Introduction: This study investigated the extent of driving cessation planning among older drivers, characteristics associated with planning, and types of plans made. Method: Cross-sectional analysis of baseline data from New Zealand Prospective Older Adult Transport and Health Study (NZPATHS); population-based study of 1181 community-dwelling drivers (65-97 years). Results: Fifty-five percent of participants had considered the possibility of driving cessation; 10 % had made at least one plan (active planners), such as exploring alternative transport options. Having made active plans for driving cessation was independently associated with older age, identifying as female, and ethnicity. After adjusting for these factors, those who reported poorer health, anticipated driving problems within five years or had discussed their driving with family or friends were more likely to be active planners. They were more likely to walk or use alternate modes compared with non-planners. Conversely, drivers who considered continuing to drive to be very important, drove more kilometres, or had access to rides with others were less likely to be planners. Conclusions: Driving cessation planning is shaped by personal perceptions and contextual factors, with older adults who perceive potential challenges to their driving or health more likely to actively prepare. Older adults who see driving as essential or have access to transport through social networks may delay or avoid planning, potentially a problem if cessation is abrupt. The importance of planning in adaptation to driving cessation and transport dependence remains unclear and longitudinal research with waves 1-4 (2016-2023) of the NZPATHS cohort is underway to examine this.

BACKGROUND AND AIMS:Quantifying the health burden of alcohol has largely focused upon harm to drinkers, which is an underestimate. There is a growing literature on alcohol's harm to others (HTO), but it lacks the systematic transfer of HTO into a comparative risk assessment framework. This study calculated disability-adjusted life years (DALYs) for fetal alcohol spectrum disorder (FASD), interpersonal violence and traffic injury due to another's drinking. DESIGN:This study is a disease burden analysis, using modelling of DALYs for New Zealand in 2018. SETTING AND PARTICIPANTS:The study took place among the Aotearoa/New Zealand population in 2018. MEASUREMENTS:The involvement of others' drinking was obtained from prevalence, alcohol-attributable fraction studies and administrative data. Disability weights (DW) for FASD were adapted from fetal alcohol syndrome (FAS) weights using a Beta-Pert probability distribution; for interpersonal injury, DWs used hospital events linked with injury compensation; for traffic injury, DWs used hospital events. Populations were stratified by ethnicity, age group and gender. A descriptive comparison was made with a previous estimate of DALYs for drinkers. FINDINGS:In 2018, 78 277 healthy life years were lost in Aotearoa/New Zealand due to alcohol's HTO. The main contributor (90.3%) was FASD, then traffic crashes (6.3%) and interpersonal violence (3.4%). The indigenous population, Māori, was impacted at a higher rate (DALYs among Māori were 25 per 1000 population; among non-Māori 15 per 1000 population). The burden of HTO was greater than that to drinkers (DALYs HTO = 78 277; DALYs drinkers = 60 174). CONCLUSIONS:Disability from fetal alcohol spectrum disorder (FASD) appears to be a major contributor to alcohol's harm to others in Aotearoa/New Zealand. Taking FASD into account, the health burden of harm to others is larger than harm to the drinker in Aotearoa/New Zealand, and ethnicity differences show inequity in harm to others. Quantification of the burden of harm informs the value of implementing effective alcohol policies and should include the full range of harms.

INTRODUCTION While effective policies exist to reduce alcohol-related harm, political will to enact them is low in many jurisdictions. We aimed to identify key barriers and strategies for strengthening political priority for alcohol policy reform. METHODS A framework synthesis was conducted, incorporating relevant theory, key informant interviews (n = 37) and a scoping review. Thematic analysis informed the development of a framework for understanding and influencing political priority for alcohol policy. RESULTS Twelve barriers and 14 strategies were identified at multiple levels (global, national and local). Major barriers included neoliberal or free trade ideology, the globalised alcohol industry, limited advocate capacity and the normalisation of alcohol harms. Strategies fell into two categories: sector-specific and system change initiatives. Sector-specific strategies primarily focus on influencing policymakers and mobilising civil society. Examples include developing a clear, unified solution, coalition building and effective framing. System change initiatives target structural change to reduce the power imbalance between industry and civil society, such as restricting industry involvement in policymaking and securing sustainable funding for advocacy. A key example is establishing an international treaty, similar to the Framework Convention on Tobacco Control, to support domestic policymaking. DISCUSSION AND CONCLUSIONS Our findings provide a framework for understanding and advancing political priority for alcohol policy. The framework highlights that progress can be achieved at various levels and through diverse groups of actors. The importance of upstream drivers of policymaking was a key finding, presenting challenges for time-poor advocates, but offering potential facilitation through effective global leadership.

