Work-place focused responsibility for both Occupational Health and Safety (OHS) management and the development of employee skills arising from new legislative and regulatory frameworks have imposed new responsibilities on managers and OHS practitioners in the work-place. The purpose of this research study was to identify and describe designated OHS practitioners' and work-place managers' perceptions of the implementation of OHS policy in the work-place within agencies of the public sector of South Australia and whether these perceptions are congruent with policy and workplace practice. A case study method was selected as the research design and the data gathering instruments were a questionnaire of OHS practitioners, semi-structured interviews of work-place managers and a document analysis. This study revealed that respondent OHS practitioners perceived that they received support from Chief Executives and management for the implementation of OHS. Results also indicated that work-place managers and OHS practitioners held differing perceptions of their respective roles in the area of OHS policy implementation. Policy documentation, intended to support work-place managers, was found to be comprehensive but was perceived by managers as overwhelming and may need to be designed to meet their needs. OHS practitioners' perception of organisational achievement of best-practice in OHS appeared to be linked to policy development and audit activity.

Pulses (legumes) are a common dietary constituent of ethnic communities exhibiting lower rates of cardiovascular disease (CVD). The following studies examined the effect of including chickpeas in an 'Australian' diet on CVD risk factors. Participants were free-living volunteers aged 30 to 70 years. Study 1 investigated the effect of chickpeas on serum lipids, lipoproteins, glycaemic control, bowel function and satiation (degree of fullness leading to meal cessation) compared to a higher-fibre wheat-supplemented diet (Chapter 2). Participants completed two controlled dietary interventions (chickpea-supplemented and higher-fibre wheat-supplemented), isocaloric with their usual dietary intake, in random order. The design of the intervention diets was for matched macronutrient content and dietary fibre however increased consumption of polyunsaturated fatty acids (PUFA) during the chickpea-supplemented diet was noted. Small but significant reductions in mean serum total cholesterol and low density lipoproteincholesterol (LDL-C) were reported following the chickpea diet compared to the wheat. Statistical analysis suggested a relationship between increased consumption of PUFA and reduction in cholesterol during the chickpea intervention but could not discern the source of PUFA. Chickpea supplementation did not adversely affect bowel function and participants found them very satiating. There was no effect on glycaemic control. A small, sub-study compared the effects of an isocaloric, lower-fibre wheat diet to the higher-fibre wheat, to evaluate the effect of quantity of fibre as well as source on bowel health and satiety. During the lower-fibre wheat intervention, some participants reported lower satiation, and poorer bowel health. Some of the results from this study were included in a larger, collaborative study investigating the effect of chickpeas on serum lipids and lipoproteins in two centres, Launceston and Melbourne. The Melbourne group followed a similar controlled, random crossover comparison of a chickpeasupplemented diet to a higher-fibre wheat-supplemented diet, also endeavouring to match macronutrient content and dietary fibre. The Melbourne group also reported small but significant reductions in mean serum LDL- and total cholesterol but reported discrepancies in consumption of PUFA as well as dietary fibre between the intervention diets. Statistical analysis of the combined results suggested a relationship between increased consumption of PUFA and dietary fibre and a reduction in cholesterol during the chickpea intervention. Appendix 1 is a description of this collaborative study, formatted as a scientific paper, accepted for publication. Study 2 investigated whether results from the controlled study would translate to ad libitum situations (Chapter 3). The study followed an ordered crossover design where participants followed their habitual ad libitum dietary intake for four weeks (familiarisation phase), incorporated a minimum of four 300g (net weight) cans of chickpeas per week for 12 weeks and then resumed their habitual diet for another four weeks (usual phase). Small but significant reductions in body weight, body mass index (BMI), serum TC, fasting insulin and HOMA-IR occurred following the chickpea phase, compared to the post-chickpea usual phase. Results suggested that participants positively altered their eating pattern during the pre-chickpea familiarisation phase, sustained these changes during the 12-week chickpea phase but regressed during the usual phase. Participants consumed significantly more dietary fibre and PUFA during the chickpea phase and less total fat and saturated fatty acids (SFA) compared to the usual phase. Perceived bowel health remained constant throughout the study, while satiation increased significantly during the chickpea phase along with a small but significant reduction in mean body weight. Incorporating chickpeas into an 'Australian' style diet resulted in increased consumption of PUFA and dietary fibre that produced small but significant reductions in serum TC, BMI and glycaemic control, high satiation and little effect on bowel function. Individuals wishing to reduce CVD risk may choose to include chickpeas in their diet.

