ISSUE ADDRESSED:Appealing e-cigarette flavours have been an important factor in experimentation and uptake among young people. In an effort to curb high rates of youth vaping, in 2024, the New Zealand Government introduced regulations to restrict e-cigarette flavours that may appeal to young people. The regulations require that e-cigarette products are described using up to two flavour names from a specified list. This research analyses whether online retailers comply with the regulations and provides insights into popular flavours. METHODS:Using content analysis methods, we identified popular online retailers in New Zealand. We extracted flavour names from e-cigarette product listings on retailer websites to analyse compliance and categorised products to explore popular flavour profiles. RESULTS:Of the 22 retailers included in the sample, only 4 (18.0%) fully complied with the restrictions. Of the 6939 total e-cigarette products (e-liquids, pods and disposables), 25.9% (n = 1794) did not comply with the regulations. Most flavours in the sample were fruity or sweet (78.9%). CONCLUSION:New Zealand retailers frequently breach the flavour regulations. Despite many permitted options, retailers often attempt workarounds to bypass regulations, including listing products under previous names or descriptors that are not permitted, such as 'ice' or 'cola'. Sweet and fruit flavours dominate the online market. SO WHAT?: E-cigarette flavour restrictions should include sweet and fruit flavours to reduce appeal to youth and be supported by rigorous enforcement to prevent common retail workarounds.

This qualitative interview study explored older people's experiences and perceptions around mental wellbeing and using digital technology in later life, and the relationship between the two. Twenty-three community-dwelling older people aged 65+ years took part in a one-to-one, semi-structured interview between January and March 2025. Reflexive thematic analysis led to the development of five key factors involved in maintaining older people's mental wellbeing and digital technology's double-edged role in each: psychological, social, cognitive, physical, and financial health. Reviewing the findings through a critical gerontology lens reveals the persistence of ageism impacting on older people's digital experiences during a time of rapid digital shifts towards AI-based and online-only services. The need for a strengths-based approach to supporting older people's digital inclusion and technology independence is discussed.

This scoping review synthesises existing evidence from systematic reviews on the effectiveness and implementation of digital mental health interventions among community-dwelling older adults. Twenty-one systematic reviews were included. Results showed that a range of digital tools demonstrate potential to improve common mental health and psychosocial symptoms among older adults, with most evidence concentrating on digital tools to improve depressive symptoms. However, reviews’ findings were frequently mixed and accompanied with cautions that primary evidence under-reported key elements such as theoretical underpinnings, intervention design process, participant demographics, intervention acceptability and usability, participant retention, adverse events, and long-term outcomes. More rigorous research and reporting are needed to understand the mechanisms underpinning effective digital mental health interventions for older adults and how they might mitigate the age-related digital divide in mental health services.

INTRODUCTION:The importance of access to reliable information during pregnancy is heightened in pregnancy complications. Impaired fetal growth (including small for gestational age (SGA) and growth restricted (FGR) fetuses) affects up to 10% of pregnancies and is associated with increased risk of morbidity and mortality. However, there is a paucity of accessible, evidence-based, information to support parents told their baby is not growing as expected. This study sought to explore patient experiences of information provision and seeking during pregnancies at risk of impaired fetal growth. METHODS:Focus groups and individual in-depth interviews (totalling 24 participants from across Aotearoa New Zealand) were conducted and recorded via Zoom. Discussions were led using pre-defined prompts to explore the experiences, preferences, and suggested improvements for information delivery. Interviews were transcribed verbatim, and data underwent inductive thematic analysis. RESULTS:Participants held expectations that their pregnancy would proceed normally; the majority experienced some level of distress at a diagnosis of complications. Information provided by the clinical team was highly valued, particularly when well curated and delivered with empathy. However, for many, this information needed to be supplemented. Additional, nuanced information was sought through online sources, and this included information on causes of impaired fetal growth, the meaning of medical terminology used, and lived experiences of pregnancy and birth. The timing of information provided by their clinical team impacted participant perceived capacity to comprehend information and their response to it. Participants preferred information to be offered at various times, in a range of forms, each adding to the layering of a more complete understanding of their situation. Preferences for information included being able to access a range of credible information in one place to promote greater coherence between the needs and lived experiences of patients and their healthcare providers. CONCLUSIONS:Timely, nuanced and salient information is extremely important to pregnant people and their families when navigating high-risk clinical pathways during pregnancy. Our results provide guidance on improving informational resources in the context of impaired fetal growth.

