The allergic disease of asthma is characterized by an infiltration of inflammatory cells to the lung, a process co-ordinated by T-helper (TH) cells. The TH2 cytokine Interleukin (IL)-4 promotes infiltration of eosinophils to sites of inflammation. Eosinophil-selective chemoattractant cytokines (eg. eotaxins) are synthesized by lung epithelial cells. Eotaxin-3 is expressed at high levels in the asthmatic lung, predominantly after IL-4 stimulation. Eotaxin-3 is therefore a marker of inappropriate airway inflammation. Polyphenolic (PP) compounds found in high concentrations in berries may have beneficial effects in inflammatory conditions. Plant and Food Research produced high-PP extracts of blackcurrant (BC) cultivars that were tested for inflammation modulating effects. Since high doses of PPs have been shown to cause cell death, we tested two BC cultivars at a range of concentrations in a cell viability (WST-1) assay. While no toxic effects were attributable to the BC extracts (1-50µg/ml), a dose-related trend in cell death was observed and therefore 10µg/ml was chosen for further experiments Ten BC cultivars were compared for efficacy by measuring eotaxin-3 production in IL-4 stimulated human lung epithelial (A549) cells in vitro. Cells were incubated with BC extracts (10µg/ml) and IL-4 (10ng/ml) for 24 hours. The supernatants were then quantified for eotaxin-3 levels by an enzyme-linked immunosorbent assay (ELISA). All ten BC extracts reduced eotaxin-3 levels after stimulation with IL-4, and six BC extracts were effective by statistically significant levels (P<0.05), (BC cultivars -01, -02, -03, -05, -09 & -10). Of those, BC extracts of four cultivars demonstrated a reduction of more than 65% from the IL-4 stimulated control. In addition, a positive trend in inflammation modulation vs. one anthocyanin (ACN) in the BC extracts was shown. This study has demonstrated the beneficial inflammation modulatory effects of polyphenolic BC extracts, which could be related to cyanidin 3-O-rutinoside content. These results may have therapeutic potential for asthma.

Adolescence is a time of great changes, a time where experimentation and exploration is expected and when the values of authority figures are examined and challenged. Adolescents will experiment and push the boundaries of all aspects of their life in order to find their own place and identity in a world that has changed its expectations of them. Use of drugs is one of the ways that they do this. Australian adolescents grow up in a society where alcohol and tobacco is an acceptable part of daily life. Their use of drugs is at least on par with and in some cases exceeds that of the general population. The overall goals of this research were to gain more information on drug use of Australian adolescents, using existing data sets. This research examined, using a number of different age groups, the differences in adolescent drug use between urban and rural Australia for lifetime use, use in the last year and use in the last month using the 2002 edition of the Australian School Student Alcohol and Drug (ASSAD) survey series in conjunction with the 2001 National Drug Strategy Household Survey (NDSHS). It also used these data sets to investigate differences between indigenous adolescents and non-Indigenous adolescents and whether there were any differences in adolescent drug use across socio-economic status groups. Four hypotheses were developed. The first was that rural adolescents are more likely than urban adolescents to use licit drugs and the second was that urban adolescents are more likely than rural adolescents to use illicit drugs. Thirdly, that Indigenous adolescents are more likely than non-Indigenous adolescents to use both licit and illicit drugs and the fourth was that adolescents from low socio-economic status (SES) groups are more likely than adolescents from high SES groups to use licit and illicit substances. The data offered little support for any of the hypotheses. The hypothesis on rural adolescents being more likely to use licit drugs was supported by the ASSAD surveydata but not the NDSHS. All other hypotheses were not supported by either of the data sets. While there are aspects of the information from the two data sets that are contradictory making it difficult to prove or disprove the hypotheses formulated for this research, they highlighted a number of aspects of adolescent drug use. The first of these is that this research supports the premise that rural adolescent drug use rates are converging with urban drug use rates for younger adolescents. It also highlighted that there are a large number of rural school students who are using alcohol and cannabis. The ASSAD data also confirmed other Australian research showing that Indigenous adolescents are less likely than their non-Indigenous counterparts to use alcohol. Both data sets confirmed previous research by indicating that adolescents from the high SES groups are more likely than their counterparts in the lower SES groups to consume alcohol. Further investigation is needed to find out why the data sets did not substantiate each other and to gain further insight into the consumption of alcohol by Indigenous adolescents and adolescents from the higher socio-economic status groups. Increasing the samples of Indigenous people in both of the data sets and lobbying the Australian Bureau of Statistics to increase their sample for the Indigenous Social Survey to include 12-14 year olds should give more information on Indigenous adolescents that could be used in research and prevention activities.

