Campylobacter is the most frequent cause of bacterial enteric disease in New Zealand, often linked to food-borne transmission from contaminated fresh poultry. However, socioeconomic, agricultural, and environmental factors, including drinking water sources, also play a role in infections. About 15% of New Zealand residents rely on private water supplies, which are not regulated for water quality under the Water Services Act 2021. This situation poses a risk for waterborne transmission of Campylobacter. We analysed publicly notified cases of Campylobacter infection from 2015 to 2019 using Poisson regression models to evaluate the impact of water supply type, rurality, livestock density, and climate extremes on campylobacteriosis incidence. The results showed a significant association between private water supply in rural areas and increased campylobacteriosis incidence in high dairy density areas (Relative Risk (RR) = 2.21, 95% CI: 1.60-3.05). Higher dairy density was also linked to increased campylobacteriosis incidence, with low dairy density having an RR of 1.18 (95% CI: 1.04-1.34), medium density an RR of 1.17 (95% CI: 1.03-1.33), and high density an RR of 1.47 (95% CI: 1.28-1.69) in rural areas with private water supplies. These findings suggest that contaminated water may be a significant pathway for Campylobacter infection, indicating a potential need for additional support for private water users in rural areas.

Good quality drinking water requires multiple barriers of protection, implemented through coordinated efforts across society. How drinking water is framed in media discourse can potentially help or hinder these efforts. We analysed newspaper coverage in New Zealand over a ten-year period, before and after a large-scale waterborne campylobacteriosis outbreak in 2016. While articles often led with health risks and expectation of population-level interventions for safe drinking water, broader drivers of inadequate drinking water were obscured by technocratic and/or managerialist framing. Perspectives of M & amacr;ori (Indigenous population) were strikingly under-represented. These factors appeared likely to limit understanding of, and action on, drinking water issues.

AbstractPurposeDuring the COVID-19 pandemic, the NZ COVID Tracer App (NZCTA) was released as a digital intervention to support contact tracing processes in Aotearoa New Zealand. This paper examines whether NZCTA met the data governance requirements of the Indigenous Māori people. Māori are an interesting case study as they have unique Treaty and data sovereignty rights, and a higher risk of COVID-related mortality.MethodsThe NZCTA was assessed against 24 criteria drawn from the Māori Data Governance Model. The assessment drew on documentary sources and the authors’ knowledge of NZCTA and contact tracing process. Each criteria was assessed as ‘met’, ‘partially met’ or ‘not met’.ResultsOur retrospective assessment showed a mixed performance against the Māori Data Governance Model, with NZCTA only fulfilling seven of the 24 model criteria and failing to meet nine.ConclusionThere is significant room for improvement in future digital health interventions for Māori. Much work remains to be done in the Aotearoa public sector to uphold Māori data sovereignty and address systemic barriers to genuine partnership with Māori.

AbstractBackgroundDigital contact tracing (DCT) was a central component of the global response to containing COVID‐19. Research has raised concerns that DCT could exacerbate inequities, yet the experiences of diverse communities at greater risk from COVID‐19 are typically underrepresented.MethodsThe present study aimed to understand the perceived barriers to the adoption of the app amongst Māori, Pasifika, and disabled people. Focus groups and interviews were undertaken with Māori, Pasifika, and disability sector stakeholders and community participants.ResultsParticipants (n = 34) generally expressed willingness to utilise DCT and support its adoption within the communities. Simultaneously, participants revealed how the app could marginalise community members who struggled with the usability and those distrusting of the government's COVID‐19 interventions.ConclusionsThe findings highlight how addressing communication inequality can assist in the development of contact‐tracing responses that are both effective and equitable. The study provides insights about the role of information and communication technologies as health resources.Patient or Public ContributionConsulting with members of the target communities was central throughout the present study, including recommendations for potential participants, participation in interviews and sharing early findings for feedback. This study reports on focus groups and interviews with individuals from Māori and disability sectors.

