Vili Nosa

Attachment to parents, parental tobacco smoking and smoking among Year 10 students in the 2005 New Zealand national survey.

Aims: To assess whether low attachment to parents is a consistent risk factor for adolescent smoking or is modified by ethnicity and parental smoking.

Keeping Kids Smokefree: rationale, design, and implementation of a community, school, and family-based intervention to modify behaviors related to smoking among Māori and Pacific Island children in New Zealand.

Despite a concerted, sustained and comprehensive tobacco control effort, smoking is prevalent among young people in New Zealand, particularly for Māori and Pacific Island teenagers. Many took up smoking in their pre-teen years. New Zealand research has shown that daily smoking by children aged 14–15 years is strongly influenced by parental smoking. The Keeping Kids Smokefree study is investigating whether changing parental smoking behavior and attitudes via a community-partnership approach with parents, schools, and local health providers can reduce smoking initiation by 11–12 year olds. It is a quasi-experimental trial involving four schools in an urban area of high social deprivation with large numbers of Māori and Pacific Islands families. Schools were allocated to intervention or control and the intervention was developed through a process of engagement with the schools, parents of children and local healthcare organizations. This article describes the rationale, context, methodology and methods involved in establishing the study. Building Māori and Pacific Islander research capacity was a secondary objective of the study.

Development of a text message intervention aimed at reducing alcohol-related harm in patients admitted to hospital as a result of injury

BackgroundScreening for alcohol misuse and brief interventions (BIs) for harm in trauma care settings are known to reduce alcohol intake and injury recidivism, but are rarely implemented. We created the content for a mobile phone text message BI service to reduce harmful drinking among patients admitted to hospital following an injury who screen positive for hazardous alcohol use. The aim of this study was to pre-test and refine the text message content using a robust contextualisation process ahead of its formal evaluation in a randomised controlled trial.MethodsPre-testing was conducted in two phases. First, in-depth interviews were conducted with 14 trauma inpatients (16–60 years) at Auckland City Hospital and five key informants. Participants were interviewed face-to-face using a semi-structured interview guide. Topics explored included: opinions on text message ideas and wording, which messages did or did not work well and why, interactivity of the intervention, cultural relevance of messages, and tone of the content. In a second phase, consultation was undertaken with Māori (New Zealand’s indigenous population) and Pacific groups to explore the relevance and appropriateness of the text message content for Māori and Pacific audiences.ResultsFactors identified as important for ensuring the text message content was engaging, relevant, and useful for recipients were: reducing the complexity of message content and structure; increasing the interactive functionality of the text message programme; ensuring an empowering tone to text messages; and optimising the appropriateness and relevance of text messages for Māori and Pacific people. The final version of the intervention (named ‘YourCall™’) had three pathways for people to choose between: 1) text messages in English with Te Reo (Māori language) words of welcome and encouragement, 2) text messages in Te Reo Māori, and 3) text messages in English (with an option to receive a greeting in Samoan, Tongan, Cook Island Māori, Niuean, Tokelauan, Tuvaluan, or Fijian).ConclusionsWe have developed a text message intervention underpinned by established BI evidence and behaviour change theory and refined based on feedback and consultation. The next step is evaluation of the intervention in a randomised-controlled trial.

Predictors of cigarette use amongst Pacific youth in New Zealand

BackgroundDespite progressive population health policies to reduce tobacco harm, smoking prevalence continues to be inequitable amongst key ethnic groups in New Zealand. The purpose of this study is to describe the predictors of cigarette use amongst Pacific youth in New Zealand.MethodsData were collected as part of Youth’07, a nationally representative survey of the health and well-being of New Zealand adolescents. The study sample comprised 5471 students and this includes 1,178 were Pacific youth.ResultsThe smoking prevalence rate for Pacific youth was twice that of New Zealand European youth. Pacific girls and older age groups, ages 16–17, smoked more than Pacific boys and younger adolescents. Pacific youth from higher and mid-deprivation neighbourhoods smoked at twice the rate of youth from low deprivation areas. Local neighbourhood stores (dairies) were the most used location for purchasing cigarettes, and only 12.7% of under-aged adolescents were asked “most of the time” for age identification. Pacific adolescent smoking was associated with parental smoking, peer-group smoking and binge drinking. Parents not knowing the whereabouts of adolescents during after-school hours and night-times were also associated with adolescent smoking. A majority of Pacific adolescent smokers (70.2%) had tried to quit smoking.ConclusionThe strategies for addressing ethically the issue of equal health for all is to allocate increased public health investments towards targeted quit-smoking treatment programmes for Pacific youth in New Zealand. Further qualitative studies with Pacific youth to inform the development of culturally-appropriate youth-focused quit-substance interventions is recommended.