Background: In an increasingly digitalised world, the ability of older adults to effectively utilise digital devices and navigate online health information has become crucial for maintaining their wellbeing and independence. The DIGIFALE programme was developed to improve the mobile literacy skills of Pacific communities in recognition of the digital shift required because of COVID-19.Objective: To test the acceptability and impact of DIGIFALE-a mobile health literacy programme-with Pacific communities and to explore how developing mobile literacy skills can improve access to online platforms to improve health and wellbeing.Methods: Pacific adults (Niue, Samoan, Tongan, or Cook Island descent) who were digitally excluded, either lacking a mobile phone, having stopped using one due to difficulty, or feeling unconfident. were recruited through their church communities for a 5-week pilot (n = 50). Each participant was supported by a DIGIFALE navigator.Results: At baseline participants could only complete only a few of the 27 skills assessed. At follow up, the mean number of skills per participant was significantly higher. Participants rated their experience with DIGIFALE as excellent and highly positive, including learning new mobile skills and working with their navigators. Most planned to use their skills within 6 months, and 94% would recommend the programme to others.Conclusion: DIGIFALE is an acceptable and effective way of improving mobile literacy among Pacific communities. The pilot study offers key insights for refining and expanding similar initiatives among minority ethnic-specific communities across Aotearoa New Zealand.Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12621001045808.

Background:New Zealand experienced a prolonged period of minimal regulation on e-cigarettes until the passing of the 2020 Smokefree Environments and Regulated Products (Vaping) Amendment Act. Methods:Interrupted time series analyses of the Action for Smokefree 2025 (ASH) Year 10 Snapshot Survey data from 1999 to 2023 to compare changes in smoking trends among 14-15-year-old students (n = 690,470) before and after the advent of vaping in New Zealand (around 2010). Findings:The prevalence of daily-vaping increased from 1.1% in 2015 (the first year the question was asked) to 1.8% in 2018 before rising to 10.0% in 2023, a nine-fold increase over eight years. From 1999 to 2023, considerable declines in ever-, regular-, and daily-smoking prevalence were observed. However, the rates of decline in ever- and regular-smoking slowed significantly from 2010 onwards (p < 0.001 for both), coinciding with the advent and rapid growth of vaping among New Zealand adolescents. In contrast, the rate of decline in daily-smoking did not significantly change from 2010 onwards (p = 0.066). These findings were robust to sensitivity analyses, including the use of different time series interruption points (change-years) and controlling for inflation-adjusted cigarette prices. Interpretation:Our findings starkly contrast with those from a previous analysis of ASH data, which suggested that e-cigarettes appear to be displacing smoking among New Zealand youth. Instead, our findings suggest that among 14-15-year-olds, the rapid rise of vaping may have slowed the rates of decline in ever- and regular-smoking, while having little or no impact on the rate of decline in daily smoking. Our findings underscore the importance of effective policy approaches to curb both adolescent vaping and smoking. Funding:None.