INTRODUCTION Foetal alcohol spectrum disorder (FASD) is 100% caused by alcohol. The lifelong disability caused by prenatal alcohol exposure cannot be reversed. Lack of reliable national prevalence estimates of FASD is common internationally and true of Aotearoa, New Zealand. This study modelled the national prevalence of FASD and differences by ethnicity. METHODS FASD prevalence was estimated from self-reported data on any alcohol use during pregnancy for 2012/2013 and 2018/2019, combined with risk estimates for FASD from a meta-analysis of case-ascertainment or clinic-based studies in seven other countries. A sensitivity analysis using four more recent active case ascertainment studies was performed to account for the possibility of underestimation. RESULTS We estimated FASD prevalence in the general population to be 1.7% (95% confidence interval [CI] 1.0%; 2.7%) in the 2012/2013 year. For Māori, the prevalence was significantly higher than for Pasifika and Asian populations. In the 2018/2019 year, FASD prevalence was 1.3% (95% CI 0.9%; 1.9%). For Māori, the prevalence was significantly higher than for Pasifika and Asian populations. The sensitivity analysis estimated the prevalence of FASD in the 2018/2019 year to range between 1.1% and 3.9% and for Māori, from 1.7% to 6.3%. DISCUSSION AND CONCLUSIONS This study used methodology from comparative risk assessments, using the best available national data. These findings are probably underestimates but indicate a disproportionate experience of FASD by Māori compared with some ethnicities. The findings support the need for policy and prevention initiatives to support alcohol-free pregnancies to reduce lifelong disability caused by prenatal alcohol exposure.

In car-dependent societies like New Zealand, getting the right balance between mobility and safety could improve outcomes for older people but will require changes to policy and practice. Driving cessation is a major life transition with many impacts, and adult children are frequently involved in both the transition to non-driving and maintaining mobility afterward. This cross-sectional study (N = 675) sought perspectives of family members of drivers aged 65 or older enrolled in a longitudinal study. Most (94%) were adult children, two thirds were women, and 19% were moderately to extremely anxious about their parent's driving. Loss of independence, driving's role in identity, and reluctance to rely on family were recognized as important barriers to driving cessation. Most (80%) felt that families, as well as older drivers, would be adversely affected by driving cessation. Families identified accessible local information and services, alternative transport, and community-based programs for drivers and families as assistance most needed.

Background Diagnosis rates of Chlamydia trachomatis are high in New Zealand; 1.3% of men and 3.7% of women aged 15 to 29 years were diagnosed in 2016. Because testing rates are also higher in women, we sought to understand chlamydia testing by demographic and behavioral characteristics. Methods Chlamydia testing in the past year, sexual behavior, and demographic characteristics were reported in the population-based 2014/2015 New Zealand Health Survey. Those aged 16 to 44 years who had a sexual partner in the past year were included. Testing prevalence was calculated, and associations were modeled. Results A total of 1677 men and 2323 women participated (89% response rate). Of these, 5.6% (95% confidence interval, 4.3%-7.2%) of men and 16.6% (14.7%-18.7%) of women were tested in the past year. Likelihood of testing in men was associated with having multiple partners and any condomless sex (adjusted relative risk, 11.93; 95% confidence interval, 5.70-24.98) and multiple partners with consistent condom use (3.77, 1.40-10.15) compared with one sexual partner and consistent condom use, and with Maori ethnicity (1.87, 1.05-3.31) compared with European/other. Among women, testing was associated with multiple partners with and without condomless sex (3.61 [2.69-4.85] and 2.81 [1.95-4.05], respectively), pregnancy (1.61, 1.18-2.18), and Asian ethnicity (0.52, 0.30-0.89). Conclusions The study confirms that New Zealand men are much less likely to be tested than women, a potential reason for ongoing high chlamydia incidence among both sexes. The high testing rate in women includes many at low risk, and this divergence from recommendations is another issue to address.

INTRODUCTION AND AIMS:Bhutan has a high incidence of alcohol-related disease. With economic development, motorised transport is proliferating, increasing the potential for traffic injury. We investigated drink-driving in the country's largest urban environment. METHODS:Working with police, we set up checkpoints at major thoroughfares in Thimphu, on Tuesday, Friday and Saturday nights, from May to July 2017. Police directed cars to testing bays where drivers were breathalysed and interviewed. RESULTS:All 1596 drivers stopped by police were breathalysed, and 212 (13%) tested positive. Blood alcohol of >0.02 g/dL (which we defined as 'probable impairment') was detected in 178 drivers (11%), while 67 (4.2%) exceeded the legal limit of 0.08 g/dL. Probable impairment was more common in men, older drivers, on Tuesdays (versus Fridays or Saturdays) and later at night. CONCLUSION:Drink-driving is very common at night-time in Bhutan. Routine roadside random breath-testing, and media campaigns emphasising the risk of apprehension and consequent serious financial and social penalties, should be considered to deter drink-driving.

