Tania Huria

A cohort study comparing cardiovascular risk factors in rural Māori, urban Māori and non-Māori communities in New Zealand

Objectives To understand health disparities in cardiovascular disease (CVD) in the indigenous Māori of New Zealand, diagnosed and undiagnosed CVD risk factors were compared in rural Māori in an area remote from health services with urban Māori and non-Māori in a city well served with health services. Design Prospective cohort study. Setting Hauora Manawa is a cohort study of diagnosed and previously undiagnosed CVD, diabetes and risk factors, based on random selection from electoral rolls of the rural Wairoa District and Christchurch City, New Zealand. Participants Screening clinics were attended by 252 rural Māori, 243 urban Māori and 256 urban non-Māori, aged 20–64 years. Main outcome measures The study documented personal and family medical history, blood pressure, anthropometrics, fasting lipids, insulin, glucose, HbA1c and urate to identify risk factors in common and those that differ among the three communities. Results Mean age (SD) was 45.7 (11.5) versus 42.6 (11.2) versus 43.6 (11.5) years in rural Māori, urban Māori and non-Māori, respectively. Age-adjusted rates of diagnosed cardiac disease were not significantly different across the cohorts (7.5% vs 5.8% vs 2.8%, p=0.073). However, rural Māori had significantly higher levels of type-2 diabetes (10.7% vs 3.7% vs 2.4%, p<0.001), diagnosed hypertension (25.0% vs 14.9% vs 10.7%, p<0.001), treated dyslipidaemia (15.7% vs 7.1% vs 2.8%, p<0.001), current smoking (42.8% vs 30.5% vs 15.2%, p<0.001) and age-adjusted body mass index (30.7 (7.3) vs 29.1 (6.4) vs 26.1 (4.5) kg/m2, p<0.001). Similarly high rates of previously undocumented elevated blood pressure (22.2% vs 23.5% vs 17.6%, p=0.235) and high cholesterol (42.1% vs 54.3% vs 42.2%, p=0.008) were observed across all cohorts. Conclusions Supporting integrated rural healthcare to provide screening and management of CVD risk factors would reduce health disparities in this indigenous population.

A Kaupapa Māori approach to a community cohort study of heart disease in New Zealand

Objective: To report the processes and protocols that were developed in the design and implementation of the Hauora Manawa Project, a cohort study of heart disease in New Zealand and to report the participation at baseline.

Community screening for cardiovascular risk factors and levels of treatment in a rural Māori cohort

Objectives : To document levels of cardiovascular disease (CVD), diagnosed and undiagnosed risk factors and clinical management of CVD risk in rural Māori.

Working With Racism: A Qualitative Study of the Perspectives of Māori (Indigenous Peoples of Aotearoa New Zealand) Registered Nurses on a Global Phenomenon

Purpose: Substantial health disparities exist between Māori—the indigenous people of Aotearoa New Zealand—and non-Māori New Zealanders. This article explores the experience and impact of racism on Māori registered nurses within the New Zealand health system. Method: The narratives of 15 Māori registered nurses were analyzed to identify the effects of racism. This Māori nursing cohort and the data on racism form a secondary analysis drawn from a larger research project investigating the experiences of indigenous health workers in New Zealand and Canada. Jones’s levels of racism were utilized as a coding frame for the structural analysis of the transcribed Māori registered nurse interviews. Results: Participants experienced racism on institutional, interpersonal, and internalized levels, leading to marginalization and being overworked yet undervalued. Discussion and Conclusions: Māori registered nurses identified a lack of acknowledgement of dual nursing competencies: while their clinical skills were validated, their cultural skills—their skills in Hauora Māori—were often not. Experiences of racism were a commonality. Racism—at every level—can be seen as highly influential in the recruitment, training, retention, and practice of Māori registered nurses. Implications for Practice: The nursing profession in New Zealand and other countries of indigenous peoples needs to acknowledge the presence of racism within training and clinical environments as well as supporting indigenous registered nurses to develop and implement indigenous dual cultural-clinical competencies.

Higher prevalence of left ventricular hypertrophy in two Māori cohorts: findings from the Hauora Manawa/Community Heart Study

Objectives: Cardiovascular disease (CVD) is the leading cause of mortality in New Zealand with a disproportionate burden of disease in the Māori population. The Hauora Manawa Project investigated the prevalence of cardiovascular risk factors and CVD in randomly selected Māori and non‐Māori participants. This paper reports the prevalence of structural changes in the heart.