The International Health Regulations (IHR) form the basis of the World Health Organization's governing framework for global health security and have a key role in preventing the international spread of disease. The COVID-19 pandemic rightfully brought the 'fitness for purpose' of the IHR (2005) into question, spurring WHO Member States to embark on a process of amending and improving the Regulations. This process concluded in mid-2024, with a package of substantive amendments adopted through Member State consensus. Global commentary during the COVID-19 pandemic spotlighted issues with both the letter and spirit of the Regulations, but one unifying theme was that of non-compliance. As such, much of the debate in the lead up to the amendment negotiations focused on the need for stronger enforcement and accountability mechanisms. However, the distinction between true IHR breaches and legitimate deviations was often ignored. Instead, these were frequently lumped together under the banner of 'non-compliance,' and with a predominantly negative slant; often as prelude to justification that stronger rules (and perhaps even punitive measures) were needed. The subtext was that the same rules must apply to all. There is little doubt that a legally binding instrument must have robust accountability mechanisms to underpin global collaboration and prevent pandemics. However, New Zealand's COVID-19 pandemic response - considered among the best in the world - illustrates why the balance between uniform compliance and State Party flexibility had to remain an essential consideration during the IHR amendment negotiations.

BACKGROUND:Burnout prevalence and its determinants among Pacific communities are not well established. AIM & METHODS:We conducted a community co-designed cross-sectional online survey through social media platforms to investigate determinants of burnout and high burnout frequency among NZ-born Pacific people aged 18-65 years. Regression models were used to examine determinants of burnout prevalence and high burnout frequency. RESULTS:Burnout prevalence was very high (89.5%) from the 1092 survey participants recruited. Of the 977 people who reported burnout, 50.3% identified work life as the primary source and 49.4% experienced high burnout frequency. In best-fitting model analysis, responsibilities preventing adequate sleep, exercise or healthy eating (odds ratio (OR) = 1.86, 95% CI: 1.23-2.81, p < 0.001) and financial giving with few boundaries (OR=1.54, 95%, CI: 0.99-2.45, p=0.049) were associated with higher odds of burnout. This pattern was also reflected in best-fitting model analysis, where responsibilities preventing adequate sleep, exercise or healthy eating (OR = 1.92, 95% CI: 1.43-2.60, p < 0.001) and financial giving with few boundaries (OR=1.67, 95% CI: 1.26-2.22, p < 0.001) were significant determinants of high burnout frequency. CONCLUSIONS:Culturally contextualized burnout interventions are needed for Pacific communities. Selflessness and responsibilities preventing physiological needs to be met are associated with increased odds of burnout and high burnout frequency.

Background:Ethnic inequities in health and mortality in Aotearoa/New Zealand have been driven in part by historic and ongoing inequities in smoking prevalence, with Māori and Pacific peoples most affected. Although overall smoking rates among year 10 students aged 14-15 years have declined substantially in recent decades, recent analyses suggested that e-cigarette use (vaping) may have slowed the decline in ever- and regular-smoking, while having little or no impact on daily smoking. However, it remains unclear whether these patterns differ for Māori, Pacific, European, or Asian adolescents. Methods:Interrupted time series analyses of the Snapshot Survey data (2003-2024; n = 588,143) to assess changes in smoking trends before and after the emergence of vaping in Aotearoa among 14-15-year-old Māori, Pacific, European, and Asian adolescents. Findings:From 2003 to 2024, ever-, regular-, and daily-smoking prevalence declined substantially among Māori, Pacific, European, and Asian adolescents. However, the rates of decline in ever-smoking slowed significantly from 2010 onwards-coinciding with the emergence of vaping in Aotearoa-for Māori (p = 0.025), European (p < 0.001), and Asian (p = 0.018) adolescents. Similarly, declines in regular-smoking slowed significantly for Māori (p = 0.012), Pacific (p = 0.003), and European (p < 0.001) adolescents. A significant change in the rate of decline in daily smoking was observed only for European adolescents, who showed a small slowing (p = 0.004). Findings were robust to different time series interruption-points (change-years) and controlling for cigarette affordability. Interpretation:We found no evidence that vaping is displacing adolescent smoking among any of the four ethnic groups analysed. On the contrary, our findings suggest that the emergence and rise of vaping in Aotearoa may have undermined progress in reducing regular-smoking among Māori, Pacific, and European adolescents, but with more serious implications for Māori and Pacific youth. Funding:None.