Background Prior to the commencement of this study, gambling was not considered a significant health issue for Maori, even though the first national gambling prevalence study in New Zealand in 1991, identified that Maori had at least three times the risk of problem gambling of non-Maori. In the early 1990s, through the provision of a gambling telephone helpline and gambling counselling services, it was identified that Maori and in particular Maori women, were increasingly seeking help with problems with gambling. Gambling is an integral part of the culture of New Zealand. To understand gambling and problem gambling requires an understanding of the social, economic and cultural context it plays in being Maori. Aim of Study This study investigated whether gambling and problem gambling is an emerging health issue for Maori and if so, the extent of the problem, its effects on Maori and health approaches, and interventions which are likely to be effective for Maori. A public health approach to address problem gambling has been investigated and a plan developed. Methodology This study has been undertaken from a Maori-centered and an action-oriented research approach. It has involved integrating existing and new information from the following sources: Maori patterns of gambling and expenditure, gambling prevalence data, Maori utilisation of gambling treatment services and gambling by indigenous people. Fifteen Maori problem gamblers have been interviewed to understand from the "inside looking out" their experience of problem gambling. Thirty key informants have also been interviewed to understand from the "outside looking in" their perspective as to whether gambling is an emerging health issue for Maori. This research has involved quantitative analysis and qualitative research. Findings This study has found that problem gambling is an emerging public health issue for Maori. The effects of problem gambling for Maori are invisible and masked by other health problems such as alcohol abuse or mental health problems. Maori prevalence of problem gambling is similar to other indigenous populations which have shared similar historical and socio-economic experiences. Problem gambling often leads to crime, imprisonment, development of other health problems and the break down of families. Focusing alone on problem gambling ignores the real issues for Maori, a wider perspective is needed which focuses on Maori and tribal development. A public health strategy is proposed to reduce Maori gambling related harm.

Whole document restricted until August 2010, see Access Instructions file below for details of how to access the print copy. / Abstract Background Asthma is a common problem in New Zealand, and is associated with significant morbidity and costs to children, their families, and wider society. Previously published New Zealand literature suggested that Māori and Pacific children were less likely than NZ European children to receive asthma medications and elements of asthma education, had poorer knowledge of asthma, and experienced greater morbidity and hospitalisations. However, none of the previous literature had been specifically designed to assess the nature of asthma care in the community, or to specifically answer whether there were ethnic disparities in care. A systematic review of studies published in the international literature that compared asthma management among different ethnic groups drawn from community-based samples was undertaken. The results of this review suggested that minority ethnic group children were less likely to receive elements of asthma medication use, asthma education and self-management (action) plans. Objectives The primary objectives of the study were to: • describe the use of medications, medication delivery systems, asthma education, and self-management plans in primary care for Māori, Pacific, and Other ethnic group children • ascertain whether there were any ethnic disparities in the use of medications, medication delivery systems, asthma education, and self-management plans in primary care after controlling for differences in socio-economic position and other potential confounders. Secondary objectives were to: • describe the asthma-related utilisation of GP, after hours medical care, emergency departments, and hospital admissions among Māori, Pacific, and Other ethnic group children with asthma • ascertain whether differences in medication use, the provision of asthma education, and the provision of self-management plans explained ethnic differences in health service utilisation. Methods A cross-sectional survey was conducted in Auckland, New Zealand. The caregivers of 647 children who were aged 2–14 years, had a diagnosis of asthma or experienced ‘wheeze or whistling in the chest’, and had experienced symptoms in the previous 12 months were identified using random residential address start points and door knocking. Ethnically stratified sampling ratios were used to ensure that approximately equal numbers of children of Māori, Pacific and Other ethnicity were enrolled into the study. A face-to-face interview was conducted with the caregivers of these children. Data was collected about: socio-demographic factors; asthma morbidity; asthma medications and delivery devices; exposure to, and experiences of, asthma education and asthma action plans; and asthma-related health services utilisation. Results In this study, the caregivers of 647 eligible children were invited to participate and 583 completed the interview, giving an overall completion rate of 90.1%. There were no ethnic differences in completion rates. The overall use of inhaled corticosteroid medications had increased since previous New Zealand research was published. Multivariable modelling that adjusted for potential confounders did not identify ethnic differences in the