The burden of asthma disproportionately affects minority and low-income communities, resulting in racial and socioeconomic disparities in asthma prevalence, asthma exacerbations, and asthma-related death. Social determinants of health are increasingly implicated as root causes of disparities, and healthy housing is perhaps the most critical social determinant in asthma health disparities. In many minority communities, poor housing conditions and value are a legacy of historical policies and practices imbued with structural racism, including redlining, displacement, and exclusionary zoning. As a result, poor-quality, substandard housing is a characteristic feature of many underrepresented minority communities. Consequently, structurally deficient housing stock cultivates home environments rife with indoor asthma triggers. In this review we consider the historical context of urban housing policies and practices and how these policies and practices have contributed to the substandard housing conditions for many minoritized children in the present day. We describe the impact of poor housing quality on asthma and interventions that have attempted to mitigate its influence on asthma symptoms and health care utilization. We discuss the need to promote asthma health equity by reinvesting in these neighborhoods and communities to provide healthy housing. (J Allergy Clin Immunol 2021;148:1 121-9.)

Alcoholics Anonymous (AA) is a spiritual program and involvement in it has been associated with increases in spirituality. Some who pursue recovery outside AA also use spirituality for support. Decreasing drinking without AA involvement might result in spiritual change, but this has not been explored in previous research. This study investigates drinking and AA behavior to determine their association with 7 dimensions of subsequent spirituality. A 30-month panel study recruited 364 individuals with alcohol dependence. Multilevel models examined drinking and AA at 6 months as predictors of both the levels and trajectories of 7 dimensions of spirituality assessed 5 times over 6–30 months. Controlling for AA involvement, less drinking was associated with higher levels of purpose in life, self-forgiveness, and spiritual/religious practices. Controlling for drinking, greater AA involvement was associated with higher levels of positive religious coping, daily spiritual experiences, forgiveness of others, and spiritual/religious practices. Neither AA nor drinking predicted trajectories of spirituality. Data visualizations identified a pattern of elevated purpose in life and self-forgiveness among individuals who were abstinent and among individuals who drank less intensely. Reduced drinking influenced aspects of spirituality that have been shown to respond to experience and maturation. AA was associated with aspects of spirituality embedded in the 12 steps which have been shown to be responsive to learning and modeling. This knowledge has the potential to inform decisions about recovery options, and contributes to theoretical understandings of the nature of spiritual change over the course of addiction recovery.

BackgroundMindfulness-based interventions show promise for stress reduction in general medical conditions, and initial evidence suggests that they are accepted in trauma-exposed individuals. Mindfulness-based cognitive therapy (MBCT) shows substantial efficacy for prevention of depression relapse, but it has been less studied in anxiety disorders. This study investigated the feasibility, acceptability, and clinical outcomes of an MBCT group intervention adapted for combat posttraumatic stress disorder (PTSD).MethodsConsecutive patients seeking treatment for chronic PTSD at a VA outpatient clinic were enrolled in 8-week MBCT groups, modified for PTSD (four groups, n=20) or brief treatment-as-usual (TAU) comparison group interventions (three groups, n=17). Pre and posttherapy psychological assessments with clinician administered PTSD scale (CAPS) were performed with all patients, and self-report measures (PTSD diagnostic scale, PDS, and posttraumatic cognitions inventory, PTCI) were administered in the MBCT group.ResultsIntent to treat analyses showed significant improvement in PTSD (CAPS (t(19)=4.8, P<.001)) in the MBCT condition but not the TAU conditions, and a significant Condition x Time interaction (F[1,35]=16.4, P<.005). MBCT completers (n=15, 75%) showed good compliance with assigned homework exercises, and significant and clinically meaningful improvement in PTSD symptom severity on posttreatment assessment in CAPS and PDS (particularly in avoidance/numbing symptoms), and reduced PTSD-relevant cognitions in PTCI (self blame).ConclusionsThese data suggest group MBCT as an acceptable brief intervention/adjunctive therapy for combat PTSD, with potential for reducing avoidance symptom cluster and PTSD cognitions. Further studies are needed to examine efficacy in a randomized controlled design and to identify factors influencing acceptability and efficacy. Depression and Anxiety 30: 638-645, 2013. (C) 2013 Wiley Periodicals, Inc.

