Ross Barnett

The neighbourhood effects of geographical access to tobacco retailers on individual smoking behaviour

Objective: To investigate whether neighbourhood measures of geographical accessibility to outlets selling tobacco (supermarkets, convenience stores and petrol stations) are associated with individual smoking behaviour in New Zealand. Methods: Using geographical information systems, travel times from the population-weighted centroid of each neighbourhood to the closest outlet selling tobacco were calculated for all 38 350 neighbourhoods across New Zealand. These measures were appended to the 2002/03 New Zealand Health Survey, a national survey of 12 529 adults. Two-level logistic regression models were fitted to examine the effects of neighbourhood locational access upon individual smoking behaviour after controlling for potential individual- and neighbourhood-level confounding factors, including deprivation and urban/rural status. Results: After controlling for individual-level demographic and socioeconomic variables, individuals living in the quartiles of neighbourhoods with the best access to supermarkets (OR 1.23, 95% CI 1.06 to 1.42) and convenience stores (OR 1.19, 95% CI 1.03 to 1.38) had a higher odds of smoking compared with individuals in the worst access quartiles. However, the association between neighbourhood accessibility to supermarkets and convenience stores was not apparent once other neighbourhood-level variables (deprivation and rurality) were included. Conclusions: At the national level, there is little evidence to suggest that, after adjustment for neighbourhood deprivation, better locational access to tobacco retail provision in New Zealand is associated with individual-level smoking behaviour.

Sociospatial inequalities in health-related behaviours: Pathways linking place and smoking

There has been a resurgence of interest in how the social, built and cultural environments contribute to shaping health outcomes. The pathways relating place to health behaviour have received less attention. We develop a nuanced understanding of the pathways linking individuals, places and smoking. Two key pathways operate: place-based ‘practices’ and place-based ‘regulation’. Future geographical research should pay attention to the different scale effects, encompass a wider set of influences which affect the liveability and social composition of neighbourhoods, and specify group differences in the impact of the local economic and social environment upon smoking.

The influence of road curvature on fatal crashes in New Zealand.

Bends in roads can cause crashes but a recent study in the UK found that areas with mostly curved roads had lower crash rates than areas with straighter roads. This present study aimed to replicate the previous research in a different country. Variations in the number of fatal road crashes occurring between 1996 and 2005 in 73 territorial local authorities across New Zealand were modelled against possible predictors. The predictors were traffic flow, population counts and characteristics, car use, socio-economic deprivation, climate, altitude and road characteristics including four measures of average road curvature. The best predictors of the number of fatal crashes on urban roads, rural state highways and other rural roads were traffic flow, speed limitation and socio-economic deprivation. Holding significant factors constant, there was no evidence that TLAs with the most curved roads had more crashes than elsewhere. Fatal crashes on urban roads were significantly and negatively related to two measures of road curvature: the ratio of road length to straight distance and the cumulative angle turned per kilometre. Weaker negative associations on rural state highways could have occurred by chance. These results offer limited support to the suggestion that frequently occurring road bends might be protective.

Assessing the effects of the introduction of the New Zealand Smokefree Environment Act 2003 on acute myocardial infarction hospital admissions in Christchurch, New Zealand.

Objective: To examine trends in Acute Myocardial Infarction (AMI) hospital admissions in Christchurch, New Zealand before and after the implementation of the New Zealand Smokefree Environments Act 2003 in December 2004.

Nomadic identities and socio-spatial competence: making sense of post-smoking selves

The reconstruction of smoking as an unhealthy practice has given rise to a discursive field in which some people shy away from smoking identities that are tainted with the attendant notions of dirt and disgust and also from overt external control over individual behaviour. In many cases individuals demonstrate social competence by quitting smoking. Social and secret smokers challenge both binary understandings of smoking identities (smoker/non-smoker) as well as the addiction model that is prevalent in explaining smoking. Social and secret smoking are conceptualised as nomadic identities that are situationally constructed and deconstructed, but always with the potential to slip into one or other identity more permanently. While these identities remain ambivalent and appear to manage their own risks, they provide us with a window into the body as a potentiality rather than a problem and thus move us beyond a compliance/resistance schema. The paper concludes that ex-, secret and social smoking involve different types of socio-spatial competence and, in order to make sense of this, we utilise both Foucauldian and Deleuzo-Guattarian frameworks.

