Racism as a determinant of social and emotional wellbeing for Aboriginal Australian youth
In this exploration into the associations between self-reported racism and health and wellbeing outcomes for young Aboriginal Australians, 345 Aboriginal Australians aged 16–20 years completed a questionnaire validated as culturally appropriate that sought to uncover any evidence on the effects of racism upon health outcomes. All participants had been recruited at birth between 1987 and 1990 in the prospective Aboriginal Birth Cohort Study and were followed-up between 2006 and 2008. A third of the subjects (32%) reported self-reported racism. Significant associations were observed between racism and anxiety (odds ratio [OR], 2.18), depression (OR, 2.16), suicide risk (OR, 2.32) and poor overall mental health (OR, 3.35). No significant associations were found between self-reported racism and resilience or any anthropometric measures.
More evidence showing the effects of racism on health outcomes – unfortunately in young people. Some readers may also be interested by the findings on ‘resilience’.
Reference: Med J Aust. 2011;194(10):546-50.
A Kaupapa Māori approach to a community cohort study of heart disease in New Zealand
This paper reports on the processes and protocols that were developed in the design and implementation of the Hauora Manawa Project, a cohort study of heart disease in New Zealand. The study applied a Kaupapa Māori methodology to gain tribal and health community engagement, design the project and randomly select participants from territorial electoral rolls. Time invested in gaining tribal and health community engagement assisted in the development and design of clear protocols and processes for the study. Response rates for the three study cohorts of rural Māori, urban Māori and urban non-Māori were 57.6%, 48.3% and 57.2%, respectively. Co-operation rates (participation among those with whom contact was established) were 74.7%, 66.6% and 71.4%. The study authors comment that these co-operation rates highlight the acceptability of this research project to the participants and demonstrate the strength of Kaupapa Māori methodologies in engaging Māori participants and community.
Very useful and practical information and a great reference for papers or funding applications. Also expect to see more innovative ways of incorporating Kaupapa Māori methodologies into advancing technology (e.g. Facebook pages for studies) in order to improve sampling and follow-up.
Reference: Aust N Z J Public Health. 2011;35(3):249-55.
Do Māori and Pacific Islander men present with more advanced prostate cancer than European New Zealand men? An analysis of 486 men undergoing biopsy in Auckland
This retrospective audit analysed data from the Auckland Hospital Urology Service database of all men presenting there for a first prostate biopsy in 2005 and 2006. The study aim was to determine whether Māori and Pacific Islander men in Auckland present with more advanced prostate cancer at diagnosis than New Zealand European or European men. Ethnicity was coded from self-identification codes on hospital databases. No appreciable difference was observed when Māori and Pacific Islander men were compared with European men for median PSA level (13.30 vs 12.55 ng/mL); median Gleason score (7 and 7), mean Gleason score (7.0 vs 6.9) or the proportion of Gleason Score 7 or 8–10. Likewise, the rates of metastatic disease did not differ at presentation (11.5% vs 7.8%). However, there appeared to be a significant difference in the proportion of Māori and Pacific Islanders presenting with palpable disease compared with European men (67.2% vs 53.3%; p=0.042). The crude population biopsy rate per 100,000 was similar for Māori and Pacific Islander and European men (560 vs 547).
An important study given the significant inequalities in survival rates for prostate cancer between Māori and non-Māori. Interestingly, whilst ‘late presentation’ is considered to be a major contributing factor to survival disparities between Māori and non-Māori, these findings contest its occurrence. A review of treatment rates by ethnicity is required.
Reference: BJU Int. 2011;107 Suppl 3:27-32.
Streptokinase antibodies in patients presenting with acute coronary syndrome in three rural New Zealand populations
This paper states that New Zealand Māori have some of the highest rates of Group A streptococcal infection (GAS) in the world. Since GAS elevates titres of anti-streptokinase (SK) neutralising antibodies, GAS may induce resistance to SK. The study measured anti-SK titres in 180 patients presenting with symptoms consistent with an acute coronary syndrome to three New Zealand rural hospitals, selected because they provide care for patients from communities with different socioeconomic and ethnic mixes (Māori proportions were between 6% and 67%). Compared with the community with the lowest proportion of Māori, patients in the community with the highest proportion of Māori had mean anti-SK titres that were 2.8 times higher (p=0.05) and they were 2.5 times more likely to have a high anti-SK titre (33% vs 13% p=0.035).
There appears to be an increasing focus in research and clinical fields on the role of ethnicity in pharmaceutical treatment. My concern is that such ‘literature’ may influence clinical decisions to the detriment of Māori health outcomes (for example, SK is not offered to Māori presenting with ST elevation MI because they MAY have higher anti-SK titre). As the researchers suggest, the point is that evidence based best practice should be made available to all citizens. Therefore, firstly we should strive to treat GAS asap and reduce the incidence of SK resistance. And if SK is not clinically appropriate, alternatives (such as PCI or CABG) must be offered to ensure best and equitable outcomes.
Reference: J Clin Pathol. 2011;64(5):426-9.