use of inhaled corticosteroids or oral steroids. Some findings about medication delivery mechanisms indicated that care was not consistent with guidelines. About 15% of participants reported they had not received asthma education from a primary care health professional. After adjusting for potential confounders there were no ethnic differences in the likelihood of having received asthma education from a health professional. Among those participants who had received education from a primary care health professional, significantly fewer Māori and Pacific caregivers reported receiving education about asthma triggers, pathophysiology and action plans. Lower proportions of Pacific (77.7%; 95% confidence interval (95%CI) 70.3, 85.1) and Māori (79.8%; 95% CI 73.6, 85.9) caregivers were given information about asthma triggers compared to Other caregivers (89.2%; 95% CI 84.9, 93.6; p=0.01). Fewer Māori (63.6%; 95% CI 55.7, 71.4) and Pacific (68.1%; 95% CI 60.1, 76.1) caregivers reported receiving information about pathophysiology (Other 75.9%; 95% CI 69.5, 82.3; p=0.05). Information about asthma action plans had been given to 22.7% (95% CI 15.5, 29.9) of Pacific and 32.9% (95% CI 25.3, 40.6) of Māori compared to Other participants (36.5%; 95% CI 28.6, 44.3; p=0.04). In addition, fewer Māori (64.2%; 95% CI 56.1, 72.3) and Pacific (68.5%; 95% CI 60.1, 77.0) reported that the information they received was clear and easy to understand (Other 77.9%; 95% CI 71.8, 84.1; p=0.03). About half of those who had received education from a health professional reported receiving further education and, after adjustment for potential confounders, Pacific caregivers were less likely to have been given further education (odds ratio 0.57; 95% confidence interval 0.33, 0.96). A minority of participants (35.3%) had heard about action plans and, after adjustment for potential confounders, Pacific caregivers were less likely to have heard about these plans (odds ratio 0.54; 95% confidence interval 0.33, 0.96). About 10% of the sample was considered to have a current action plan. The mean number of visits to a GP for acute and routine asthma care (excluding after-hours doctors and medical services) in the previous twelve months were significantly higher for Pacific (3.89; CI 3.28, 4.60) and Māori (3.56; CI 3.03, 4.16) children than Other ethnic group children (2.47; CI 2.11, 2.85; p<0.0001). Multivariable modelling of health service utilization outcomes (‘number of GP visits for acute and routine asthma care in the previous twelve months’, ‘high use of hospital emergency departments’, and ‘hospital admissions’) showed that adjustment for potential confounding and asthma management variables reduced, but did not fully explain, ethnic differences in these outcomes. Māori children experienced 22% more GP visits and Pacific children 28% more visits than Other children (p=0.05). Other variables that were significantly associated with a higher number of GP visits were: regular source of care they always used (regression coefficient (RC) 0.24; p<0.01); lower household income (RC 0.31; p=0.004) and having a current action plan (RC 0.38; p=0.006). Increasing age (RC -0.04; p=0.003), a lay source of asthma education (RC -0.41; p=0.001), and higher scores on asthma management scenario (RC -0.03; p=0.05) were all associated with a lower number of GP visits. Pacific (odds ratio (OR) 6.93; 95% CI 2.40, 19.98) and Māori (OR 2.60; 95% CI 0.87, 8.32) children were more likely to have used an emergency department for asthma care in the previous twelve months (p=0.0007). Other variables that had a significant effect on the use of EDs in the multivariable model were: not speaking English in the home (OR 3.72; 95% CI 1.52, 9.09; p=0.004), male sex (OR 2.43; 95% CI 1.15, 5.15; p=0.02), and having a current action plan (OR 7.85; 95% CI 3.49, 17.66; p<0.0001). Increasing age was associated with a reduced likelihood of using EDs (OR 0.90; 95% CI 0.81, 1.00; p=0.05). Hospitalisations were more likely in the Pacific (OR 8.94; 95% CI 2.25, 35.62) and Māori (OR 5.40; 95% CI 1.28, 23.06) ethnic groups (p=0.007). Four other variables had a significant effect on hospital admissions in the multivariable model. Participants who had a low income (OR 3.70; 95% CI 1.49, 9.18; p=0.005), and those who had a current action plan (OR 8.39; 95% CI 3.85, 18.30; p<0.0001) were more likely to have been admitted to hospital in the previous 12 months. Increasing age (OR 0.88; 95% CI 0.80, 0.98; p=0.02) and parental history of asthma (OR 0.39; 95% CI 0.18, 0.85; p=0.02) were associated with reduced likelihood of admission. Conclusions The study is a robust example of cross-sectional design and has high internal validity. The study population is representative of the population of children with asthma in the community. The three ethnic groups are also considered to be representative of those ethnic groups in the community. The study, therefore, has good representativeness and the findings of the study can be generalised to the wider population of children with asthma in the Auckland region. The results suggested that some aspects of pharmacological management were more consistent with guideline recommendations than in the past. However, given the higher burden of disease experienced by Māori and Pacific children, the lack of observed ethnic differences in the use of preventative medications may reflect under treatment relative to need. There are important ethnic differences in the provision of asthma education and action plans. Future approaches to improving care should focus on interventions to assist health professionals to implement guideline recommendations and to monitor ethnic disparities in their practice. Asthma education that is comprehensive, structured and delivered in ways that are effective for the people concerned is needed.