Diet influences the coronary heart disease (CHD) risk factors including lipids and lipoproteins, glucose, insulin, and endothelial function. This research thesis examined the effects of the three different (tomato-olive oil combination and chilli) but widely consumed dietary components, on a range of metabolic and vascular parameters of CHD risk. The aims of this thesis were to investigate the effects of: o a lycopene (tomato)-rich high monounsaturated fat (light olive oil) diet and a lycopene-rich high carbohydrate diet (each diet of 10 days duration) on serum lycopene, lipid profile and serum oxidation in 21 men and women aged between 22 and 70 years with a BMI of 18 - 30kg/m2. o a chilli blend (30g/day) supplemented diet and a bland (chilli free) diet (each diet of four week duration) on a range of metabolic and vascular parameters in 36 men and women aged between 22 and 70 years with a BMI of 18 - 35kg/m2. The measured parameters included serum lipids and lipoproteins, lipid oxidation, glucose, insulin, basal metabolic rate (BMR), heart rate (HR), peripheral and aortic blood pressure, augmentation index (AIx; a measure of arterial stiffness) and subendocardial viability ratio (SEVR; an indicator of myocardial perfusion). o single meals containing chilli blend (30g) with or without the background of a chilli-containing diet on a range of postprandial metabolic and vascular parameters (n = 36). o a chilli blend supplemented diet (of three weeks duration) on endothelial-independent and -dependent vasodilation (assessed after administration of glyceryl trinitrate (GTN) and salbutamol, respectively) compared to the effects of a bland diet (n = 15). o the active ingredient of spices (in different concentrations) including chilli (capsaicin and its analogue dihydrocapsaicin), turmeric (curcumin), piprine (black pepper) and the colour pigment of tomatoes (lycopene) on the in vitro copper-induced oxidation of serum lipids. The dietary intervention studies were conducted using a randomized crossover design on a weight maintenance regime. Two different groups of people volunteered to take part in the tomato-olive oil and the chilli studies. All participants from the four week chilli study also took part in the meal studies. Ten days of a high lycopene monounsaturated fat rich and high lycopene carbohydrate rich diets presented similar increase in serum lycopene concentration and a similar reduction in serum total and LDL cholesterol. The AIx after three weeks of regular chilli consumption was lower on the chilli diet compared to the bland diet, but there was no significant difference in the overall effects of GTN and salbutamol on endothelium-independent and -dependent vasodilation between the two diets. Four weeks of iso-energetic weight maintenance chilli and bland diets produced no significant differences in serum lipids, glucose, insulin, peripheral and central blood pressure, AIx, SEVR or BMR. HR was lower after four weeks of chilli-supplemented diet in men, but not in women. Serum collected after the chilli-supplemented diet exhibited a lower rate of copper-induced oxidation compared to the serum after the bland diet. Women, but not men, also showed a longer lag phase after the chilli-supplemented diet compared to the bland diet. This was probably due to the higher chilli/capsaicin and dihydrocapsaicin intake (per kg body weight) in women. In vitro studies with capsaicin, dihydrocapsaicin (and curcumin) also exhibited a concentration effect for the resistance to copper-induced serum lipid oxidation. Results of the meal tests were surprising and exciting. The CAB meal (chilli-containing meal after the bland diet, eaten on day 29 of the bland diet) and the CAC meal (chilli-containing meal after the chilli diet, eaten on day 29 of the chilli diet) showed a lower maximum increase in postprandial serum insulin and overall postprandial serum insulin response compared to the BAB meal (bland meal after the bland diet, eaten on day 22 of the bland diet). The probable reason for this ameliorated insulin profile was a small reduction in insulin secretion and a large increase in the hepatic insulin clearance. The correlation between insulin and SEVR indicated an increase in the myocardial perfusion after the CAC meal compared to the BAB meal. All these results were more pronounced after the CAC meal and in people with BMI greater than 26kg/m2. Contrary to popular belief and some previously published data, we did not observe a significantly higher energy expenditure (EE) after the CAB meal or the CAC meal compared to the BAB meal. In fact, a lower EE was observed in people with increased BMI on the CAC meal compared to the BAB meal. This effect was possibly the consequence of improved postprandial insulin profile and reduced sympathetic nervous system activity after the CAC meal. The results from these investigations may have significance in improving serum lycopene concentrations, lipid profile (tomatoes and olive oil), postprandial insulin response (chilli) and increased resistance of serum to copper induced oxidation (chilli) and hence decreasing the risk of CHD, especially in people with increased BMI for whom the risk of cardiovascular morbidity and mortality is higher than in lean individuals. Together, the results from these studies not only advance our knowledge relating to the relationship between some foods and the CHD risk factors but provide an opportunity to combine olive oil, tomatoes and chillies with other foods and spices (as often used in curries) in an attempt to further investigate foods and cuisines that will minimise the various risk factors for CHD.