OBJECTIVE:To describe trends in self-reported sexual and reproductive health behaviours among New Zealand secondary school students.METHODS:Nationally representative health and wellbeing surveys conducted in 2001 (n=9,699), 2007 (n=9,107) and 2012 (n=8,500) were analysed. Logistic regressions were used to explore variations in sexual health outcomes between 2001 and 2012.RESULTS:'Ever had sex' (-6.9%, p<0.001); 'currently sexually active' (- 2.3%, p<0.001); 'always use condoms' (-3.3%, p=0.006); 'condoms at last sex' (-7.0, p=0.002); 'contraception at last sex' (-5.8%, p<0.001) and sexually transmitted infections (-0.3%, p=0.001) have reduced over time. 'Always use contraception' did not change significantly (-1.4%, p=0.514) over time. Māori (OR 0.7), Pacific (OR 0.5) and socioeconomically deprived students (OR 0.7) less frequently used condoms. Māori (OR 0.6), Pacific (OR 0.4), Asian (OR 0.5), younger (OR 0.6), and socioeconomically deprived (OR 0.6) students less frequently used contraception.CONCLUSIONS:Students in 2012 were more likely to delay sexual activity, but were less likely to use condoms and contraception consistently, compared to students in 2001. Declining contraceptive use over an 11-year period suggests that current strategies are inadequate, particularly for Māori, Pacific and socioeconomically deprived students. Appropriate and accessible sexual and reproductive health services are urgently required.

OBJECTIVE:To investigate the association between kava use and the risk of four-wheeled motor vehicle crashes in Fiji. Kava is a traditional beverage commonly consumed in many Pacific Island Countries. Herbal anxiolytics containing smaller doses of kava are more widely available.METHODS:Data for this population-based case-control study were collected from drivers of 'case' vehicles involved in serious injury-involved crashes (where at least one road user was killed or admitted to hospital for 12 hours or more) and 'control' vehicles representative of 'driving time' in the study base. Structured interviewer administered questionnaires collected self-reported participant data on demographic characteristics and a range of risk factors including kava use and potential confounders. Unconditional logistic regression models estimated odds ratios relating to the association between kava use and injury-involved crash risk.FINDINGS:Overall, 23% and 4% of drivers of case and control vehicles, respectively, reported consuming kava in the 12 hours prior to the crash or road survey. After controlling for assessed confounders, driving following kava use was associated with a four-fold increase in the odds of crash involvement (Odds ratio: 4.70; 95% CI: 1.90-11.63). The related population attributable risk was 18.37% (95% CI: 13.77-22.72). Acknowledging limited statistical power, we did not find a significant interaction in this association with concurrent alcohol use.CONCLUSION:In this study conducted in a setting where recreational kava consumption is common, driving following the use of kava was associated with a significant excess of serious-injury involved road crashes. The precautionary principle would suggest road safety strategies should explicitly recommend avoiding driving following kava use, particularly in communities where recreational use is common.

OBJECTIVE Parental monitoring of adolescents' diabetes self-care is associated with better adherence and glycemic control (A1c). A number of parent-level factors are associated with higher levels of parental monitoring, including lower levels of parental distress (depressive symptoms, stress, anxiety), as well as higher levels of parental self-efficacy for diabetes management and authoritative parenting. Often studied in isolation, these factors may be best considered simultaneously as they are interrelated and are associated with parental monitoring and youth adherence. METHOD Structural equation modeling with a cross-sectional sample of 257 parent/youth (aged 11-14) dyads: (a) examined a broad model of parental factors (i.e., parental distress, parental diabetes self-efficacy, authoritative parenting), and (b) assessed their relation to parental monitoring, youth adherence, and A1c. Post hoc analyses of variance (ANOVAs) evaluated clinical implications of daily parental monitoring. RESULTS Parental distress was not related directly to parental monitoring. Instead less distress related indirectly to more monitoring via higher parental self-efficacy and more authoritative parenting which, in turn, related to better adherence and A1c. Higher parental self-efficacy also related directly to better youth adherence and then to better A1c. Clinically, more parental monitoring related to more daily blood glucose checks and to better A1c (8.48% vs. 9.17%). CONCLUSIONS A broad model of parent-level factors revealed more parental distress was linked only indirectly to less monitoring via lower parental self-efficacy and less authoritative parenting. Behaviorally, more parental monitoring related to better adherence and to clinically better A1c in adolescents. Further study of parent-level factors that relate to parental distress and monitoring of adherence appears warranted. (PsycINFO Database Record