Children are often referred to as the 'hidden' generation, a powerless group who in infancy and childhood depend on their parents and families/whanau to ensure they receive everything in life required to enable them to grow into healthy young people and adults. Some are more disadvantaged than others due to the socioeconomic circumstances they grow up in. This can have lasting effects on their health in childhood with associated impacts later in life. In New Zealand the populations of children most disadvantaged are those from Maori, Pacific and other low income families/whanau. The disparities that exist between children from these populations and other groups whilst lessening, is still significant. The purpose of this study was to explore with Maori, Pacific and low income parents and caregivers why they choose to 'seek' health services for their children, or not as the case may be. Patterns of use are established early in life therefore it is important to understand children's health care use. The literature suggests that children's access to health care is influenced by predisposing factors such as their socioeconomic status, ethnicity, the availability of services, choice of providers, availability of school–based health services, outreach services, relationships between the community and health service providers and having a regular source of primary health care. A qualitative exploratory design was the methodology chosen for this research. A modified 'community as partner' model (Anderson, 2008) formed the conceptual framework for the research. Sixteen Maori, Pacific and Pakeha parents and caregivers participated in three focus groups to discuss their perceptions of children's access to health care. Thematic analysis was used to identify codes, categories, themes and sub themes from the data. The New Zealand Child Health Strategy (Ministry of Health, 1998) was used as a model to inform the discussion. The main themes were: reality of life, visibility, knowing you, knowing me and kids come first. The findings suggest that relationships with primary health care providers, the cost of health care for children over five years, awareness of services and a need to prioritise children's needs, enable or prevent children's access to health care. Decisions made regarding further service provision for children will be enhanced by health providers and practitioners having a clearer understanding of the enablers and barriers to access and the factors that influence parental choice of services.

Whole document restricted until August 2010, see Access Instructions file below for details of how to access the print copy. / Abstract Background Asthma is a common problem in New Zealand, and is associated with significant morbidity and costs to children, their families, and wider society. Previously published New Zealand literature suggested that Māori and Pacific children were less likely than NZ European children to receive asthma medications and elements of asthma education, had poorer knowledge of asthma, and experienced greater morbidity and hospitalisations. However, none of the previous literature had been specifically designed to assess the nature of asthma care in the community, or to specifically answer whether there were ethnic disparities in care. A systematic review of studies published in the international literature that compared asthma management among different ethnic groups drawn from community-based samples was undertaken. The results of this review suggested that minority ethnic group children were less likely to receive elements of asthma medication use, asthma education and self-management (action) plans. Objectives The primary objectives of the study were to: • describe the use of medications, medication delivery systems, asthma education, and self-management plans in primary care for Māori, Pacific, and Other ethnic group children • ascertain whether there were any ethnic disparities in the use of medications, medication delivery systems, asthma education, and self-management plans in primary care after controlling for differences in socio-economic position and other potential confounders. Secondary objectives were to: • describe the asthma-related utilisation of GP, after hours medical care, emergency departments, and hospital admissions among Māori, Pacific, and Other ethnic group children with asthma • ascertain whether differences in medication use, the provision of asthma education, and the provision of self-management plans explained ethnic differences in health service utilisation. Methods A cross-sectional survey was conducted in Auckland, New Zealand. The caregivers of 647 children who were aged 2–14 years, had a diagnosis of asthma or experienced ‘wheeze or whistling in the chest’, and had experienced symptoms in the previous 12 months were identified using random residential address start points and door knocking. Ethnically stratified sampling ratios were used to ensure that approximately equal numbers of children of Māori, Pacific and Other ethnicity were enrolled into the study. A face-to-face interview was conducted with the caregivers of these children. Data was collected about: socio-demographic factors; asthma morbidity; asthma medications and delivery devices; exposure to, and experiences of, asthma education and asthma action plans; and asthma-related health services utilisation. Results In this study, the caregivers of 647 eligible children were invited to participate and 583 completed the interview, giving an overall completion rate of 90.1%. There were no ethnic differences in completion rates. The overall use of inhaled corticosteroid medications had increased since previous New Zealand research was published. Multivariable modelling that adjusted for potential confounders did not identify ethnic differences in the