Māori Health Review Issue 54

Smoking prevalence data from the New Zealand 2013 Census reported a lower than expected smoking prevalence, especially for Māori. These data were combined with smoking prevalence data from the New Zealand 2006 Census to upgrade projections on future smoking prevalence in New Zealand to inform policy around tobacco endgame planning. Between the 2006 and 2013 censuses (adjusted for no tax rises since 2010), initiation of daily smoking by age 20 years decreased annually by 3.4% (95% uncertainty interval 3.2% to 3.6%) and 2.7% (2.5% to 2.8%) for non-Māori men and women, and by 2.9% (2.6% to 3.2%) and 3.2% (2.9% to 3.5%) for Māori, respectively. Annual net smoking cessation rates ranged from 3.7% to 7.7% across demographic groups. These data led to revised projected smoking prevalence rates for 2025 of 18.7% and 19.3% for Māori men and women, and 8.3% and 6.4% for non-Māori, respectively. The study authors point out that in these projections, smoking prevalence below 5% by 2025 is not attained by any demographic group.

This study compared patients’ uptake of publicly funded blood glucose test strips in New Zealand against published consensus guidelines on appropriate rates of usage. An audit identified an estimated 183,000 patients who were dispensed diabetes medicines and/or self-monitoring of blood glucose (SMBG) test strips between 1 January and 31 December 2011. Approximately 122,000 of these patients received the same script combination in the first and fourth quarter of the 2011 year and were identified as ‘steady-state’ (stabilised) patients. The audit revealed both under- and over-dispensing of test strips among different patient groups; e.g., overall test strip dispensing in stabilised patients was apparently 8% less than what was expected. Notably, Māori and Pacific peoples in the 25–44-year age group were appreciably under-dispensed in some insulin-containing regimens and a high over-dispensing was observed among patients using metformin alone or on no diabetic medication. Patient numbers and median ages varied widely across treatment groups and by gender and ethnicity.

These researchers explored the concept of health from both a Māori world view and occupational therapy perspectives, as a means to understand and value indigenous knowledge and promote culturally safe responsive practice. The research used Māori methodologies to protect the Māori knowledge shared in the study. The research applied 7 principles, which included respect for people, the need to be cautious, and look, listen, and speak. Throughout 2008 and 2009, the researchers collected perspectives on health and wellbeing from a total of 23 indigenous occupational therapists, other occupational therapists and indigenous health practitioners, using interviews and a questionnaire. The findings are presented as a conceptual framework, depicting a whare, a Māori meeting house, in order to show relationships between culture and health and provide a tool for informing, guiding, and evaluating practice understandings. Key concepts held by occupational therapists and Māori were spirituality, holistic views, client responsive practice, and environmental contexts. Areas of difference were the focus on occupations, the interdependence of indigenous relationships, and the place of the extended family in supporting wellness.

These researchers examined the inter-relationships between comorbidity, receipt of treatment, ethnicity and cancer survival among a cohort of patients with liver and stomach cancers in New Zealand. New Zealand Cancer Registry data identified 269 Māori patients diagnosed with stomach and liver cancers, who were compared with a randomly selected group of 255 non-Māori patients. By 2 years post-diagnosis, over 70% of patients had died. As comorbidity burden increased among those with Stage I–III disease, it was increasingly less likely that the patient would receive curative surgery (e.g., C3 Index score 6 vs 0, adjusted odds ratio [OR] 0.32; 95% CI, 0.13 to 0.78) and the risk of mortality increased (e.g., C3 Index score 6 vs 0, adjusted all-cause hazards ratio [HR] 1.44; 95% CI, 0.93 to 2.23). Receipt of curative surgery reduced this excess mortality, in some cases substantially; the extent to which this occurred varied by level of comorbidity. Māori patients had somewhat higher levels of comorbidity (34% in highest comorbidity category compared with 23% for non-Māori) and poorer survival that could not be explained by age, sex, site, stage, comorbidity or receipt of curative surgery (adjusted cancer-specific HR 1.36; 95% CI, 0.97 to 1.90; adjusted all-cause HR 1.33; 95% CI, 0.97 to 1.82). Access to healthcare factors accounted for 25–36% of this survival difference.

