 1.07-3.72) after controlling for age, level of education, and difficulty paying a

Experiences and perceptions of oral health and oral health care among a sample of older New Zealanders

100 dental bill. The relationship between self-reported racism and experience of toothache was mediated by sense of control. The direct effect of self-reported racism on experience of toothache became only marginally significant, and the indirect effect was significant (β coefficient=0.04, bias-corrected 95 percent CI 0.004-0.105, 21.2 percent of effect mediated). Stress was insignificant as a mediator. Social support was insignificant as a moderator. CONCLUSIONS The findings indicate that high levels of self-reported racism were associated with experience of toothache and that sense of control, but not perceived stress, mediated the association between self-reported racism and experience of toothache among this sample of pregnant Aboriginal Australian women. Social support did not moderate the association between self-reported racism and experience of toothache.

Fidelity of Motivational Interviewing in an Early Childhood Caries Intervention Involving Indigenous Australian Mothers

BACKGROUND  Most research on older peoples oral health has been quantitative. A need for more in-depth understanding of the oral health of that age group has pointed to a need for more qualitative investigations. OBJECTIVE To explore experiences and perceptions of oral health and oral health care among an ethnically-mixed sample of older New Zealanders. METHODS In-depth interviews were conducted with 24 older people in two communities in New Zealands South Island. Thematic analysis of transcribed data was undertaken. RESULTS Three main themes that emerged were: (1) the processes of negotiating a tension between cost and convenience of access; (2) the experiential constraining of oral health maintenance; and (3) trusting in dental professionals. These serve to organise processes such as normalising, justifying and social comparisons that create an equilibrium or tolerance and acceptance of what might otherwise be considered to be relatively poor oral health. CONCLUSIONS We identified a number of shared experiences which affect older peoples ability to maintain their oral health in the face of material and social barriers to oral health care. Because expectations were generally lower, there was greater concordance between experience and expectation, and people tended to be fairly satisfied with their oral health and the care they had received.