use of inhaled corticosteroids or oral steroids. Some findings about medication delivery mechanisms indicated that care was not consistent with guidelines. About 15% of participants reported they had not received asthma education from a primary care health professional. After adjusting for potential confounders there were no ethnic differences in the likelihood of having received asthma education from a health professional. Among those participants who had received education from a primary care health professional, significantly fewer Māori and Pacific caregivers reported receiving education about asthma triggers, pathophysiology and action plans. Lower proportions of Pacific (77.7%; 95% confidence interval (95%CI) 70.3, 85.1) and Māori (79.8%; 95% CI 73.6, 85.9) caregivers were given information about asthma triggers compared to Other caregivers (89.2%; 95% CI 84.9, 93.6; p=0.01). Fewer Māori (63.6%; 95% CI 55.7, 71.4) and Pacific (68.1%; 95% CI 60.1, 76.1) caregivers reported receiving information about pathophysiology (Other 75.9%; 95% CI 69.5, 82.3; p=0.05). Information about asthma action plans had been given to 22.7% (95% CI 15.5, 29.9) of Pacific and 32.9% (95% CI 25.3, 40.6) of Māori compared to Other participants (36.5%; 95% CI 28.6, 44.3; p=0.04). In addition, fewer Māori (64.2%; 95% CI 56.1, 72.3) and Pacific (68.5%; 95% CI 60.1, 77.0) reported that the information they received was clear and easy to understand (Other 77.9%; 95% CI 71.8, 84.1; p=0.03). About half of those who had received education from a health professional reported receiving further education and, after adjustment for potential confounders, Pacific caregivers were less likely to have been given further education (odds ratio 0.57; 95% confidence interval 0.33, 0.96). A minority of participants (35.3%) had heard about action plans and, after adjustment for potential confounders, Pacific caregivers were less likely to have heard about these plans (odds ratio 0.54; 95% confidence interval 0.33, 0.96). About 10% of the sample was considered to have a current action plan. The mean number of visits to a GP for acute and routine asthma care (excluding after-hours doctors and medical services) in the previous twelve months were significantly higher for Pacific (3.89; CI 3.28, 4.60) and Māori (3.56; CI 3.03, 4.16) children than Other ethnic group children (2.47; CI 2.11, 2.85; p<0.0001). Multivariable modelling of health service utilization outcomes (‘number of GP visits for acute and routine asthma care in the previous twelve months’, ‘high use of hospital emergency departments’, and ‘hospital admissions’) showed that adjustment for potential confounding and asthma management variables reduced, but did not fully explain, ethnic differences in these outcomes. Māori children experienced 22% more GP visits and Pacific children 28% more visits than Other children (p=0.05). Other variables that were significantly associated with a higher number of GP visits were: regular source of care they always used (regression coefficient (RC) 0.24; p<0.01); lower household income (RC 0.31; p=0.004) and having a current action plan (RC 0.38; p=0.006). Increasing age (RC -0.04; p=0.003), a lay source of asthma education (RC -0.41; p=0.001), and higher scores on asthma management scenario (RC -0.03; p=0.05) were all associated with a lower number of GP visits. Pacific (odds ratio (OR) 6.93; 95% CI 2.40, 19.98) and Māori (OR 2.60; 95% CI 0.87, 8.32) children were more likely to have used an emergency department for asthma care in the previous twelve months (p=0.0007). Other variables that had a significant effect on the use of EDs in the multivariable model were: not speaking English in the home (OR 3.72; 95% CI 1.52, 9.09; p=0.004), male sex (OR 2.43; 95% CI 1.15, 5.15; p=0.02), and having a current action plan (OR 7.85; 95% CI 3.49, 17.66; p<0.0001). Increasing age was associated with a reduced likelihood of using EDs (OR 0.90; 95% CI 0.81, 1.00; p=0.05). Hospitalisations were more likely in the Pacific (OR 8.94; 95% CI 2.25, 35.62) and Māori (OR 5.40; 95% CI 1.28, 23.06) ethnic groups (p=0.007). Four other variables had a significant effect on hospital admissions in the multivariable model. Participants who had a low income (OR 3.70; 95% CI 1.49, 9.18; p=0.005), and those who had a current action plan (OR 8.39; 95% CI 3.85, 18.30; p<0.0001) were more likely to have been admitted to hospital in the previous 12 months. Increasing age (OR 0.88; 95% CI 0.80, 0.98; p=0.02) and parental history of asthma (OR 0.39; 95% CI 0.18, 0.85; p=0.02) were associated with reduced likelihood of admission. Conclusions The study is a robust example of cross-sectional design and has high internal validity. The study population is representative of the population of children with asthma in the community. The three ethnic groups are also considered to be representative of those ethnic groups in the community. The study, therefore, has good representativeness and the findings of the study can be generalised to the wider population of children with asthma in the Auckland region. The results suggested that some aspects of pharmacological management were more consistent with guideline recommendations than in the past. However, given the higher burden of disease experienced by Māori and Pacific children, the lack of observed ethnic differences in the use of preventative medications may reflect under treatment relative to need. There are important ethnic differences in the provision of asthma education and action plans. Future approaches to improving care should focus on interventions to assist health professionals to implement guideline recommendations and to monitor ethnic disparities in their practice. Asthma education that is comprehensive, structured and delivered in ways that are effective for the people concerned is needed.