This investigation used data from the Waikato breast cancer register to identify all women with newly diagnosed invasive non-metastatic breast cancer diagnosed during 1999–2012, who underwent adjuvant chemotherapy (n=922) or radiation therapy (n=996) as first adjuvant therapy after surgery. The research sought to determine factors associated with delay in adjuvant chemotherapy and radiotherapy for breast cancer, and its impact on the mortality inequity between indigenous Māori and European women in New Zealand. Overall, 32.4% and 32.3% of women experienced delays exceeding the thresholds for chemotherapy (60 days) and radiotherapy (90 days), respectively. Higher proportions of Māori compared with NZ European women experienced delays longer than thresholds for adjuvant radiation therapy (39.8% vs 30.6%; p=0.045) and chemotherapy (37.3% vs 30.5%; p=0.103). In multivariate analysis, factors associated with significantly longer delays for adjuvant therapy included rural compared with urban residency, requiring a surgical re-excision and treatment in public compared with private hospitals (p<0.05). Breast cancer mortality was significantly higher among women who experienced a delay in initiating first adjuvant therapy (HR 1.45; 95% CI, 1.05 to 2.01). Mortality risks were higher among women with delays in chemotherapy (HR1.34; 95% CI, 0.89 to 2.01) or radiation therapy (HR 1.28; 95% CI, 0.68 to 2.40), although these were statistically non-significant

This group of researchers employed a quasi-experimental pre-/postintervention design to explore the impact of facilitated access to free counselling support amongst 581 culturally diverse youth aged 10–24 years. The research using the following outcome measures: Strengths and Difficulties Questionnaire (SDQ), Substance Abuse Choices Scale (SACS), Children’s Global Assessment Scale (C-GAS), as well as consumer feedback questionnaires. Those participants who completed the intervention reported significant improvements from baseline in global social and psychiatric functioning measured by C-GAS (p<0.001), a reduced risk of clinically significant mental health concerns measured by the SDQ (p<0.001), and reductions in the use and impact of drugs/alcohol as measured by SACS scores (p<0.001). Participants and their families/whānau perceived the interventions to be safe and appropriate, resulting in increased skill development around coping and communication.

Outcomes are reported from a feasibility study that sought to determine the likely effectiveness of an incentives-based cessation trial among pregnant Māori women that smoked. The study recruited 24 pregnant smokers aged ≥16 years (mean age 25 years) who self-identified as Māori, were 2–30 weeks pregnant, and currently smoked. A total of 74 women were approached through health practitioners, print media, and radio adverts in Auckland, New Zealand; 50 declined involvement in the study. Participants were randomised to (1) usual cessation support, including information about different cessation products and services, and access to nicotine replacement therapy (n=8; controls), (2) usual cessation support plus a retail voucher to the value of NZ$25 for each ‘abstinent from smoking’ week for 8 weeks (n=8; voucher), or (3) usual cessation support plus product to the value of NZ$25 for each ‘abstinent from smoking’ week for 8 weeks (n=8; product). Outcomes measures included weekly self-reported and monthly biochemically verified smoking status, and acceptability. Overall, 5 women (21%) were abstinent from smoking for at least 6 weeks of the 8-week study period; 1 woman from the control group, 6 from the product group and 3 from the voucher group.

These researchers systematically reviewed the international and Aotearoa literature concerning key considerations for Māori parents with substance use disorders (SUDs) who present to an Alcohol and Drug (AoD) specialist for assessment and treatment. This paper details the knowledge and skills that adult AoD services must possess in order to provide effective support to parents with SUDs. Comprehensive assessment and intervention plans must consider both individual and familial risk and protective factors. Possible child welfare issues have to be identified early to ensure prevention or intervention. The paper also notes that the AoD workforce must have the knowledge and skills to facilitate access to other relevant sectors, such as education, employment, and housing. An AoD workforce that is effective with Māori must not only have these abilities, but also have at least some basic knowledge and skills in Whānau Ora philosophy and Whānaucentered best practice. The paper describes a set of knowledge and skills that are essential for developing an appropriate AoD workforce and improve service delivery for Māori parents with SUDs. This skillset must be based on Māori foundations, understand intergenerational dynamics, and endorse a group capacity for self-determination. Moreover, the paper recommends that AoD services increase their knowledge and skills associated with the realities of lifestyles centered in low socioeconomic communities and co-occurring issues that contribute to poor health outcomes.