Views From a Small Pacific Island Prospects for Tobacco Control on Niue

Background and aims. Tobacco smoking is a significant public health issue in Niue, a small Western Pacific nation where 31% of males and 16% of females smoke, and smoking initiation is still occurring at high levels among young people. There is evidence of political support for stronger tobacco control measures in Niue with ratification of the Framework Convention on Tobacco Control in 2005 and the Niue Tobacco Control Bill 2007 currently in discussion. However, more information is needed about how best to implement tobacco control measures in Niue. The aim of this research was to identify key contextual factors for progressing effective tobacco control in Niue. Methods. Twelve in-depth interviews were conducted with health, tobacco control, and public health professionals selected purposively from both Niue and New Zealand. A semistructured interview format was used and a qualitative thematic analysis undertaken to explore common and divergent viewpoints. Results. Significant progress in tobacco control is feasible in Niue, but outside technical assistance will be needed as there is very limited capacity to undertake all that needs to be done. Key steps will include developing a comprehensive tobacco control plan that will adopt a health promotion paradigm. This will include the building of strong cross-sectoral political support and community engagement to ensure local contextual knowledge guides the development of interventions. Capacity building throughout will be vital. Conclusion. A comprehensive health promotion approach that draws on outside technical assistance for support and capacity when needed is recommended to advance tobacco control in Niue.

A response for substance and harm reduction in Pacific Island countries and territories

The Pacific is characterised as a region for the purposes of many international interventions and assistance programmes. Representatives of Pacific States participate in regional fora to build a strategic and unified approach to development. Regionally, bilateral trade agreements impact upon strategies to regulate alcohol imports. Policing and customs initiatives are increasingly supporting prevention of illicit drug production and trafficking, and model laws have been proposed to achieve consistency in enforcement. The aim of this commentary is to provide a response for policies using the case of alcohol and other drug research in the Pacific Islands Countries Territories. This commentary undertook a review of the current literature for regional developments for alcohol and other drug use in the Pacific Island Countries Territories region. A total of 14 articles were used in this article. The publication date for the articles used in this review ranged from 1997 to 2011. The findings of the review found that there should be a co-ordinated approach for adopting alcohol and other drug approaches. Furthermore, there should be a co-ordinated regional response with the inclusion of targeted domestic programming that will meet the needs for the Pacific Island countries and territories. Countries in the Pacific Island territories are characterised by varying degrees of political stability. Without stable government and democratic process, it is likely to remain difficult to develop consistent and effective legislation and policy for implementation of successful alcohol and other drug programmes. We found that there is a lack of robust and current data for alcohol and other drugs in Pacific Island countries and territories. Further research funding is needed to build the limited knowledge of alcohol and other drug substance use.

Is driving under the influence of kava associated with motor vehicle crashes? A systematic review of the epidemiological literature.

Objective: Kava is marketed as a herbal anxiolytic in several countries and is consumed recreationally in high doses in many indigenous Pacific and Australian Aboriginal communities. We reviewed the published literature examining the association (if any) between kava use and motor vehicle crashes (MVCs), MVC‐related injuries or driving performance.