Background: Most women decide about infant immunisation during pregnancy. However, we have limited knowledge of the immunisation intentions of their partners. We aimed to describe what pregnant women and their partners intended for their future child's immunisations, and to identify associations between parental intentions and the subsequent timeliness of infant immunisation.Methods: We recruited a cohort of pregnant New Zealand (NZ) women expecting to deliver between April 2009 and March 2010. The cohort included 11% of births in NZ during the recruitment period and was generalisable to the national birth cohort.We completed antenatal interviews independently with mothers and partners. We determined immunisation receipt from the National Immunisation Register and defined timely immunisation as receiving all vaccines (scheduled at 6-weeks, 3- and 5-months) within 30 days of their due date. We described independent associations of immunisation intentions with timeliness using adjusted odds ratios (OR) and 95% confidence intervals (CI).Results: Of 6172 women, 5014 (81%) intended full immunisation, 245 (4%) partial immunisation, 140 (2%) no immunisation and 773 (13%) were undecided. Of 4152 partners, 2942 (71%) intended full immunisation, 208 (5%) partial immunisation, 83 (2%) no immunisation and 921 (22%) were undecided. Agreement between mothers and partners was moderate (Kappa = 0.42).Timely immunisation occurred in 70% of infants. Independent of their partner's intentions, infants of pregnant women who decided upon full immunisation were more likely to be immunised on time (OR = 7.65, 95% CI: 4.87 - 12.18). Independent of the future mother's intentions, infants of partners who had decided upon full immunisations were more likely to be immunised on time (OR = 3.33, 95% CI: 2.29 - 4.84).Conclusions: During pregnancy, most future parents intend to fully immunise their child; however, more partners than mothers remain undecided about immunisation. Both future mothers' and future fathers' intentions are independently associated with the timeliness of their infant's immunisations. (C) 2016 Elsevier Ltd. All rights reserved.

This study sought to determine the prevalence of gambling and unhealthy gambling behaviour and describe risk and protective factors associated with these behaviours amongst a nationally representative sample of New Zealand secondary school students (n=8,500). Factor analysis and item response theory were used to develop a model to provide a measure of 'unhealthy gambling'. Logistic regressions and multiple logistic regression models were used to investigate associations between unhealthy gambling behaviour and selected outcomes. Approximately one-quarter (24.2 %) of students had gambled in the last year, and 4.8 % had two or more indicators of unhealthy gambling. Multivariate analyses found that unhealthy gambling was associated with four main factors: more accepting attitudes towards gambling (p<0.0001); gambling via gambling machines/casinos/track betting (p=0.0061); being worried about and/or trying to cut down on gambling (p<0.0001); and, having attempted suicide (p=0.0009). Unhealthy gambling is a significant health issue for young people in New Zealand. Ethnic and social inequalities were apparent and these disparities need to be addressed.

This study examined whether increases in purpose in life (PIL) over 2.5 years were associated with Diagnostic and Statistical Manual of Mental Disorders (4th ed.) remission among 364 individuals with alcohol dependence. Remission from alcohol dependence at final follow-up was associated with significantly greater increases in PIL over time, compared to those without remission or with partial remission. The strong relationship between increases in PIL and remitted status at final follow-up indicates the importance of existential issues to recovery, and the value of incorporating these concerns into treatment and further investigating their role in initiating and supporting recovery.

OBJECTIVE:To compare the birth characteristics of the Growing Up in New Zealand cohort with those of all New Zealand (NZ) births over a similar time period, and to describe cohort alignment to current NZ births.METHOD:The Growing Up in New Zealand longitudinal study recruited 6,846 children from before birth via their pregnant mothers who were residing in the greater Auckland and Waikato regions during 2009 and 2010. Data were collected from mothers antenatally and six weeks after their expected delivery date, and from routine perinatal health records. These data were compared to Ministry of Health data for all births in NZ between 2007 and 2010.RESULTS:The proportion of males and singleton births were not statistically different to national births. Compared to national births fewer of the cohort children were born low birth weight (4.9% vs. 6.1%, p<0.0001) or preterm (6.4% vs. 7.4%, p=0.001) and the cohort was expected to be more ethnically diverse than national births.CONCLUSION:Birth parameters for the cohort were generally closely aligned to all NZ births in 2007-2010. Some statistically significant differences reflected small absolute differences, attributable in some part to cohort recruitment requiring survival to six weeks post expected delivery.IMPLICATIONS:The explicit documentation of the alignment of the cohort to national data provides assurance that the study is well placed to deliver findings that can inform policy development relevant to the diversity of the contemporary NZ child population.