Whole document restricted, see Access Instructions file below for details of how to access the print copy. / This exploratory study investigates Traumatic Brain Injury (TBI) rehabilitation processes and outcomes among culturally diverse outpatients in community-based rehabilitation who have sustained a Mild to Moderate TBI. The major aims of this study are twofold: firstly, to determine whether community-based rehabilitation outcomes following TBI differ across Mäori, Pacific and Pakeha cultures; and secondly, to determine and identify any service delivery needs for Mäori and Pacific people in TBI rehabilitation that may be distinct from Pakeha. A fixed comparative non-experimental design was utilised where participants were selected using direct control based on their self-identified ethnic group resulting in sub-samples of 11 Mäori, l1 Pacific and 11 Pakeha (n=33). A "Close Other" from their care-giving support network was selected by the participant to take part in the study (n=20). Each participant completed the Neurobehavioural Cognitive Status Examination (Cognistat), the Brain Injury Community Rehabilitation Outcome Scales (BICRO Scales), the Client Satisfaction Questionnaire (CSQ-31), the Beck Depression Inventory, 2nd Edition (BDI-II), the Impact of Events Scale Revised (IES-R) and a semi-structured qualitative interview, while a "Close Other" completed a BICRO "Carer" questionnaire. Results indicate that all participants were at a homogenous level of overall cognitive functioning but Pacific peoples scored significantly lower than both Mäori and Pakeha on two Language subtests and significantly lower than Pakeha on the Memory subtest. Statistical analysis suggests that both Years of Formal Education and English as a Second Language are important factors contributing to these differences. Individual handicap increased following TBI and decreased following rehabilitation, with no significant difference across cultures and suggesting efficacy of rehabilitation. Of the total sample, 42% scored in the clinically depressed range (half of whom were Pakeha) and 24% of the sample showed mild signs of post-traumatic stress (of whom almost 90% were Mäori or Pacific). Although 97% of participants were generally satisfied with their overall rehabilitation service, Mäori and Pacific people were significantly less satisfied with their Physical Surroundings and the Quantity of Services they received. In conclusion, there appears to be universalities in TBI experience and global rehabilitation outcomes that transcends individual cultures. However, there are micro-level cultural variations that have valuable implications when planning culturally appropriate rehabilitation services for the future. For Mäori and Pacific People, acculturation levels will determine the extent to which these implications apply.

Background Prior to the commencement of this study, gambling was not considered a significant health issue for Maori, even though the first national gambling prevalence study in New Zealand in 1991, identified that Maori had at least three times the risk of problem gambling of non-Maori. In the early 1990s, through the provision of a gambling telephone helpline and gambling counselling services, it was identified that Maori and in particular Maori women, were increasingly seeking help with problems with gambling. Gambling is an integral part of the culture of New Zealand. To understand gambling and problem gambling requires an understanding of the social, economic and cultural context it plays in being Maori. Aim of Study This study investigated whether gambling and problem gambling is an emerging health issue for Maori and if so, the extent of the problem, its effects on Maori and health approaches, and interventions which are likely to be effective for Maori. A public health approach to address problem gambling has been investigated and a plan developed. Methodology This study has been undertaken from a Maori-centered and an action-oriented research approach. It has involved integrating existing and new information from the following sources: Maori patterns of gambling and expenditure, gambling prevalence data, Maori utilisation of gambling treatment services and gambling by indigenous people. Fifteen Maori problem gamblers have been interviewed to understand from the "inside looking out" their experience of problem gambling. Thirty key informants have also been interviewed to understand from the "outside looking in" their perspective as to whether gambling is an emerging health issue for Maori. This research has involved quantitative analysis and qualitative research. Findings This study has found that problem gambling is an emerging public health issue for Maori. The effects of problem gambling for Maori are invisible and masked by other health problems such as alcohol abuse or mental health problems. Maori prevalence of problem gambling is similar to other indigenous populations which have shared similar historical and socio-economic experiences. Problem gambling often leads to crime, imprisonment, development of other health problems and the break down of families. Focusing alone on problem gambling ignores the real issues for Maori, a wider perspective is needed which focuses on Maori and tribal development. A public health strategy is proposed to reduce Maori gambling related harm.