Challenges and Opportunities in the Provision of Surgical Care in Vanuatu: A Mixed Methods Analysis

BackgroundThe Pacific island nation of Vanuatu faces a number of challenges in delivering surgical care to its population. We aimed to understand and document the barriers, opportunities and required actions to improve surgical care in the country using a mixed methods analysis which incorporated the perspectives of local health stakeholders.MethodsA baseline quantitative assessment of surgical capacity in Vanuatu was carried out using the WHO situational analysis tool. Twenty semi-structured interviews were then conducted on the two main islands (Efate and Espiritu Santo) with surgeons, allied health staff, health managers, policy-makers and other key stakeholders, using a grounded theory qualitative case study methodology. Initial informants were identified by purposive sampling followed by snowball sampling until theoretical saturation was reached. Interviews were open and axially coded with subsequent thematic analysis.ResultsVanuatu faces deficits in surgical infrastructure, equipment and human resources, especially in the rural provinces. Geographic isolation, poverty and culture—including the use of traditional medicine and low health literacy—all act as barriers to patients accessing timely surgical care. Issues with governance, human resourcing and perioperative care were commonly identified by stakeholders as key challenges facing surgical services. Increasing outreach clinics, developing efficient referral systems, building provincial surgical capacity and undertaking locally led research were identified as key actions that can improve surgical care.ConclusionDocumenting locally identified challenges and opportunities for surgical care in Vanuatu is an important first step towards developing formal strategies for improving surgical services at the country level.

Distinctive alcohol cultural practices amongst Niuean men living in Auckland, New Zealand

Abstract The aim of this paper is to describe some of the distinctive cultural practices evident in Niuean mens drinking behaviours. The paper is also intended to illustrate that alcohol is an integral aspect of the Niuean culture and part of the system of cultural exchange. Alcohol has become an integral component of Niuean cultural rituals to the extent that celebrations and festivals are thought to be incomplete if alcohol is not present. Alcohol is used as a tool for expressing cultural values such as fakaalofa (gifting), generosity, respect, status and host obligations. Finally, alcohol is used as a symbol of ‘being Niuean’ and being a ‘real’ Niuean man. This paper will describe how practices specific to Niuean men such as drinking the ‘Niuean way’ and kalaga are symbols that help to reinforce mens cultural identity, enhancing their feeling of communal identity. It is important to emphasize that it is difficult to divorce the ‘cultural’ components of Niuean mens drinking styles from their drinking and behaviour more generally. Culture shapes peoples values and behaviours. Although this paper points to some of the specific and distinctively ‘cultural’ aspects of Niuean drinking, we must recognize that all of the participants’ drinking behaviours and attitudes are likely to have been shaped by their cultural and social context. Furthermore, this paper provides only a brief snapshot of how culture and alcohol are intertwined for Niuean men. Educational programmes and host responsibility guidelines need to be culturally appropriate to suit the needs of the Niuean community. Further work is needed to elucidate this complex topic.

Māori and Pasifika perceptions of their local maternity care in Logan, Australia

BACKGROUND Many childbearing women from Māori and Pasifika backgrounds living in the Logan region of Queensland, Australia experience poor health outcomes. Compared to the general population of childbearing women, Māori and Pasifika women are more likely to experience gestational diabetes mellitus and obesity, are less likely to attend recommended antenatal visits and present for initial antenatal visits at later gestations. AIM To describe womens awareness of maternity service options, explore the barriers to participating in pregnancy care and identify possible enablers to improved uptake of services. METHOD Qualitative descriptive. Thirty-three women attended one of six culturally specific focus groups. Latent content analysis was used to analyse the data set. FINDINGS The key source of information for childbearing women was their families. Poor communication, lack of cultural safety and financial constraints were the major barriers to accessing services. Conversely, enablers were perceived to be continuity of midwifery care that was delivered in the community and was culturally safe. DISCUSSION Strategies to increase uptake of maternity services and optimise services to better meet the needs of women from Māori and Pasifika backgrounds are needed. These should be partnership-based, engage women and families, incorporate cultural needs and preferences and provide services at accessible community locations. CONCLUSION These findings may be relevant to other groups of women, such as women from culturally diverse backgrounds and from communities experiencing poorer health outcomes.