AIMS:To estimate the effect of national restrictions on late-night availability of alcohol on alcohol-related assault at a population level as indicated by (1) change in hospitalizations for weekend assaults and (2) change in the proportion of assaults documented by police that occur at night.DESIGN:Evaluation of a natural experiment, involving: (1) pre-post comparisons of age-specific incidence rates, adjusted for seasonality and background trend using Poisson regression; and (2) interrupted time-series analyses, using seasonal autoregressive integrated moving average (SARIMA) models of national data with no control site.SETTING:New Zealand.PARTICIPANTS:(1) Inpatients discharged from NZ hospitals following assault during the weekend (Friday-Sunday) from 2004 to 2016 (n = 14 996) and (2) cases of assault recorded by NZ Police from 2012 to 2018.INTERVENTION:introduction of national maximum trading hours for all on-licence (8 a.m.-4 a.m.) and off-licence premises (7 a.m.-11 p.m.), abolishing existing 24-hour licences, on 18 December 2013.MEASUREMENTS:(1) Age-specific incidence of hospitalization for assault on Friday, Saturday or Sunday from the national hospital discharge data set, excluding short-stay emergency department admissions and (2) proportion of weekly police-documented assaults occurring between 9 p.m. and 5.59 a.m., from NZ Police Demand and Activity data set.FINDINGS:Following the restrictions, weekend hospitalized assaults declined by 11% [incidence rate ratio (IRR) = 0.89; 95% confidence interval (CI) = 0.84, 0.94], with the greatest reduction among 15-29-year-olds (IRR = 0.82; 95% CI = 0.76, 0.89). There was an absolute reduction (step change) of 1.8% (95% CI = 0.2, 3.5%) in the proportion of police-documented assaults occurring at night, equivalent to 9.70 (95% CI = 0.10, 19.30) fewer night-time assaults per week, out of 207.4.CONCLUSIONS:The 2013 implementation of national maximum trading hours for alcohol in NZ was followed by reductions in two complementary indicators of alcohol-related assault, consistent with beneficial effects of modest nation-wide restrictions on the late-night availability of alcohol.

A recent genome-wide association study identified molecular-genetic associations with age-at-first-birth. However, the meaning of these genetic discoveries is unclear. Drawing on evidence linking early pregnancy with disinhibitory behavior, we tested the hypothesis that genetic discoveries for age-at-first-birth predict disinhibition. We included participants with genotype data from the two-decade-long Environmental Risk (E-Risk) Study ( N  = 1,999) and the four-decade-long Dunedin Study ( N  = 918). We calculated a genome-wide polygenic score for age-at-first-birth and tested whether it was associated with a range of disinhibitory outcomes across the life course, including low childhood self-control; risk for externalizing psychopathology; officially recorded criminal offending; substance dependence; informant reports of disinhibitory problems; and number of lifetime sexual partners. We further tested whether associations were attributable to accelerated pubertal maturation. In both cohorts, the age-at-first-birth polygenic score predicted low childhood self-control, externalizing psychopathology, officially recorded criminal offending, substance dependence, and number of sexual partners. Associations were modest, but robust across replication. Childhood disinhibition partly mediated associations between the polygenic score and reproductive behaviors. In contrast, associations were not attributable to accelerated pubertal timing. Genomic discoveries for age-at-first-birth are about more than reproductive biology: They provide insight into the disinhibitory traits and behaviors that accompany early parenthood. Age-at-first-birth is a useful proxy phenotype for researchers interested in disinhibition. Further, interventions that improve self-regulation abilities may benefit young parents and their children.

BackgroundA recent genome‐wide association study identified molecular‐genetic associations with age‐at‐first‐birth. However, the meaning of these genetic discoveries is unclear. Drawing on evidence linking early pregnancy with disinhibitory behavior, we tested the hypothesis that genetic discoveries for age‐at‐first‐birth predict disinhibition.MethodsWe included participants with genotype data from the two‐decade‐long Environmental Risk (E‐Risk) Study (N = 1,999) and the four‐decade‐long Dunedin Study (N = 918). We calculated a genome‐wide polygenic score for age‐at‐first‐birth and tested whether it was associated with a range of disinhibitory outcomes across the life course, including low childhood self‐control; risk for externalizing psychopathology; officially recorded criminal offending; substance dependence; informant reports of disinhibitory problems; and number of lifetime sexual partners. We further tested whether associations were attributable to accelerated pubertal maturation.ResultsIn both cohorts, the age‐at‐first‐birth polygenic score predicted low childhood self‐control, externalizing psychopathology, officially recorded criminal offending, substance dependence, and number of sexual partners. Associations were modest, but robust across replication. Childhood disinhibition partly mediated associations between the polygenic score and reproductive behaviors. In contrast, associations were not attributable to accelerated pubertal timing.ConclusionsGenomic discoveries for age‐at‐first‐birth are about more than reproductive biology: They provide insight into the disinhibitory traits and behaviors that accompany early parenthood. Age‐at‐first‐birth is a useful proxy phenotype for researchers interested in disinhibition. Further, interventions that improve self‐regulation abilities may benefit young parents and their children.