Implementation and impact of indigenous health curricula: a systematic review

The effectiveness of cultural competency education in improving health practitioner proficiency and addressing health inequities for minoritised patient groups is uncertain. Identification of institutional factors that shape or constrain development of indigenous health curricula may provide insights into the impact of these factors on the broader cultural competency curricula.

Loose tobacco, ethnicity, income and rurality

In New Zealand (NZ) and other western countries, tobacco taxation has lagged in addressing roll-your-own cigarettes and loose tobacco and has focused on increasing the relative cost of factory-made cigarettes, which has made roll-your-owns comparatively less costly and unintentionally created an incentive for smokers to switch to them. In NZ, roll-your-own use has increased since 1990. Almost half of smokers report using roll-your-owns, and this includes approximately 61% of 15-19 year olds and 60% of Māori smokers. These rates are greater than those reported in other countries. Young people may use roll-your-owns because they are cheaper than factory-made cigarettes, as smaller amounts of tobacco can be rolled in individual cigarettes, potentially to significantly less than the weight of a standard 0.7 gram manufactured cigarette. By 2010, in NZ there was a 14% difference in taxation between factory-mades versus loose tobacco, making roll-your-owns comparatively cheaper. This study investigated roll-your-own use and implications for tobacco taxation. Methods are published elsewhere. In 2007, 2008 and 2009, 751 participants (252 Wairoa Māori, 243 Christchurch Māori and 256 Christchurch non-Māori), randomly selected from the electoral roll received a CVD risk assessment, including questions on smoking from the NZ Tobacco Use Survey 2006. Of those who had ever smoked, 35% used roll-your-owns and a further 17% said they smoked them but also factory-mades when offered. For this research, they were combined into one category. Analysis used SPSS version 17. Statistical tests included Pearsons chi-square and logistic regression. Roll-your-own use was significantly more prevalent in the Māori samples (70% of Wairoa Māori current smokers, 71% of Christchurch Māori and 44% of Christchurch non-Māori, p=0.006). This was particularly evident in men (80% of Wairoa Māori men were current smokers, 76% of Christchurch Māori men and 36% of Christchurch non-Māori men, p=0.001). However, approximately 65% of women in the Māori samples also used roll-your-owns. Roll-your-own use tended to be more prevalent in Māori younger than 40 years (approximately 76% of current smokers in both Māori samples). However, more than 63% of Māori aged 40 and older also used them. In Wairoa Māori, 91% of current smokers in households with annual incomes under

Meihana Model: A Clinical Assessment Framework

30,000 used roll-your-owns (compared with 60% in households with incomes of NZ

Medical education to improve Māori health.

30,000 and over) (p=0.001, 1 df). In Christchurch Māori, approximately 70% of smokers in both lower and higher income households used them. With Christchurch non-Māori as the reference group, logistic regression analysis of current smokers, predicting roll-your-own use, confirmed the existence of statistically significant differences between the samples (0.03). Other significant predictors were age (0.02), and total household income (0.01). The relationship between roll-yourown use and income was statistically significant, independent of age. Gender was not significant. Limitations include small sample and that the study was not designed to investigate why smokers chose roll-your-owns nor the use of cannabis rolled with loose tobacco. It also did not include the 15-19 year age group, however, we consider that if this age group had been included the results were unlikely to be different. Our results show that roll-your-own use is more prevalent in Māori in a rural area (Wairoa), particularly in lower income Wairoa households, compared with data from nationwide surveys. The NZ government has been lobbied to increase taxation on loose tobacco. In 2010, it announced a progressive increase in taxation, which is estimated to increase the tax by 52% and the retail price of loose tobacco by 40% by 2012. Our results tend to support this increase because elasticity (or price sensitivity) is greater in lower income groups and in younger people, in whom roll-your-own use is more prevalent. The effectiveness of the tax increase will depend on (a) their quitting response and (b) their price elasticity of demand. However, it should be recognised that sales taxes are regressive and have a more severe impact on lower income populations. Other policies are also needed, particularly to address nicotine addiction and to support quitting.