In February 2023, Severe Tropical Cyclone Gabrielle devastated the North Island of Aotearoa New Zealand with loss of life, extreme flooding, damage to homes, roads and infrastructure particularly in the regions of Te Tair & amacr;whiti (Gisborne) and the Te Matau-a-M & amacr;ui (Hawke's Bay). This paper presents key findings from a qualitative study of the impacts of Cyclone Gabrielle on community health and wellbeing in these two communities. Drawing upon interviews and focus groups with 143 residents of these two regions, we present five high-level findings, specifically the impacts on: (1) physical health, (2) mental wellbeing, (3) the most at-risk groups (i.e. residents with a disability, chronic illness, elderly), (4) rural and remote communities, and (5) communities of care. This paper contributes to Critical Disaster Studies, with a focus on the uneven health and wellbeing impacts of extreme weather events. It also highlights how communities come together to support one another, grieve and recover in relational and connected ways. Additionally, it underscores the value of trauma-informed, place-based methodologies for conducting ethical and responsible research within, by and for affected communities.

BACKGROUND:Trade liberalisation has contributed to obesogenic food environments globally. Small Island Developing States (SIDS) have some of the world's highest rates of obesity and nutrition-related noncommunicable diseases. Nutrition regulations have been recognised as necessary population health measures for combating malnutrition, however, legally-binding trade and investment agreements (TIAs) can constrain the policy options available to governments. Geographical, economic, historical, and cultural contexts of SIDS may place them at greater risk of TIA constraints resulting in barriers to the uptake of public health nutrition policies. This article explores the perceptions and experiences of key SIDS nutrition and trade policy stakeholders regarding SIDS' ability to formulate and implement healthy nutrition policies in the context of TIAs. METHODS:Twelve semi-structured interviews were conducted with key Pacific and Caribbean stakeholders. Analysis was performed via a critical realist grounded theory approach. TIA constraints to policy space, challenges faced by SIDS, and solutions for improving nutrition policy space were identified. FINDINGS:Participants identified that TIAs did not substantively constrain nutrition policy so long as the policy targeted a legitimate public health objective, was evidenced-based, non-discriminatory, non-arbitrary, necessary, and the least trade-restrictive measure available. However, TIAs were perceived to pose structural and procedural constraints in the form of regulatory chill, increased burden of ensuring trade-compliant nutrition policies, unfair TIA negotiation processes, inconsistent perceptions of 'unhealthy' foods, trade liberalisation ideology, and industry interference. These constraints were noted to be particularly acute for SIDS due to their financial and capacity constraints, industry influence and limited international power. CONCLUSION:TIA obligations were deemed unlikely to substantively prevent meaningful public health nutrition policies from being developed and implemented in SIDS if nutrition policy met specific trade principles. However, concerns were noted that some of these principles may impose procedural and structural constraints that risked preventing, postponing or diluting potential nutrition policies. These constraints may be particularly problematic for SIDS due to their contextual challenges. Despite this, local, regional and international actors can increase SIDS' policy space through capacity building, fostering multisectoral collaboration, developing conflict of interest policies, improving TIA negotiation processes, and championing the prioritisation of public health nutrition in trade governance.

Social media has been instrumental in the promotion of electronic cigarette (e-cigarette) brands globally. As a result of concerns around these types of promotions, many countries have introduced policies to restrict aspects of digital e-cigarette marketing, along with some restrictions introduced by social media platforms. This paper critiques the Instagram account of the leading global e-cigarette brand 'Vuse', owned by British American Tobacco. Focusing on the Instagram account @Vuse.Worldwide, this study explores the strategies and techniques used in this account to promote the Vuse brand in an international context. Using content analysis methods, we extracted images, videos, and metadata for the posts made by the Vuse account between 1 August 2023 and 31 July 2024. We identified the most viewed and liked content, associated social media influencers, and brand collaborations and assessed the potential reach of these strategies. We identified 405 posts for the study period: 128 images and 277 Reels (short-form videos). We found that content that tagged Formula 1 race team McLaren had the most views and likes. Other popular content linked to music festivals, DJs, art, and designers (n = 65) who were frequently tagged in the study sample. The Vuse Worldwide Instagram account used brand collaborations, such as a 'principal partnership' with Formula 1 team McLaren, to extend its brand reach and capitalize on the racing team's extensive global audience. Other collaborations with music festivals and influencers show that the company continues to deploy its product marketing strategies to position products within youth culture.