This study aimed to understand the population and contact tracer uptake of the quick response (QR)-code-based function of the New Zealand COVID Tracer App (NZCTA) used for digital contact tracing (DCT). We used a retrospective cohort of all COVID-19 cases between August 2020 and February 2022. Cases of Asian and other ethnicities were 2.6 times (adjusted relative risk (aRR) 2.58, 99 per cent confidence interval (95% CI) 2.18, 3.05) and 1.8 times (aRR 1.81, 95% CI 1.58, 2.06) more likely than Māori cases to generate a token during the Delta period, and this persisted during the Omicron period. Contact tracing organization also influenced location token generation with cases handled by National Case Investigation Service (NCIS) staff being 2.03 (95% CI 1.79, 2.30) times more likely to generate a token than cases managed by clinical staff at local Public Health Units (PHUs). Public uptake and participation in the location-based system independent of contact tracer uptake were estimated at 45%. The positive predictive value (PPV) of the QR code system was estimated to be close to nil for detecting close contacts but close to 100% for detecting casual contacts. Our paper shows that the QR-code-based function of the NZCTA likely made a negligible impact on the COVID-19 response in New Zealand (NZ) in relation to isolating potential close contacts of cases but likely was effective at identifying and notifying casual contacts.

Digital contact tracing apps were developed to help control the spread of COVID-19 but research exploring these apps has underrepresented both ‘at-risk’ communities and contact tracers. Our study examines perspectives of the New Zealand COVID Tracer app among 53 participants, comprising policy advisors, contact tracers, and Māori, Pacific, and disability stakeholders, underpinned by the theory of social construction of which positions technology within the social context in which it evolves, operates, and is negotiated. Although community stakeholders believed the app helped safeguard communities from COVID-19, the health officials' views on the app's usefulness in contact tracing varied. Participants who oversaw the app’s technical development generally perceived it as being more useful, particularly regarding Bluetooth proximity detection, in contrast with contact tracers’ perceptions. The findings highlight a disconnection between public sentiment and operational reality in the use of the app and the need for improved collaboration and consultation in future contact tracing responses.

Spending time outdoors is associated with increased time spent in physical activity, lower chronic disease risk, and wellbeing. Many studies rely on self-reported measures, which are prone to recall bias. Other methods rely on features and functions only available in some GPS devices. Thus, a reliable and versatile method to objectively quantify time spent outdoors is needed. This study sought to develop a versatile method to classify indoor and outdoor (I/O) GPS data that can be widely applied using most types of GPS and accelerometer devices. To develop and test the method, five university students wore an accelerometer (ActiGraph wGT3X-BT) and a GPS device (Canmore GT-730FL-S) on an elastic belt at the right hip for two hours in June 2022 and logged their activity mode, setting, and start time via activity diaries. GPS trackers were set to collect data every 5 seconds. A rule-based point cluster-based method was developed to identify indoor, outdoor, and in-vehicle time. Point clusters were detected using an application called GPSAS_Destinations and classification were done in R using accelerometer lux, building footprint, and park location data. Classification results were compared with the submitted activity diaries for validation. A total of 7,006 points for all participants were used for I/O classification analyses. The overall I/O GPS classification accuracy rate was 89.58% (Kappa = 0.78), indicating good classification accuracy. This method provides reliable I/O clarification results and can be widely applied using most types of GPS and accelerometer devices.

Safe, good-quality drinking water is a foundation of public health. Its provision relies on multiple barriers, the first being the protection of source water. Source water refers to the bodies of water (aquifers, rivers, lakes, springs, reservoirs) from which communities and individuals take their drinking water. A large waterborne campylobacter outbreak in 2016 spurred the New Zealand government to make a suite of legislative and policy reforms to strengthen the country's drinking water supply system. However, the nitrate contamination of a municipal drinking water source, and its subsequent breach of drinking water standards, should bring renewed attention to the protection of source water. This article presents a case study of the exceedance and a review of legislation and policy governing drinking water sources. It finds that while important steps have been made since 2016, weaknesses in responsibility and accountability remain in Aotearoa's drinking water supply system.