Community inequality and smoking cessation in New Zealand, 1981-2006

The overall prevalence of smoking in New Zealand reduced from 32% in 1981 to 23.5% in 2006 but rates of smoking cessation have not been consistent among all social, demographic and ethnic groups. The period 1981-2006 also saw macroeconomic changes in New Zealand that resulted in profound increases in social and economic inequalities. Within this socio-political context we address two questions. First, has there been a social polarisation in smoking prevalence and cessation in New Zealand between 1981 and 2006? Second, to what extent can ethnic variation in rates of quitting be explained by community inequality, independently of socio-economic status? We find that smoking behaviour in New Zealand has become socially and ethnically more polarised over the past two decades, with greater levels of smoking cessation among higher socio-economic groups, and among New Zealanders of European origin. Variations in quit rates between Māori and European New Zealanders cannot be fully accounted for by ethnic differences in socio-economic status. Community inequality exerted a significant influence on Māori (but not European) smoking quit rates. The association with community inequality was particularly profound among women, and for particular age groups living in urban areas. These findings extend the international evidence for a relationship between social inequality and health, and in particular smoking behaviour. The research also confirms the importance of considering the role of contextual factors when attempting to elucidate the mechanisms linking socio-economic factors to health outcomes. Our findings emphasise that, if future smoking cessation strategies are to be successful, attention has to shift from policies that focus solely on engineering individual behavioural change, to an inclusion of the role of environmental stressors such as community inequality.

Geographical inequalities in health in New Zealand, 1980-2001: the gap widens

Objective: To monitor geographical inequalities in health in New Zealand during the period 1980 to 2001, a time of rapid social and economic change in society.

Practice and ethnic variations in avoidable hospital admission rates in Christchurch, New Zealand

Using hospital admissions data for 2005-2007 this paper examines variations in avoidable hospital admission rates between general practitioner surgeries in Christchurch, New Zealand. There is a substantial variation in rates between surgeries which largely reflects the influence of material deprivation and also the independent effect of ethnicity. By contrast, other quantitative measures of primary care provision were insignificant. There was also a wide variation between practices in the uptake of Care Plus funding for patients with chronic conditions. Practice deprivation, ethnicity and age only explained a minor part of this variation. The findings suggest a need for possible strategies, in particular a greater targeting of funding to high risk patients in more deprived practices, to reduce hospitalisation. The wide variability in general practice use of hospital services needs further study to identify possible individual and contextual explanations.

Place Effects on Alcohol Consumption: A Literature Review

Background and purpose of study: Recently, there has been an increasing interest in the ways in which features of residential environments influence health outcomes and health related behaviours. This paper reviews the literature which examines how features of places influence individual alcohol consumption. Gaps for further research are identified. Method: Research was selected which examined any feature of a residential neighbourhood and how it influenced alcohol consumption including alcohol access. This review was undertaken using search engines and databases including Pubmed, Scopus, Proquest and Web of Science. Of 1,821 articles examined, 64 met the above criterion and were included. Results: There are a range of social and physical characteristics of neighbourhoods that are associated with alcohol consumption. These include area-level socio-economic status, neighbourhood stress, social capital and cohesion, cultural context, retail outlets and advertising. These place effects are examined at different scales ranging from regional (e.g. state level) to census tracts or meshblocks. Conclusion: The review provided evidence of how place features influence alcohol consumption and recommended further research. There is a need for focussed attention on a few areas: understanding the mechanism of place effects; deciding on scale of measurement; examining more than one neighbourhood characteristic; and taking greater advantage of natural experiments.

Ethnic spatial segregation and tobacco consumption: a multilevel repeated cross-sectional analysis of smoking prevalence in urban New Zealand, 1981-1996

The growing literature on the role of ethnic segregation in understanding spatial inequalities in mortality and morbidity has not yet been extended to the study of health-related behaviours. We address this gap in knowledge through an examination of the geography of smoking prevalence in New Zealand, using a multilevel repeated cross-sectional analysis of smoking prevalences in 1981 and 1996 as revealed in the New Zealand census. Smoking prevalences are explored for fourteen age and sex groups, nested in 1110 census area units. These in turn are nested in forty primary and secondary urban areas. We consider different measures of segregation and focus in detail on the relationship between smoking and Māori ethnic isolation. We examine the interplay between deprivation and segregation, addressing questions concerning the impact of changing segregation on changes in smoking behaviour. We hypothesise that more highly segregated populations suffer more psychosocial stress and so may smoke more. Results reveal the changing dynamics of smoking prevalence over time, and challenge initial assumptions that spatial ethnic segregation should relate to smoking prevalence.