Māori Health Review Issue 28

This trial involved 726 American urban adolescents aged 14–18 years presenting to a level I emergency department (ED) between September 2006 and September 2009, who screened positive for both alcohol and violence and reported past-year alcohol use and aggression. Patients were randomised to a control group that received a brochure (n=235) or a 35-minute brief intervention delivered by either a computer (n=237) or therapist (n=254) in the ED. The brief intervention combined motivational interviewing with skills training, a review of goals, tailored feedback, decisional balance exercise, role plays, and referrals. At 3 months’ follow-up, compared with controls, participants in the therapist intervention showed self-reported reductions in the occurrence of peer aggression (therapist, –34.3%; control, –16.4%; relative risk [RR], 0.74), experience of peer violence (therapist, –10.4%; control, +4.7%; RR, 0.70), and violence consequences (therapist, –30.4%; control, –13.0%; RR, 0.76). At 6 months, participants in the therapist intervention showed self-reported reductions in alcohol consequences (therapist, –32.2%; control, –17.7%; OR, 0.56) compared with controls; participants in the computer intervention also showed self-reported reductions in alcohol consequences (computer, –29.1%; control, –17.7%; OR, 0.57).

This Californian study explored diagnostic and therapeutic care delays among a multi-ethnic sample of 1377 breast and cervical cancer survivors and examined contextual factors influencing diagnostic and therapeutic care delays. The study cohort comprised 449 European American, 185 African American, 468 Latina American, and 275 Asian American survivors. Latina Americans were significantly more likely to report diagnostic delays, whereas African Americans were significantly more likely to report therapeutic delays. In terms of cancer type, cervical cancer survivors (n=679) were significantly more likely to report diagnostic and therapeutic delays compared with the 698 breast cancer survivors. “Fear of finding cancer” was the most frequently cited reason for diagnostic delays, and “medical reasons” were most frequently cited for therapeutic delays.

Cancer registry data were reviewed from a nationally representative cohort of 301 Maori (indigenous) patients and 329 randomly selected non-Māori patients who were diagnosed with colon cancer between 1996 and 2003. Rates of surgical resection were similar between Māori and non-Māori patients, although Māori patients were less likely to undergo extensive lymph node clearance and were more likely to die during the postoperative period. Māori patients were significantly less likely to receive chemotherapy for stage III disease (relative risk [RR], 0.69) and were more likely to experience a delay of ≥8 weeks before starting chemotherapy (RR, 1.98). Treatment disparities were not explained by differences in tumor characteristics or patient comorbidity.

According to New Zealand 2006 Census data, smoking contributes to the 7- to 8-year gap between Māori and non-Māori life expectancy. The researchers specified six modelling scenarios, formed by combining two options for future per annum declines in mortality rates among never-smokers (1.5%/2.5% and 2.0%/3.5% for non-Māori/Māori; i.e. assuming a return to long-run trends of closing ethnic gaps as in pre-1980s decades), and three options for future per annum reductions in the mortality rate difference comparing current to never-smokers (0%, 1% and 2%). In 1996–1999, current smokers had an estimated 3.9 to 7.4 years less of life expectancy relative to never-smokers. This smoking difference in life expectancy was less among Māori than among non-Māori. If the 2006 census smoking prevalence remains unchanged into the future, this paper estimated that the difference in 2040 between Māori and non-Māori life expectancy will range from 1.8 to 6.1 years across the six scenarios and two sexes (average 3.8). If nobody smokes tobacco from 2020 onwards, the paper estimated additional gains in life expectancy for Māori ranging from 2.5 to 7.9 years (average 4.7) and for non-Māori ranging from 1.2 to 5.4 years (average 2.9). Going smokefree as a nation by 2020, compared to no change from the 2006 Census population smoking prevalence, is predicted to close ethnic inequalities in life expectancy by 0.3 to 4.6 years (average 1.8 years; consistently greater for females).

This paper reports updated outcomes for the assessment of discrepancies in ethnicity counts in the 2001 census and mortality data for the 2004–2006 period. 2001 census data were anonymously and probabilistically linked to 5 years of subsequent mortality data (135,849 eligible mortality records), in order to compare ethnicity recording for the years 2001–2004 and 2004–2006. When using total ethnicity, little bias occurs in census and mortality ethnic group counts for 2004–06 and resemble comparisons in 2001–04, except at younger ages where counts for Pacific and Asian ethnicities are up to a third less for mortality data. Due to multiple ethnicities being more commonly recorded on census data, sole ethnicity counts are generally greater on mortality than census data, particularly for Māori ethnicity.

I was fortunate to facilitate a number of fantastic sessions at the HRC Hui Whakapiripiri in July. I have highlighted two here but the entire programme and most presentations can be viewed at http://hui.hrc.govt.nz/programme/.

This paper describes an extreme burden of untreated gout arthritis in South Auckland. Transcripts of 11 semi-structured interviews conducted with male patients with gout were subjected to grounded theory qualitative analysis. Focus groups were held with health professionals involved in the provision of healthcare to patients with gout, patient and community groups, to validate the themes arising from the transcripts and to generate realistic recommendations to improve the quality of care for Māori and Pacific island patients with gout. The majority of patients were Māori or Pacific Island. The paper demonstrates that patients who are not successfully started on uricosuric treatment in primary care experience progressive disability and deterioration in other health parameters including weight gain, hypertension, and morbidity from nonuricosuric treatments such as anti-inflammatory medication, prednisone, and colchicine. The groups with the greatest burden of disease are the least likely to be started on treatment despite regular presentations to healthcare with exacerbations of increasing severity. The paper describes a huge impact on patients in terms of pain, disability, employment, and family members. Compliance is strongly linked to the quality of the information and depth of understanding of the patient.

The second presentation was from a ‘multi talented’ team including Māori health providers, researchers, communities and clinicians. I plan to use the findings from this research in the planning of an ‘oranga niho’ programme at our PHO.

This series of five presentations details a comprehensive investigation into issues surrounding oral health research priorities for Māori. The first presentation discusses project goals designed to improve Māori oral health and reduce disparities; the second describes an oral health research project run by Ngāti Pahauwera Hauora in 2009; the third concerns the impact of oral health problems among Māori adults with low income, elderly Māori, and Māori with special needs, disabilities or who are medically compromised; Presentation 4 discusses the involvement of Kokiri Marae in this research project; and the final presentation concludes with a vision of oral health system for all Māori for life, with appropriate models of oral health service delivery, and solutions to workforce issues.