Background: Digital contact tracing (DCT) aims to improve time-to-isolation (timeliness) and find more potentially exposed individuals (sensitivity) to enhance the utility of contact tracing. The aim of this study was to evaluate the public uptake of a DCT self-service survey and its integration with the Bluetooth exposure notification system within the New Zealand Covid Tracer App (NZCTA). Methods: We adopted a retrospective cohort study design using community COVID-19 cases from February 2022 to August 2022 in New Zealand (1.2 million cases). We examined the proportion of cases completing a selfservice survey and the time to complete the survey by age, sex and ethnicity. Results: Overall, 66 % of cases completed their self-service survey. Completion was influenced by age, sex and ethnicity. The median completion time was 1.8 h (IQR 0.2, 17.2), with 95 % of those completing this survey doing so within 48 h of case identification. Around 13 % of all survey completers also uploaded their Bluetooth data, which resulted in an average of 663 cases per day notifying 4.5 contacts per case. Conclusion: The combination of high public uptake and rapid response times suggest self-service DCT could be a useful tool for future outbreaks, particularly if implemented in conjunction with manual processes and other DCT tools (e.g. Bluetooth) to address issues related to performance (sensitivity, timeliness), effectiveness, and health equity.

There is emerging evidence of an association between nitrate contamination in drinking water and adverse pregnancy outcomes. Few studies have discussed the evidence in the context of plausible biological mechanisms. We performed a narrative review of the current evidence investigating associations between nitrate in drinking water and the risk of adverse pregnancy outcomes with a focus on congenital anomalies (CA) and preterm birth (PTB). We also reviewed evidence and discuss several biological mechanisms that may explain the observed associations. We reviewed cohort and case-control epidemiological studies assessing associations between maternal nitrate exposure and adverse pregnancy outcomes published until January 2023. Three plausible mechanisms may explain how maternal exposure to nitrate may impact pregnancy outcomes, which include the formation of N -nitroso compounds (NOC), thyroid dysfunction and oxidative stress. For CA, seven studies were included (two cohort and five case-control studies). The strongest associations observed in epidemiological studies were for neural tube defects. Inconsistent positive and negative associations were observed for anomalies of the limb, eye, ear, face and neck. Of the four PTB studies (all cohort studies), three of the largest cohort studies observed associations between PTB with nitrate levels >5 mg/L while one small cohort study did not. Emerging epidemiological evidence has observed a potential increased risk of adverse pregnancy outcomes with elevated maternal nitrate exposure in drinking water. There are also plausible biological mechanisms to support this association. However, the current evidence lacks homogeneity and additional longitudinal evidence with robust exposure asssessments is required. Given the increasing concentrations of nitrate contamination in drinking water in many countries, and the adverse effects observed at concentrations below the current regulatory standard, a further precautionary approach should be adopted until futher evidence emerges.

Objectives This is a protocol for a Cochrane Review (prototype). The objectives are as follows: To assess the association between nitrate and nitrite in drinking water and cancers in observational studies

OBJECTIVE:Our primary research objective was to assess the population uptake and contact tracer utilisation of the Bluetooth function of the New Zealand Covid Tracer App (NZCTA) throughout the pandemic. METHODS:We adopted a retrospective cohort study design using all diagnosed COVID-19 community cases from December 12, 2020 to February 16, 2022. RESULTS:At its height, more than 60% of the eligible population had the Bluetooth function of NZCTA activated. However, only an estimated 2.2% of the population was able to fully participate. Cases managed by the national case investigation service were 17 times (aRR 17.54, 95%CI: 13.02-23.90) and 9 times (aRR 9.27, 95%CI: 6.91, 12.76) more likely to generate a Bluetooth token than cases managed by local public health units during the Delta and Omicron periods, respectively. CONCLUSIONS:The Bluetooth functionality of the NZCTA likely had a low impact on the pandemic response in NZ despite its exceptionally high levels of public uptake. The primary reason for the lack of impact was the low utilisation by contact tracers. IMPLICATIONS FOR PUBLIC HEALTH:The results highlight the need for greater consultation and collaboration with the public health sector during the development and implementation of digital contact tracing tools.

