Healthy lifestyle and risk of breast cancer for indigenous and non-indigenous women in New Zealand: a case control study.

BACKGROUND: The reasons for the increasing breast cancer incidence in indigenous Māori compared to non-Māori New Zealand women are unknown. The aim of this study was to assess the association of an index of combined healthy lifestyle behaviours with the risk of breast cancer in Māori and non-Māori women. METHODS: A population-based case-control study was conducted, including breast cancer cases registered in New Zealand from 2005-2007. Controls were matched by ethnicity and 5-year age bands. A healthy lifestyle index score (HLIS) was generated for 1093 cases and 2118 controls, based on public health and cancer prevention recommendations. The HLIS was constructed from eleven factors (limiting red meat, cream, and cheese; consuming more white meat, fish, fruit and vegetables; lower alcohol consumption; not smoking; higher exercise levels; lower body mass index; and longer cumulative duration of breastfeeding). Equal weight was given to each factor. Logistic regression was used to estimate the associations between breast cancer and the HLIS for each ethnic group stratified by menopausal status. RESULTS: Among Māori, the mean HLIS was 5.00 (range 1-9); among non-Māori the mean was 5.43 (range 1.5-10.5). There was little evidence of an association between the HLIS and breast cancer for non-Māori women. Among postmenopausal Māori, those in the top HLIS tertile had a significantly lower odds of breast cancer (Odds Ratio 0.47, 95% confidence interval 0.23-0.94) compared to those in the bottom tertile. CONCLUSION: These findings suggest that healthy lifestyle recommendations could be important for reducing breast cancer risk in postmenopausal Māori women

Internet-Based Birth-Cohort Studies: Is This the Future for Epidemiology?

BACKGROUND: International collaborative cohorts the NINFEA and the ELF studies are mother-child cohorts that use the internet for recruitment and follow-up of their members. The cohorts investigated the association of early life exposures and a wide range of non-communicable diseases. OBJECTIVE: The objective is to report the research methodology, with emphasis on the advantages and limitations offered by an Internet-based design. These studies were conducted in Turin, Italy and Wellington, New Zealand. METHODS: The cohorts utilized various online/offline methods to recruit participants. Pregnant women who became aware volunteered, completed an online questionnaire, thus obtaining baseline information. RESULTS: The NINFEA study has recruited 7003 pregnant women, while the ELF study has recruited 2197 women. The cohorts targeted the whole country, utilizing a range of support processes to reduce the attrition rate of the participants. For the NINFEA and ELF cohorts, online participants were predominantly older (35% and 28.9%, respectively), highly educated (55.6% and 84.9%, respectively), and were in their final trimester of pregnancy (48.5% and 53.6%, respectively). CONCLUSIONS: Internet-based cohort epidemiological studies are feasible, however, it is clear that participants are self-selective samples, as is the case for many birth cohorts. Internet-based cohort studies are potentially cost-effective and novel methodology for conducting long-term epidemiology research. However, from our experience, participants tend to be self-selective. In marked time, if the cohorts are to form part of a larger research program they require further use and exploration to address biases and overcome limitations

Determinants of hand dermatitis, urticaria and loss of skin barrier function in professional cleaners in New Zealand.

This study assessed the risk of dermatitis, urticaria and loss of skin barrier function in 425 cleaners and 281 reference workers (retail workers and bus drivers). Symptoms, atopy and skin barrier function were assessed by questionnaire, skin prick tests, and measurement of transepidermal water loss. Cleaners had an increased risk of current (past 3 months) hand/arm dermatitis (14.8% vs. 10.0%; OR = 1.9, p < 0.05) and urticaria (11% vs. 5.3%; OR = 2.4, p < 0.05) and were more likely to have dermatitis as adults (17.6% vs. 11.4%; OR = 1.8, p < 0.05). The risk of atopy was not increased, but associations with symptoms were more pronounced in atopics. Transepidermal water loss was significantly higher in cleaners. Wet-work was a significant risk factor for dermatitis and hand washing and drying significantly reduced the risk of urticaria. In conclusion, cleaners have an increased risk of hand/arm dermatitis, urticaria and loss of skin barrier function

A multi-ethnic breast cancer case-control study in New Zealand: evidence of differential risk patterns.

