Pre-Adolescent Cardio-Metabolic Associations and Correlates: PACMAC methodology and study protocol

Introduction: Although cardiovascular disease is typically associated with middle or old age, the atherosclerotic process often initiates early in childhood. The process of atherosclerosis appears to be occurring at an increasing rate, even in pre-adolescents, and has been linked to the childhood obesity epidemic. This study will investigate the relationships between obesity, lifestyle behaviours and cardiometabolic health in pre-pubescent children aged 8–10 years, and investigates whether there are differences in the correlates of cardiometabolic health between Māori and Caucasian children. Details of the methodological aspects of recruitment, inclusion/exclusion criteria, assessments, statistical analyses, dissemination of findings and anticipated impact are described. Methods and analysis Phase 1: a cross-sectional study design will be used to investigate relationships between obesity, lifestyle behaviours (nutrition, physical activity/fitness, sleep behaviour, psychosocial influences) and cardiometabolic health in a sample of 400 pre-pubescent (8–10 years old) children. Phase 2: in a subgroup (50 Caucasian, 50 Māori children), additional measurements of cardiometabolic health and lifestyle behaviours will be obtained to provide objective and detailed data. General linear models and logistic regression will be used to investigate the strongest correlate of (1) fatness; (2) physical activity; (3) nutritional behaviours and (4) cardiometabolic health. Ethics and dissemination Ethical approval will be obtained from the New Zealand Health and Disabilities Ethics Committee. The findings from this study will elucidate targets for decreasing obesity and improving cardiometabolic health among preadolescent children in New Zealand. The aim is to ensure an immediate impact by disseminating these findings in an applicable manner via popular media and traditional academic forums. Most importantly, results from the study will be disseminated to participating schools and relevant Māori health entities

"Hua oranga" : best health outcomes for Māori : a thesis presented for the degree of Doctor of Philosophy in Māori Studies at Massey University, Wellington, New Zealand

Poor mental health is recognised as a major threat to Māori well-being. Over the past three decades Māori admissions to psychiatric facilities have increased dramatically and have coincided with increasing socio-economic disadvantage - gaps which exist between Māori and non-Māori, as well as progressive alienation from te ao Māori (the Māori world). Hua Oranga (translated literally as the fruits of health) is both the title of this thesis and the name given to the tool which it describes. The tool is a measure of Māori mental, health outcome and is based on Māori perspectives of health, Māori philosophies, aspirations, and world views. It is a tool designed for clinical and care settings, and measures the efficacy of treatment, or health interventions. The tool employs a triangulated method of outcome assessment and considers the views of tangata whaiora (Māori mental health consumers), clinicians, and whānau (family members). A series of five clinical-endpoints have been identified to allow the tool to be applied with greater precision. By itself the tool will not address all of the complex problems associated with Māori mental health - nor is it designed to do so, indeed that is well beyond the brief of this investigation. What it does however, is to illustrate the utility of seeking outcomes of cultural significance, the employment of Māori perspectives to shape outcome measurement, and the implications for treatment and care. At a broader level, the tool has the potential to contribute to the development of more effective strategies, policies, and service design. To this end, Hua Oranga will contribute to improved health outcomes for Māori

Hua Oranga: Service Utility Pilot of a Mental Health Outcome Measurement for an Indigenous Population

The key areas of development in this study were the criteria for the use of the Hua Oranga, an Indigenous mental health outcome measurement tool for use with Māori, the Indigenous people of Aotearoa (New Zealand). The application of the Hua Oranga was expected to improve the care and treatment of tangata whaiora (consumers) in partnership with whānau (family) and clinicians. The Outcomes Recording Analysis (ORA) database (www.ORAdatabase.co.nz), which receives the Hua Oranga data and generates the Hua Oranga reports was essential to this improvement. This development contributes to the skill and expertise of clinicians in interpreting Māori health information that benefit Māori

How do you recruit and retain a prebirth cohort? Lessons learnt from growing up in New Zealand

Growing Up in New Zealand, a longitudinal study following nearly 7,000 children, has faced some unique challenges in identifying, enrolling, and retaining a large and diverse antenatal cohort. Identification of a study region with population demographics that enabled enrollment of an appropriately diverse sample was required as was intensive community and participant engagement in order to promote the study. Complementary methods used included direct engagement with prospective participants and the community and indirect engagement via media. Thus far, retention rates above 95% have been achieved by maintaining a multimethod approach that includes valuing participants and building trusting relationships, strong brand recognition, community engagement, maintenance of participant contact and location records, ensuring high-quality interactions between the participants and the study, pretesting measures and methods prior to the main cohort, and using participant feedback to inform the measures and methods used in future waves of data collection

Growing up in New Zealand: A longitudinal study of New Zealand children and their families. Report 2: Now we are born

Growing Up in New Zealand is a longitudinal study that provides an up-to-date, population-relevant picture of what it is like to be a child growing up in New Zealand in the 21st century. It recruited and collected information from both mothers and their partners from before their children were born, and it has undertaken several further data collection waves during the children’s first two years of life. It is unique in terms of its capacity to provide a comprehensive picture of contemporary child development across multiple domains of influence for children born in New Zealand, and for including significant numbers of Māori, Pacific and Asian children as well as New Zealand European and other New Zealanders.From its inception the Growing Up in New Zealand study has been explicitly designed to follow children from before birth until they are young adults, to understand ’what works’ for children and families (rather than primarily focusing on negative outcomes) and to consider pathways of development across multiple domains of influence. This will allow a much better understanding of the complex interplay of all the factors that lead to child outcomes including growth, health, behaviours and cognitive development. The model of child development shaping this study is child centred, but never forgets that children develop in dynamic interactions with their families, communities, environments and societal contexts over time. This conceptual approach to the study acknowledges the growth in our understanding of early child development in the last few decades, with an increasing recognition of the importance of the antenatal period and the first few years of life for shaping future developmental pathways for children.This first longitudinal report describes the children’s development from before their birth and through the critical first nine months of their lives. The report highlights the breadth of information that is available from the children and their families in these early months, but it is not the end of what is possible. There is much to be done yet to describe more fully the associations that exist between the diverse environments that these children are growing up in and their development to date, as well as into the future. These analyses will be undertaken over the next several months as the more detailed level data is fully prepared and more complex modelling is undertaken by the study team. In this report there are examples of what is possible, but these are only indicative of the evidence that is yet to emerge from this rich resource. This evidence will contribute important information about the development of our new generation of New Zealand children that will help to inform strategies to ensure that every child born in 21st century in New Zealand is enabled to thrive, belong and achieve (New Zealand Government, 2011