AIMSTo estimate the health impacts of key modelled alcohol interventions among Māori (indigenous peoples) and non-Māori in New Zealand (NZ).DESIGNMulti-stage life-table intervention modelling study. We modelled two scenarios: (1) business-as-usual (BAU); and (2) an intervention package scenario that included a 50% alcohol tax increase, outlet density reduction from 63 to five outlets per 100 000 people, outlet hours reduction from 112 to 50 per week and a complete ban on all forms of alcohol marketing.SETTING AND PARTICIPANTSThe model's population replicates the 2018 NZ population by ethnicity (Māori/non-Māori), age and sex.MEASUREMENTSAlcohol consumption was estimated using nationally representative survey data combined with sales data and corrected for tourist and unrecorded consumption. Disease incidence, prevalence and mortality were calculated using Ministry of Health data. We used dose-response relationships between alcohol and illness from the 2016 Global Burden of Disease study and calculated disability rates for each illness. Changes in consumption were based on the following effect sizes: total intervention package [-30.3%, standard deviation (SD) = 0.02); tax (-7.60%, SD = 0.01); outlet density (-8.64%, SD = 0.01); outlet hours (-9.24%, SD = 0.01); and marketing (-8.98%, SD = 0.02). We measured health gain using health-adjusted life years (HALYs) and life expectancy.FINDINGSCompared with the BAU scenario, the total alcohol intervention package resulted in 726 000 [95% uncertainty interval (UI) = 492 000-913 000] HALYs gained during the life-time of the modelled population. Māori experienced greater HALY gains compared with non-Māori (0.21, 95% UI = 0.14-0.26 and 0.16, 95% UI = 0.11-0.20, respectively). When modelled individually, each alcohol intervention within the intervention package produced similar health gains (~200 000 HALYs per intervention) owing to the similar effect sizes.CONCLUSIONSModelled interventions for increased alcohol tax, reduced availability of alcohol and a ban on alcohol marketing among Māori and non-Māori in New Zealand (NZ) suggest substantial population-wide health gains and reduced health inequities between Māori and non-Māori.

Aim exposure to alcohol marketing is associated with increased consumption. We aimed to (i) measure the nature and extent of outdoor alcohol marketing within a high-density urban neighbourhood and (ii) examine temporal and spatial trends in alcohol marketing. Methods this study used a longitudinal design to monitor paid advertising in public spaces over two 10-week periods in Wellington, New Zealand (Nov-Jan 2020-2021, Nov-Jan 2021-2022). The data were collected on-foot following an established route once a week using a phone camera, which also recorded gps data of ad locations. Temporal and spatial trends in alcohol ad prevalence were assessed. Results over the study period, 13% (n = 1619) of all ads (n = 12,472) were for alcohol. Alcohol ads were predominately for spirits (29%), ready-to-drink (27%) and beer (23%). Almost half of all alcohol ads (49%) did not contain a responsible consumption message, while those with a message were de-emphasized relative to promotional features. A temporal trend was observed in 2020, whereby alcohol marketing decreased over the summer, but this trend was not reflected in 2021. Alcohol ads were more likely than non-alcohol ads to be placed in premium positions on roads of high pedestrian and motor vehicle traffic. Conclusion alcohol marketing is common in urban centres. Local and central government policy could substantially reduce the levels of alcohol marketing exposure via outdoor marketing.

Abstract Countries are rapidly developing digital contact tracing solutions to augment manual contact tracing. There is limited empirical evidence evaluating these tools. We conducted a feasibility study of a Bluetooth-enabled card with hospital staff in New Zealand (n = 42). We compared the card data against self-report contact surveys and a stronger Bluetooth device. The cards detected substantially more contacts than self-report contact surveys, while the concordance between Bluetooth devices was high, suggesting that the cards detected clinically relevant close contacts. There was high acceptability among participants, suggesting that their integration would be accepted by healthcare staff. As the pandemic shifts, there is a need to rapidly contact trace and conduct informed risk management, particularly in critical settings such as healthcare.