PURPOSE: To investigate whether the relationships between established risk factors and breast cancer risk differ between three ethnic groups in New Zealand, namely Māori, Pacific, and non-Māori/non-Pacific women. METHODS: The study is a multi-ethnic, age-, and ethnicity-matched population-based case-control study of breast cancer in women. Women with a primary, invasive breast cancer registered on the New Zealand Cancer Registry between 1 April 2005 and 30 April 2006, and Māori or Pacific women diagnosed to 30 April 2007 were eligible. Control women were identified from the New Zealand Electoral Roll, stratified by ethnicity, then frequency matched on age to the cases. Logistic regression was used to estimate odds ratios (OR) and 95 % confidence intervals (CI) between exposures and breast cancer risk in three ethnic groups separately. Likelihood ratio tests were used to test for modification of the effects by ethnicity. Post-stratification weighting of the controls was used to account for differential non-response by deprivation category. RESULTS: The study comprised 1,799 cases (302 Māori, 70 Pacific, 1,427 non-Māori/non-Pacific) and 2,543 controls (746 Māori, 194 Pacific, 1,603 non-Māori/non-Pacific), based on self-identified ethnicity. Māori women were more likely to have ER and PR positive breast cancer compared to other ethnicities. There were marked differences in exposure prevalence between ethnicities and some differing patterns of risk factors for breast cancer between the three main ethnic groups. Of interest was the strong relationship between number of children and lower breast cancer risk in Pacific women (OR for 4 or more vs. 1 child OR 0.13, 95 % CI 0.05-0.35) and a higher risk of breast cancer associated with smoking (OR 1.76, 95 % CI 1.25-2.48) and binge drinking (5 or more vs. 1-2 drinks per occasion, OR 1.55, 95 % CI 1.07-2.26) in Māori women. Some of the documented results were attenuated following post-stratification weighting. CONCLUSIONS: The findings of this study need to be interpreted with caution, given the possibility of selection bias due to low response rates among some groups of women. Reducing the burden of breast cancer in New Zealand is likely to require different approaches for different ethnic groups

Obstructive sleep apnoea syndrome among taxi drivers : consequences and barriers to accessing health services : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health at Massey University, Sleep/Wake Research Centre, Wellington Campus, New Zealand

Irregular pagination - jumps from p. 168 to p. 170.Untreated Obstructive Sleep Apnoea Syndrome (OSAS) increases the risk of motor vehicle accidents and morbidity. Its prevalence among taxi drivers is unknown. The goals of this thesis were to: (1) estimate the prevalence of OSAS symptoms and risk factors among taxi drivers; and (2) identify the barriers to accessing health care services for the diagnosis and treatment of OSAS. Between June and July 2004 questionnaires were mailed to 651 taxi drivers from two Wellington taxi companies (response rate 41.3%, n=241). Excessive daytime sleepiness (ESS>10) was reported by 18% of drivers. The estimated proportion with a pre-test risk of OSA (RDI≥ 15/hour) was 15%, according to a questionnaire-based screening tool. Pacific drivers were more likely to report OSAS symptoms than people of "other" (non-Māori) ethnicities. Logistic regression analyses identified the following independent risk factors for OSAS symptoms: increasing neck size, age groups: 46-53 years and 61-76 years, and self-reported snoring 'always'. Three focus groups were conducted in November 2004. Thematic analyses identified the following barriers to accessing health care: (1) sleepiness was not a perceived health problem; (2) personal demands; (3) industry demands; and (4) driver avoidance and dissatisfaction with general practitioner's services. Detailed examination of these themes indicated that drivers were deterred from seeking care by limited knowledge and awareness of OSAS, confusion about responsibility for health and safety, medical costs, and the risk of finding out about other health conditions. General practitioners reportedly failed to screen for OSAS symptoms and demonstrated little knowledge about sleep health. These barriers are a major cause for concern, and they are used to support the belief that earning a living is more important than personal health and safety. The key finding is that improving drivers' knowledge is unlikely to change their behaviour, without concurrent measures to address systemic issues in the taxi industry and in the health care system

Barriers to and delays in accessing breast cancer care among New Zealand women:disparities by ethnicity

BACKGROUND: Unequal access to health care contributes to disparities in cancer outcomes. We examined the ethnic disparity in barriers to accessing primary and specialist health care experienced by New Zealand women with breast cancer. METHODS: Women diagnosed with a primary invasive breast cancer between 2005 and 2007 were eligible. There were 1,799 respondents, n = 302 Māori (the indigenous population of NZ), n = 70 Pacific and n = 1,427 non-Māori/non-Pacific women. Participants completed a questionnaire listing 12 barriers grouped into three domains for analysis: personal; practical; and health care process factors, and reported the number of days between seeing a primary and a specialist care provider. Chi-squared, Fisher exact tests and logistic regression were used to assess uni- and multivariable differences in prevalence between ethnic groupings. RESULTS: The prevalence of reporting three or more barriers was 18 % among Pacific, 10 % among Māori and 3 % among non-Māori/non-Pacific women (P <0.001). The most commonly reported barriers were fear (Māori women) and cost (Pacific and non-Māori/non-Pacific women). Ethnic differences in reported barriers were not explained by deprivation or diabetes prevalence. Women with diabetes reported a two-fold higher risk of experiencing barriers to care compared to those without diabetes (odds ratio [OR]: 2.06, 95%CI 1.20 to 3.57). Māori and Pacific women were more likely to face delays (median 14 days) in seeing a specialist than non-Māori/non-Pacific women (median 7 days); these differences were not explained by the reported barriers. CONCLUSIONS: Patterns of reported barriers to care differed according to ethnicity and were not explained by deprivation, or presence of co-morbidity. Māori and Pacific women are more likely to experience barriers to breast cancer care compared to non- Māori/non-Pacific women. We identified two key barriers affecting care for Māori and Pacific women; (a) delays in follow-up, and (b) the impact of co-morbid conditions. Future New Zealand work needs to focus attention on health care process factors and improving the interface between primary and secondary care to ensure quality health care is realised for all women with breast cancer