Whole document restricted until August 2010, see Access Instructions file below for details of how to access the print copy. / Abstract Background Asthma is a common problem in New Zealand, and is associated with significant morbidity and costs to children, their families, and wider society. Previously published New Zealand literature suggested that Māori and Pacific children were less likely than NZ European children to receive asthma medications and elements of asthma education, had poorer knowledge of asthma, and experienced greater morbidity and hospitalisations. However, none of the previous literature had been specifically designed to assess the nature of asthma care in the community, or to specifically answer whether there were ethnic disparities in care. A systematic review of studies published in the international literature that compared asthma management among different ethnic groups drawn from community-based samples was undertaken. The results of this review suggested that minority ethnic group children were less likely to receive elements of asthma medication use, asthma education and self-management (action) plans. Objectives The primary objectives of the study were to: • describe the use of medications, medication delivery systems, asthma education, and self-management plans in primary care for Māori, Pacific, and Other ethnic group children • ascertain whether there were any ethnic disparities in the use of medications, medication delivery systems, asthma education, and self-management plans in primary care after controlling for differences in socio-economic position and other potential confounders. Secondary objectives were to: • describe the asthma-related utilisation of GP, after hours medical care, emergency departments, and hospital admissions among Māori, Pacific, and Other ethnic group children with asthma • ascertain whether differences in medication use, the provision of asthma education, and the provision of self-management plans explained ethnic differences in health service utilisation. Methods A cross-sectional survey was conducted in Auckland, New Zealand. The caregivers of 647 children who were aged 2–14 years, had a diagnosis of asthma or experienced ‘wheeze or whistling in the chest’, and had experienced symptoms in the previous 12 months were identified using random residential address start points and door knocking. Ethnically stratified sampling ratios were used to ensure that approximately equal numbers of children of Māori, Pacific and Other ethnicity were enrolled into the study. A face-to-face interview was conducted with the caregivers of these children. Data was collected about: socio-demographic factors; asthma morbidity; asthma medications and delivery devices; exposure to, and experiences of, asthma education and asthma action plans; and asthma-related health services utilisation. Results In this study, the caregivers of 647 eligible children were invited to participate and 583 completed the interview, giving an overall completion rate of 90.1%. There were no ethnic differences in completion rates. The overall use of inhaled corticosteroid medications had increased since previous New Zealand research was published. Multivariable modelling that adjusted for potential confounders did not identify ethnic differences in the use of inhaled corticosteroids or oral steroids. Some findings about medication delivery mechanisms indicated that care was not consistent with guidelines. About 15% of participants reported they had not received asthma education from a primary care health professional. After adjusting for potential confounders there were no ethnic differences in the likelihood of having received asthma education from a health professional. Among those participants who had received education from a primary care health professional, significantly fewer Māori and Pacific caregivers reported receiving education about asthma triggers, pathophysiology and action plans. Lower proportions of Pacific (77.7%; 95% confidence interval (95%CI) 70.3, 85.1) and Māori (79.8%; 95% CI 73.6, 85.9) caregivers were given information about asthma triggers compared to Other caregivers (89.2%; 95% CI 84.9, 93.6; p=0.01). Fewer Māori (63.6%; 95% CI 55.7, 71.4) and Pacific (68.1%; 95% CI 60.1, 76.1) caregivers reported receiving information about pathophysiology (Other 75.9%; 95% CI 69.5, 82.3; p=0.05). Information about asthma action plans had been given to 22.7% (95% CI 15.5, 29.9) of Pacific and 32.9% (95% CI 25.3, 40.6) of Māori compared to Other participants (36.5%; 95% CI 28.6, 44.3; p=0.04). In addition, fewer Māori (64.2%; 95% CI 56.1, 72.3) and Pacific (68.5%; 95% CI 60.1, 77.0) reported that the information they received was clear and easy to understand (Other 77.9%; 95% CI 71.8, 84.1; p=0.03). About half of those who had received education from a health professional reported receiving further education and, after adjustment for potential confounders, Pacific caregivers were less likely to have been given further education (odds ratio 0.57; 95% confidence interval 0.33, 0.96). A minority of participants (35.3%) had heard about action plans and, after adjustment for potential confounders, Pacific caregivers were less likely to have heard about these plans (odds ratio 0.54; 95% confidence interval 0.33, 0.96). About 10% of the sample was considered to have a current action plan. The mean number of visits to a GP for acute and routine asthma care (excluding after-hours doctors and medical services) in the previous twelve months were significantly higher for Pacific (3.89; CI 3.28, 4.60) and Māori (3.56; CI 3.03, 4.16) children than Other ethnic group children (2.47; CI 2.11, 2.85; p<0.0001). Multivariable modelling of health service utilization outcomes (‘number of GP visits for acute and routine asthma care in the previous twelve months’, ‘high use of hospital emergency departments’, and ‘hospital admissions’) showed that adjustment for potential confounding and asthma management