Abstract Background Recent studies linking low levels of nitrate in drinking water to colorectal cancer have raised public concerns over nitrate contamination. The aim of this study was to analyze the media discourse on the potential human health hazard of nitrates in drinking water in a high-income country with a large livestock industry: New Zealand (NZ). Methods Searches of media sources (“major newspapers”) held by the Factiva database for the NZ setting in the five-year period 17 December 2016 to 20 December 2021. Results The largest number of media items was observed for 2017 (n = 108), the year of a NZ general election, with a notable decrease in 2020 (n = 20) that was likely due to the Covid-19 pandemic, which dominated health media. However, the percentage of these media items with a health focus steadily increased over time, from 11.1% of all articles in 2017 to 51.2% in 2021. The most commonly mentioned health hazard was colorectal cancer, followed by methemoglobinemia. The temporal pattern of media items suggests that the release of scientific studies and scholarly blogs was associated with the publication of subsequent media items. Major stakeholders involved in the discourse included representatives of local and central government, environmental and recreational interest groups, researchers, local residents, agricultural interest groups, and health organizations. Māori (Indigenous New Zealanders) values or perspectives were rarely mentioned. Conclusions Analysis of major newspapers for a five-year period indicated that a wide range of expert comment and opinions were made available to the public and policy makers on the issue of nitrates in water. While many different stakeholder views were captured in the media discourse, there is scope for the media to better report the views of Māori on this topic. There is also a need for articles detailing the health issues to also refer to the environmental, recreational, and cultural aspects of protecting water quality to ensure that the public, policy makers, and regulators are aware of co-benefits.

OBJECTIVES:Community water fluoridation (CWF) has proven oral health benefits. We investigated whether drinking water suppliers are meeting New Zealand CWF targets (0.7-1.0 ppm) to ensure these benefits.METHODS:We retrieved fluoride testing data from 25 supplies serving 2,059,000 people (82% of people on a fluoridated supply), for the years 1992-2022 (22,220 weekly observations). We descriptively assessed compliance with fluoride targets in this convenience sample.RESULTS:The mean fluoride level was 0.66 ppm (SD 0.28). Water suppliers achieved fluoride targets 54.1% of the time (range 4.2%-77.9%). Fluoride concentration fell short of the target in 42.2% of observations, exceeded but under the maximum acceptable value (MAV) in 3.6%, and in excess of the MAV in 0.1%. The percentage of compliant observations was greater in larger than smaller supplies.CONCLUSIONS:Noncompliance with CWF targets was common. Epidemiological studies that rely on fluoridation status as their exposure may underestimate the oral health benefits of CWF. Our results highlight future challenges with the feasibility of expanding CWF under new legislation as well as the weaknesses in drinking water surveillance.

Background: The environments where children travel can present both risks as well as opportu-nities for their health and development. We aimed to explore the nature of school journeys from a child's perspective, including how exposure to environmental 'goods' and 'bads' vary by travel mode.Methods: Children aged 11-13 years (n = 153) wore wearable cameras that automatically captured images of their surroundings every 7 s on two school days in Wellington, New Zealand. School journey segments were coded as either active school travel (AST), private car travel, public transport, waiting for transport or journey breaks. Exposure to environmental 'goods' (blue space, green space or sport facilities) and 'bads' (marketing of unhealthy food, alcohol and gambling) were identified using the same wearable camera data. Differences in exposure by journey seg-ments were explored using Poisson regression.Results: On average, school journeys comprised 3.1 segments (e.g. walk - journey break - walk). Average journey time was 24.2 min and the average time contribution by segment was 29.3% for AST, 24.4% for private travel, 21.9% for public transport, 2.9% for waiting and 21.5% for journey breaks. The vast majority of journey breaks (85%) took place between AST segments and about one-third involved visits to food outlets (36.0%); breaks to visit recreation/sport settings were rare (3.3%). Journey time, journey breaks and exposure to environmental 'bads' were higher on afternoon school journeys. AST and journey break segments involved higher rates of exposure to both environmental 'goods' and 'bads'.Conclusions: The findings show that school journeys, particularly afternoon journeys and AST, involve frequent journey breaks and high rates of exposure to both environmental 'goods' and 'bads'. To bolster opportunities for healthy behaviours during the school journey, policies could usefully focus on reducing outlets selling unhealthy products close to school and increasing natural/recreation space.

Australian and New Zealand Journal of Public Health 105 © 2022 The Authors This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. Globally, nitrate levels in source water have increased as a result of agricultural intensification, which has subsequently increased nitrate contamination in drinking water.1 Recent epidemiological evidence suggests a link between ingested nitrate via drinking water and increased cancer risk, with the best evidence for colorectal cancer.2 Our own meta-analysis of six recent epidemiological studies3-8 investigating nitrate in drinking water shows a statistically significant pooled estimate for increased risk of colon and colorectal cancers but not for rectal cancers (see Figure 1).