This paper explored whether there was a relationship between staffing and quality indicators in residential care for older people, in both rest homes and continuing care hospitals. A longitudinal survey of a sample of residential-care rest homes and continuing-care hospitals explored the relationship between direct-care staffing levels, skill mix and quality indicators. The study was conducted in rest homes (n=18) and continuing care hospitals (n=16) providing long-term care for people 65 years of age and over in the greater Auckland region in New Zealand. Participating rest homes and hospitals collected monthly data on direct-care staffing (registered nurses, enrolled nurses and support workers), quality indicators (falls, new fractures, pressure ulcers, weight loss, urinary tract infections, over nine medications a day, presence of indwelling catheters and use of daily restraints), over a six-month period. Logistic analysis revealed that in continuing care hospitals, as registered nurse/enrolled nurse time increased, there was a general trend of reduction in adverse events: falls, pressure ulcers, and daily restraint use. However, there were no significant associations between registered nurse/enrolled nurse, or support worker staffing hours in rest homes in relation to the incidence of the five quality indicators: falls, weight loss, urinary tract infections, use of over nine medications, and the use of indwelling catheters. The study, utilising facility-level data, demonstrated a trend that increasing the combined time of registered and enrolled nurses to residents resulted in a decrease in adverse events in continuing-care hospitals. No other trends were identified.

In children, community-acquired pneumonia is a frequent cause of emergency department (ED) presentation and hospital admission. Quality primary care may prevent some of these hospital visits. The aim of this study was to identify primary care factors associated with ED presentation and hospital admission of preschool-aged children with community-acquired pneumonia. A case–control study was conducted by enrolling three groups: children presenting to the ED with pneumonia and admitted (n=326), or discharged home (n=179), and well-neighbourhood controls (n=351). Interviews with parents and primary care staff were conducted and health record review was performed. The association of primary care factors with ED presentation and hospital admission, controlling for available confounding factors, was determined using logistic regression. Children were more likely to present to the ED with pneumonia if they did not have a usual general practitioner (GP) (odds ratio (OR)=2.50, 95% confidence interval (CI)=1.67–3.70), their GP worked ⩽20 h/week (OR=1.86, 95% CI=1.10–3.13) or their GP practice lacked an immunisation recall system (OR=5.44, 95% CI=2.26–13.09). Lower parent ratings for continuity (OR=1.63, 95% CI=1.01–2.62), communication (OR=2.01, 95% CI=1.29–3.14) and overall satisfaction (OR=2.16, 95% CI=1.34–3.47) increased the likelihood of ED presentation. Children were more likely to be admitted when antibiotics were prescribed in primary care (OR=2.50, 95% CI=1.43–4.55). Hospital admission was less likely if children did not have a usual GP (OR=0.22, 95% CI=0.11–0.40) or self-referred to the ED (OR=0.48, 95% CI=0.26–0.89). Accessible and continuous primary care is associated with a decreased likelihood of preschool-aged children with pneumonia presenting to the ED and an increased likelihood of hospital admission, implying more appropriate referral. Lower parental satisfaction is associated with an increased likelihood of ED presentation. Preschoolers with pneumonia who have easy access to their GP and continuous care are less likely to present to emergency departments (ED). An international team led by Cameron Grant from the University of Auckland in New Zealand found in this case-controlled study that children were two and a half times more likely to present to ED if they did not have a regular GP and almost twice as likely if their GP worked less than 20 hours a week. Lower parental satisfaction with primary care doubled the likelihood of a presentation to the ED. Children were more likely to be admitted to hospital if they were on antibiotics or had been referred by their GP. The authors conclude that easily accessible and comprehensive primary care can prevent inappropriate use of emergency resources.