Functional breathing disorders are common, but poorly understood, causes of respiratory symptoms, and often co-exist with asthma and other respiratory diseases [1–3]. Hyperventilation syndrome is the most recognised form of dysfunctional breathing. It has long been suspected that dysfunctional breathing may have emotional origins, but there is little empirical evidence to support this [4]. A history of rape is a risk factor for dysfunctional breathing in adults of both sexes and for late-onset asthma diagnosis in women We thank the study members and their friends and families for their continued support. We also thank the interviewers and respiratory physiologists and who obtained the data, Richie Poulton, the study director, Phil A. Silva, the study founder, and Malcolm Sears, Terrie Moffitt and Avshalom Caspi for their support.

Background: We estimated the change in the prevalence of harms attributed by students to their drinking and to others’ drinking, over a decade of concerted effort by university authorities to reduce antisocial behaviour and improve student safety. Interventions included a security and liaison service, a stricter code of conduct, challenges to liquor license applications near campus, and a ban on alcohol advertising. Methods: We used a pre-post design adjusting for population changes. We invited all students residing in colleges of a New Zealand University to complete web surveys in 2004 and 2014, using identical methods. We estimated change in the 4-week prevalence of 15 problems and harms among drinkers, and nine harms from others’ drinking among all respondents. We adjusted for differences in sample sociodemographic characteristics between surveys. Results: Among drinkers there were reductions in several harms, the largest being in acts of vandalism (7.1% to 2.7%), theft (11% to 4.5%), and physical aggression (10% to 5.3%). Among all respondents (including non-drinkers), there were reductions in unwanted sexual advances (14% to 8.9%) and being the victim of sexual assault (1.0% to 0.4%). Conclusion: Alcohol-related harm, including the most serious outcomes, decreased substantially among college residents in this period of alcohol policy reform. In conjunction with evidence of reduced drinking to intoxication in this population, the findings suggest that strategies to reduce the availability and promotion of alcohol on and near campus can substantially reduce the incidence of health and social harms.

BACKGROUND AND AIMS:The Treaty of Waitangi stipulates equality between Māori and non-Māori, yet Māori continue to have substantially poorer health, a driver of which is alcohol-related morbidity. In 2012, the New Zealand government introduced legislation claiming it would facilitate community input on decisions about alcohol. We investigated the experience of Māori communities with the new law. DESIGN AND METHODS:We obtained submissions made to local governments and invited a diverse range of submitters from iwi (tribes), hapū (sub-tribes/clan groups) and Māori service providers, to participate in semi-structured interviews with Māori researchers. We used template analysis to develop hypotheses, and searched for disconfirmatory evidence within interview transcripts and recordings. RESULTS:Participants had committed substantial human resources to write submissions informed by technical knowledge of liquor licensing and relevant research. They reported that local governments did not seem to engage meaningfully with the content of their submissions, and failed in many instances to update participants on how the consultation was progressing. Some observed that the alcohol industry had easier access to local politicians, and therefore expected outcomes to reflect industry interests. DISCUSSION AND CONCLUSIONS:In their response to Māori constituents on proposed alcohol policies, local governments were felt to lack the inclination or capacity to consult meaningfully. By devolving responsibility for alcohol availability while failing to compel and resource local government to give regard to treaty obligations, the new legislation risks widening existing health inequalities between Māori and non-Māori.

We describe allegations that an alcohol industry executive secretly paid to smear the reputation of public health advocates, critique the New Zealand government's response to the allegations and outline subsequent legal action. The findings are partly based on an account of illegally obtained emails, written by a respected investigative journalist to whom they were given. The correspondence allegedly reveals that the CEO of the Food and Grocery Council used an intermediary PR company to produce blog posts that denigrated a senior academic psychiatrist advocating for alcohol policy consistent with World Health Organization recommendations. The CEO, representing the interests of the multinational alcohol retail industry, was concurrently on the Board of the government Health Promotion Agency. Despite repeated calls for an investigation, the government asserted that any conflict of interest was being appropriately managed. The specific allegations have not been denied by the CEO, and no legal action has been taken over their publication. In 2016, the alcohol policy advocate and two health professionals working in tobacco and food policy who had also been attacked on the blog, brought a defamation case against the blogger, the PR consultant and the Food and Grocery Council CEO. If authentic, the documents reveal that the alcohol industry attempted to secretly undermine the standing of health experts. The government also failed to uphold ethical standards by appointing the CEO to a public health authority and resisting calls to investigate serious allegations against her. Sustained scrutiny has resulted in action on both issues.