Ethical research governance across Pacific island countries and areas (PICs) faces challenges from limited local capacity and disproportionate external influences. However, a shared commitment to advance and strengthen ethical oversight is increasingly emerging. In May 2025, WHO, the Pacific Community, and the Pacific Academy of Sciences convened a workshop with PIC representatives to review existing health research ethics ecosystems and define priorities for improvement. Mapping efforts revealed wide disparities: some countries have formal legal frameworks and established ethics committees, while others rely on informal processes or external approvals. Concerns were expressed about externally driven research, limited local control, inconsistent consent practices, and weak mechanisms to ensure communities benefit from research. Key priorities included developing national policies that clarify governance roles and standards, creating Pacific-wide ethical research guidelines that reflect regional values, and embedding long-term capacity building and fair benefit-sharing into research partnerships. The workshop highlighted that ethical research governance is not only a technical necessity but also central to self-determination, cultural integrity, and equity. Moving forward, progress will require sustained investment, regional collaboration, and global partners to support research led by the Pacific, for the benefit of Pacific communities.

This scoping review explores the extent and ways in which mental health assessment tools have been culturally adapted to be fit for purpose in new contexts. In this review, the majority of recent studies reporting cultural adaptations were conducted in the Eastern Mediterranean, Europe, and Western Pacific. Assessment tools were adapted to 31 target languages, most frequently Arabic, Chinese, Persian and Korean. Most studies reported following a published cultural adaptation guideline; many reported overall positive validation results. Some studies reported needing to make further modifications to the adapted tool during validation and many concluded that further testing was required to increase generalisability. This review found few adaptations of mental health assessment tools for use in African and Latin American countries, representing a significant evidence gap. More research is also needed to analyse the studies’ rigour and fidelity to existing adaptation guidelines and to determine the sufficiency of current recommended procedures in achieving cultural equivalence.

Objective Anxiety disorders are highly prevalent around the world and are associated with significant disability, comorbidity and costs to society. Digital tools have the potential to deliver equitable, convenient and sustainable interventions for anxiety. We aimed to co-design and pilot-test an in-the-moment intervention to help young people manage anxiety. Young people with lived experience of anxiety were recruited to participate in co-design workshops with the results informing the development of the Tackling Anxiety through Innovation (TAI) intervention. TAI delivers personally tailored messaging prompting engagement in self-care behaviours at times of high anxiety/stress. Methods Young people aged 16 to 24 years were recruited into a four-week pilot study. Participants completed the Depression Anxiety Stress Scale – 21 Items (DASS-21) at baseline and four-week follow up, as well as a survey to assess the acceptability of the intervention and its components. Results Participants (n = 24) reported the intervention to be highly acceptable and useful. Participants scheduled an average of eight events over the 4 weeks. DASS-21 scores improved significantly from baseline to follow up: anxiety (mean difference 2.42 (SD = 3.65), p = 0.004), depression (3.79 (SD = 3.65), p < 0.001) and stress (3.50 (SD = 3.30), p < 0.001). Participants particularly liked the ability to personalise the messages, the timing and format of the messages, and the reminders to engage in helpful behaviours. Conclusions This study adds to the evidence for the use of digital tools in delivering tailored anxiety self-management support to young people. Further refinement and expansion of the intervention are needed to determine its efficacy on a larger scale.