Ethnic differences in risk factors for obesity in New Zealand infants

BACKGROUND: In New Zealand, the burden of childhood obesity is greatest in Māori and Pacific children. METHODS: In 687 infants from an internet-based birth cohort in New Zealand, we investigated ethnic differences in early life risk factors for later obesity, the degree to which these were explained by sociodemographic factors, and the extent to which ethnic differences in weight at age 3 months were explained by measured risk factors. RESULTS: The risk of having an obese mother was double in Māori and Pacific infants compared with NZ European infants (prevalence 24% and 14%, respectively; OR 2.23, 95% CI 1.23 to 4.04). Māori and Pacific infants had higher weights in the first week of life and at 3 months (mean difference 0.19 kg, 95% CI 0.01 to 0.38), and their mothers had higher scores on a 'snacks' dietary pattern and lower scores on 'healthy' and 'sweet' dietary patterns. These inequalities were not explained by maternal education, maternal age or area-based deprivation. No ethnic differences were observed for maternal pre-pregnancy physical activity, hypertension or diabetes in pregnancy, exclusive breastfeeding or early introduction of solid foods. Ethnic inequalities in infant weight at 3 months were not explained by sociodemographic variables, maternal pre-pregnancy body mass index or dietary pattern scores or by other measured risk factors. CONCLUSIONS: This study shows excess prevalence of early life risk factors for obesity in Māori and Pacific infants in New Zealand and suggests an urgent need for early interventions for these groups

COVID-19 and the State of Health of Pacific Islanders in the U.S.

In the United States, Pacific Islanders are disproportionately impacted by COVID-19 at alarming rates. Prior to the pandemic, the population was experiencing some of the largest health disparities in the United States driven, in part, by a lack of access to economic resources and health care. Historical events provide a context to understanding the current socioeconomic indicators that predispose Pacific Islanders to COVID-19 and provides insight into the circumstances that have led to the effective transmission of COVID-19 in this community. Other Pacific populations demonstrate more optimal control of COVID-19 and may provide models that have the potential to improve the devastatingly dis proportional rates of infection and death in this vulnerable community

Respiratory health in professional cleaners: Symptoms, lung function, and risk factors.

BACKGROUND: Cleaning is associated with an increased risk of asthma symptoms, but few studies have measured functional characteristics of airway disease in cleaners. AIMS: To assess and characterize respiratory symptoms and lung function in professional cleaners, and determine potential risk factors for adverse respiratory outcomes. METHODS: Symptoms, pre-/post-bronchodilator lung function, atopy, and cleaning exposures were assessed in 425 cleaners and 281 reference workers in Wellington, New Zealand between 2008 and 2010. RESULTS: Cleaners had an increased risk of current asthma (past 12 months), defined as: woken by shortness of breath, asthma attack, or asthma medication (OR = 1.83, 95% CI = 1.18-2.85). Despite this, they had similar rates of current wheezing (OR = 0.93, 95% CI = 0.65-1.32) and were less likely to have a doctor diagnosis of asthma ever (OR = 0.62, 95% CI = 0.42-0.92). Cleaners overall had lower lung function (FEV1 , FVC; P 3 vs ≤3 times/year), and reduced bronchodilator response (6% vs 9% mean FEV1 -%-predicted change, P < .05) compared to asthma in reference workers. Cleaning of cafes/restaurants/kitchens and using upholstery sprays or liquid multi-use cleaner was associated with symptoms, whilst several exposures were also associated with lung function deficits (P < .05). CONCLUSIONS AND CLINICAL RELEVANCE: Cleaners are at risk of some asthma-associated symptoms and reduced lung function. However, as it was not strongly associated with wheeze and atopy, and airway obstruction was less reversible, asthma in some cleaners may represent a distinct phenotype