AimTo provide an overview of the health and well-being of sexual minority high school students in New Zealand, investigate differences between sexual minority youth (SMY) and exclusively opposite-sex-attracted youth (EOSAY), and examine changes across survey waves.MethodsNationally representative cross-sectional surveys were completed in 2001 (n = 9011), 2007 (n = 8002) and 2012 (n = 8167). Logistic regressions were used to examine the associations between selected outcomes and sexual attraction across survey waves.ResultsSMY accounted for 6% of participants in all three waves, with a greater proportion being out' in 2012 (P < 0.0001). SMY were more likely to work as volunteers (OR = 1.37) than EOSAY, and the majority of SMY reported good general health, liking school and having caring friends. With the exceptions of binge drinking and being driven dangerously by someone, SMY reported comparatively diminished health and well-being relative to EOSAY. Increasing proportions of SMY had depressive symptoms from 2001 (OR = 2.38) to 2012 (OR = 3.73) compared with EOSAY. There were some differences between the sexes; female SMY were less likely to report positive family relationships (OR = 0.59) and liking school (OR = 0.55), and they were more likely to have been hit (2012 OR = 1.95) than female EOSAY. Male SMY reported especially high rates of suicide attempts (2012 OR = 5.64) compared with male EOSAY.ConclusionsHealth services, schools, communities and families must be more responsive to the needs of SMY to ensure that disparities are addressed.

AimsThe aims of this study are to provide a profile of sexual health behaviours of Māori youth and to identify factors associated with consistent condom and contraception use.MethodsMultivariable analyses were conducted to determine relationships between consistent contraception and condom use among all 2059 sexually active Māori participants in the 2007 New Zealand youth health and well‐being survey of secondary school students.ResultsForty per cent of Māori students were currently sexually active; of these, 55.3% always used contraception, and 41.1% always used condoms. Risk factors for not using contraception were less than or equal to three sexual partners (males odds ratio (OR) 0.55, P = 0.04, females OR 0.35, P = 0.04) and regular cigarette use for females (OR 0.52, P = 0.02). Risk factors for not using condoms were 13‐ to 15‐year‐old females (OR 1.95, P < 0.01) and females who enjoyed sex (OR 0.52, P = 0.02). Family connection was associated with increased use of condoms among males (OR 1.07, P < 0.01).ConclusionsReducing sexual risks, increasing opportunities for healthy youth development and family connectedness, alongside access to appropriate services, are required to improve the sexual health of Māori youth.

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.

Objective: To describe the self-reported mental health of New Zealand secondary school students in 2012 and to investigate changes between 2007 and 2012. Methods: Nationally representative health and wellbeing surveys of students were completed in 2007 ( n=9107) and 2012 ( n=8500). Logistic regressions were used to examine the associations between mental health and changes over time. Prevalence data and adjusted odds ratios are presented. Results: In 2012, approximately three-quarters (76.2%, 95% CI 74.8–77.5) of students reported good overall wellbeing. By contrast (also in 2012), some students reported self-harming (24.0%, 95% CI 22.7–25.4), depressive symptoms (12.8%, 95% CI 11.6–13.9), 2 weeks of low mood (31%, 95% CI 29.7–32.5), suicidal ideation (15.7%, 95% 14.5–17.0), and suicide attempts (4.5%, 95% CI 3.8–5.2). Between 2007 and 2012, there appeared to be slight increases in the proportions of students reporting an episode of low mood (OR 1.14, 95% CI 1.06–1.23, p=0.0009), depressive symptoms (OR 1.16, 95% CI 1.03–1.30, p=0.011), and using the Strengths and Difficulties Questionnaire - emotional symptoms (OR 1.38, 95% CI 1.23–1.54, p<0.0001), hyperactivity (OR 1.16, 95% CI 1.05–1.29, p=0.0051), and peer problems (OR 1.27, 95% CI 1.09–1.49, p=0.0022). The proportion of students aged 16 years or older reporting self-harm increased slightly between surveys, but there was little change for students aged 15 years or less (OR 1.29, 95% CI 1.15–1.44 and OR 1.10, 95% 0.98–1.23, respectively, p=0.0078). There were no changes in reported suicidal ideation and suicide attempts between 2007 and 2012. However, there has been an improvement in self-reported conduct problems since 2007 (OR 0.78, 95% CI 0.70–0.87, p<0.0001). Conclusions: The findings suggest a slight decline in aspects of self-reported mental health amongst New Zealand secondary school students between 2007 and 2012. There is a need for ongoing monitoring and for evidence-based, accessible interventions that prevent mental ill health and promote psychological wellbeing.