variables reduced, but did not fully explain, ethnic differences in these outcomes. Māori children experienced 22% more GP visits and Pacific children 28% more visits than Other children (p=0.05). Other variables that were significantly associated with a higher number of GP visits were: regular source of care they always used (regression coefficient (RC) 0.24; p<0.01); lower household income (RC 0.31; p=0.004) and having a current action plan (RC 0.38; p=0.006). Increasing age (RC -0.04; p=0.003), a lay source of asthma education (RC -0.41; p=0.001), and higher scores on asthma management scenario (RC -0.03; p=0.05) were all associated with a lower number of GP visits. Pacific (odds ratio (OR) 6.93; 95% CI 2.40, 19.98) and Māori (OR 2.60; 95% CI 0.87, 8.32) children were more likely to have used an emergency department for asthma care in the previous twelve months (p=0.0007). Other variables that had a significant effect on the use of EDs in the multivariable model were: not speaking English in the home (OR 3.72; 95% CI 1.52, 9.09; p=0.004), male sex (OR 2.43; 95% CI 1.15, 5.15; p=0.02), and having a current action plan (OR 7.85; 95% CI 3.49, 17.66; p<0.0001). Increasing age was associated with a reduced likelihood of using EDs (OR 0.90; 95% CI 0.81, 1.00; p=0.05). Hospitalisations were more likely in the Pacific (OR 8.94; 95% CI 2.25, 35.62) and Māori (OR 5.40; 95% CI 1.28, 23.06) ethnic groups (p=0.007). Four other variables had a significant effect on hospital admissions in the multivariable model. Participants who had a low income (OR 3.70; 95% CI 1.49, 9.18; p=0.005), and those who had a current action plan (OR 8.39; 95% CI 3.85, 18.30; p<0.0001) were more likely to have been admitted to hospital in the previous 12 months. Increasing age (OR 0.88; 95% CI 0.80, 0.98; p=0.02) and parental history of asthma (OR 0.39; 95% CI 0.18, 0.85; p=0.02) were associated with reduced likelihood of admission. Conclusions The study is a robust example of cross-sectional design and has high internal validity. The study population is representative of the population of children with asthma in the community. The three ethnic groups are also considered to be representative of those ethnic groups in the community. The study, therefore, has good representativeness and the findings of the study can be generalised to the wider population of children with asthma in the Auckland region. The results suggested that some aspects of pharmacological management were more consistent with guideline recommendations than in the past. However, given the higher burden of disease experienced by Māori and Pacific children, the lack of observed ethnic differences in the use of preventative medications may reflect under treatment relative to need. There are important ethnic differences in the provision of asthma education and action plans. Future approaches to improving care should focus on interventions to assist health professionals to implement guideline recommendations and to monitor ethnic disparities in their practice. Asthma education that is comprehensive, structured and delivered in ways that are effective for the people concerned is needed.

Whole document restricted, see Access Instructions file below for details of how to access the print copy. / This exploratory study investigates Traumatic Brain Injury (TBI) rehabilitation processes and outcomes among culturally diverse outpatients in community-based rehabilitation who have sustained a Mild to Moderate TBI. The major aims of this study are twofold: firstly, to determine whether community-based rehabilitation outcomes following TBI differ across Mäori, Pacific and Pakeha cultures; and secondly, to determine and identify any service delivery needs for Mäori and Pacific people in TBI rehabilitation that may be distinct from Pakeha. A fixed comparative non-experimental design was utilised where participants were selected using direct control based on their self-identified ethnic group resulting in sub-samples of 11 Mäori, l1 Pacific and 11 Pakeha (n=33). A "Close Other" from their care-giving support network was selected by the participant to take part in the study (n=20). Each participant completed the Neurobehavioural Cognitive Status Examination (Cognistat), the Brain Injury Community Rehabilitation Outcome Scales (BICRO Scales), the Client Satisfaction Questionnaire (CSQ-31), the Beck Depression Inventory, 2nd Edition (BDI-II), the Impact of Events Scale Revised (IES-R) and a semi-structured qualitative interview, while a "Close Other" completed a BICRO "Carer" questionnaire. Results indicate that all participants were at a homogenous level of overall cognitive functioning but Pacific peoples scored significantly lower than both Mäori and Pakeha on two Language subtests and significantly lower than Pakeha on the Memory subtest. Statistical analysis suggests that both Years of Formal Education and English as a Second Language are important factors contributing to these differences. Individual handicap increased following TBI and decreased following rehabilitation, with no significant difference across cultures and suggesting efficacy of rehabilitation. Of the total sample, 42% scored in the clinically depressed range (half of whom were Pakeha) and 24% of the sample showed mild signs of post-traumatic stress (of whom almost 90% were Mäori or Pacific). Although 97% of participants were generally satisfied with their overall rehabilitation service, Mäori and Pacific people were significantly less satisfied with their Physical Surroundings and the Quantity of Services they received. In conclusion, there appears to be universalities in TBI experience and global rehabilitation outcomes that transcends individual cultures. However, there are micro-level cultural variations that have valuable implications when planning culturally appropriate rehabilitation services for the future. For Mäori and Pacific People, acculturation levels will determine the extent to which these implications apply.