Risk and protective factors for suicide attempt among Indigenous Māori youth in New Zealand: the role of family connection
These researchers sought to describe risk and protective factors associated with a suicide attempt for Māori youth and also explore whether family connection moderates the relationship between depressive symptoms and suicide attempts for Māori youth. The study cohort comprised 1702 Māori young people aged 12–18 years from an anonymous representative national school-based survey of New Zealand (NZ) youth in 2001. In a logistic regression analysis, risk factors identified as being associated with a suicide attempt in the past year included depressive symptoms (odds ratio [OR], 4.3; p<0.0001), having a close friend or family member commit suicide (OR, 4.2; p<0.0001), being 12–15 years old (reference group: 16–18 years) (OR, 2.7; p<0.0001), having anxiety symptoms (OR, 2.3; p=0.0073), witnessing an adult hit another adult or a child in the home (OR, 1.8; p=0.001), and being uncomfortable in NZ European social surroundings (OR, 1.7; p=0.0040). While family connection was associated with fewer suicide attempts (OR, 0.9; p=0.0002), this factor failed to moderate the relationship between depressive symptoms and suicide attempt (χ2 = 2.84; p=0.09).
Given the high suicide rates in NZ, and recent ‘epidemics’ in some communities, this study provides a timely reminder of the ‘red flags’ for suicide risk. New to me was ‘being uncomfortable in NZ European social settings’ as a significant risk factor and one that I will need to consider when managing young Māori with depression.
Reference: Journal of Aboriginal Health. 2011;March:16-31.
Cytisine’s potential to be used as a traditional healing method to help Indigenous people stop smoking: a qualitative study with Māori
These researchers explored the potential of using cytisine, a plant extract found in Golden Rain (Cytisus laburnum L.) and the New Zealand Kowhai (Sophora tetraptera L.) with a similar molecular makeup to nicotine, as a ‘rongoā Māori’ (traditional Māori remedy) and its attractiveness to Māori smokers compared with other cessation products. Focus groups and individual semi-structured interviews with Māori that smoked, as well as interviews with two key informants, revealed the following barriers to using cessation products: financial and effort cost; pervasive smoking among family and peers; environments permissive of smoking; and perceived cultural inappropriateness of treatments. Participants were very interested in cytisine, supported the idea that it would be acceptable to package it as a rongoā Māori, and all wanted to use it. Named appropriately, packaged and promoted as a Māori cessation product, participants thought cytisine would contribute to the restoration of Māori identity and traditional beliefs and practices in addition to reducing smoking.
I welcome studies such as this where the researchers are looking ‘outside of the box’ to tackle the issue of smoking cessation with Maori. I guess we should watch this space.
Reference: Nicotine Tob Res. 2011;13(5):353-60.
Sociodemographic differences in prevalence of diagnosed coronary heart disease in New Zealand estimated from linked national health records
Linked health records, comprising hospital treatment for CHD, dispensing of selected anti-anginal drugs and mortality were used in this study to estimate sociodemographic differences in the prevalence of coronary heart disease (CHD) in New Zealand in December 2008. Among a “health contact” population of adults (≥15 years), about one in 20 (6.5% of men and 4.1% of women) had indicators of a past diagnosis or treatment for CHD or both. Prevalence differed substantially by gender, ethnic group and socioeconomic status. For example, among New Zealanders aged 35–74 years, Indian men had the highest age-adjusted prevalence (7.78%), almost double the prevalence of males in the ‘Other’ ethnic group (mainly New Zealand European). Among women, Māori had the highest adjusted prevalence (4.03%), just over twice that of ‘Others’.
CVD risk is often considered an issue for males (as seen in many social marketing campaigns). However, the results send a clear message that prevention and management of CVD risk in Māori women is just as vital. As the editorial1 suggests, a population-wide approach, in addition to individual risk assessment, is required to reduce CVD risk. Smoking cessation is probably a good place to start, given the high rates amongst Māori women. 1. Stewart RAH. The challenge of reducing socioeconomic and ethnic differences in cardiovascular disease. N Z Med J. Available at: http://www.nzma.org.nz/journal/124-1334/4667/.
Reference: N Z Med J. 2011;124(1334).
Achieving equitable outcomes for Māori women with cervical cancer in New Zealand: health provider views
This paper presents an analysis of key themes identified from transcripts of focus groups undertaken with three health provider groups in different regions of New Zealand working across the range of cervical cancer services. The focus groups sought to uncover health provider views on changing survival disparities between Māori and non-Māori women, the management of cervical cancer in New Zealand, and achieving equitable outcomes from cervical cancer for Māori women. Providers were encouraged by improvements over time in survival disparities between Māori and non-Māori. Key themes of discussion relating to cervical cancer management included: communication and education; screening; access to treatment; pathways through care; patient factors; and system standards. Providers suggested options for further improvements in the management of cervical cancer to achieve equitable outcomes for Māori, particularly in the areas of prevention and early detection.
Data confirms the disparities in cervical screening rates between Māori, Pacifica and women living in deprived neighbourhoods compared with ‘Others’. The options provided here to improve management, including screening, of cervical cancer, are particularly useful to someone like me working in primary care.
Reference: N Z Med J. 2011;124(1334).