The circadian clock defines physiologically optimal times for sleeping, which vary along a continuum of circadian phenotypes from morning- to evening-type. Although different ‘chronotypes’ can be discriminated reliably by the Morningness/Eveningness Questionnaire (MEQ), there is little published information on their prevalence. The timing of sleep is also heavily influenced by societal norms. However, the relative contribution of circadian physiology versus psychosocial factors is unknown. This thesis took a multidimensional approach to investigating preferred sleep timing within the general population of New Zealand (30-49 years). A New Zealand version of the MEQ was mailed to a random stratified sample of 5,000 adults living in the Wellington region (55.7% response rate). Using scoring criteria for middle-aged adults, approximately 25% of the population were morning-types and 25% were evening-types. The sleeping patterns of 15 morning- and 16 evening-types were monitored using actiwatches and sleep diaries. Morning-types slept significantly earlier, but there were no differences in sleep duration or quality. Both chronotypes showed evidence of using the weekend to catch-up on sleep, although this was more evident among evening-types. Differences between chronotypes were also investigated using the endogenous melatonin rhythm as a circadian phase marker. The timing of the melatonin rhythm was earlier among morning-types, with the difference being greater for melatonin onset, than offset. However, differences between weekday versus weekend sleep explained more of the variability in sleep timing that did circadian phase. Understanding the genetic differences in the circadian clock is evolving rapidly. While this is of particular scientific interest, little consideration has been given to the ethical implications of this type of work. In the final study, a Kaupapa Māori framework was used to explore Māori hopes and concerns for genetic research in Aotearoa/New Zealand. Thematic analysis indicated that Māori are not anti-science, however there is an urgent need for ethical guidelines that uphold and respect the values of Māori society. This thesis argues that sleep is a major public health issue for New Zealand. However, a number of challenges must be met to ensure that new scientific knowledge meets the needs and expectations of the community.

There has been considerable debate among cognitive psychologists and epidemiologists regarding which determinants of children’s intelligence are most important. Factors such as children’s diet, maternal stress and social support are important for general health and wellbeing, but have received little research attention in longitudinal studies involving cognitive outcomes. Few studies have examined the determinants of intelligence in children born small-for-gestational age (SGA) at term even though these children may be particularly vulnerable to poorer postnatal environments. The aim of this study was to identify factors associated with cognitive ability in middle childhood in New Zealand (NZ) European children and children born SGA. The present research was conducted as part of the Auckland Birthweight Collaborative (ABC) study. Approximately half of the children in this study were born SGA (birthweight<10th percentile) and half were born appropriate-for-gestational age (AGA=birthweight>10th percentile). Information was collected from mothers and children on pregnancy, obstetric, socio-demographic, postnatal and dietary factors when the children were born (n=871), at one year (n=744), 3.5 years (n=550), and 7 years of age (n=591). Cognitive ability was assessed at 7 years using the Wechsler Intelligence Scale for Children – Third Edition. For the total sample, the analyses utilised weighting to allow for the disproportionate sampling of children born SGA. Results showed that SGA and AGA children did not differ in intelligence at 7 years. Factors associated with intelligence included maternal pregnancy factors (e.g. hypertension), socio-demographic factors (e.g. paternal education), and postnatal factors (e.g. maternal social support). In general, the effects of environmental factors did not differ significantly for SGA children compared with AGA children. A number of dietary factors were also found to be significantly and positively associated with intelligence measures including higher intakes of breads and cereals and weekly fish consumption. In contrast, daily margarine consumption was associated with significantly lower intelligence scores, particularly in SGA children, and this is the first study to report this association. iii Dietary and “environmental” factors were stronger predictors of children’s intelligence in middle childhood than “biological” factors, such as infant’s birthweight. Importantly, most of the factors associated with intelligence that were identified in this study are potentially modifiable. Further research is needed to examine whether these factors continue to be associated with cognitive ability in later childhood.

Pregnancy can have important effects on oral health and pregnant women are a population group requiring special attention with regard to their oral health and their babies? health. International research shows that oral health care for pregnant women has been inadequate, especially in relation to education and health promotion and there is some evidence of disparities by SES and ethnicity. Improving oral health is one of the health priorities in the New Zealand Health Strategy (Ministry of Health, 2000) and the Ministry of Health (Ministry of Health, 2006a) has recently identified a need for more information on the oral health and behaviour of pre-natal women. The aims of this study were to gain an understanding of pregnant women?s oral health care practices, access to oral health care information and use of dental care services and to identify any difference by ethnicity and socio-economic position. A self-reported questionnaire was completed by 405 pregnant women (55% response rate) who attended antenatal classes in the Wellington region. The questionnaire was broadly divided into four parts: (1) care of the teeth when the woman was not pregnant; (2) care of the teeth and diet during the pregnancy; (3) sources of oral health information during pregnancy and; (4) demographic information . Data were analysed by age, ethnicity, education and income and odds ratios (OR) and 95% confidence intervals (95%CI) were calculated using logistic regression. The majority of women in this survey were pakeha (80.2%), compared to 19.7% „Others? (8.8% Maori, 1.9% Pacific, 8.6% other). Most of the subjects were aged 31-35 years (34.5%), of high SES (household income and education level). Half of the women reported having regular visits to the dentist previous pregnancy while a significant percentage of women saw a dentist basically when they had problems. The usual dental hygiene habits were maintained during pregnancy. However, during pregnancy more than 60% of women reported bleeding gums. Just 32% of women went to see the dentist during pregnancy and less than half had access to oral health information related to pregnancy. „Others? (OR 0.38, 95% CI 0.15-0.91) and low income (OR 0.27, 95% CI 0.10-0.76) groups were significantly less likely to report access to oral health information compared to pakeha and high income groups (respectively). Women who went to see the dentist during pregnancy were more likely to receive information on dental health. However, low income women were more likely to report the need to see a dentist (OR 2.55, CI 1.08-5.99). Information on dental health and access to oral care should be prioritised to low income women, Maori, Pacific and other ethnic groups. Little attention has previously been given to oral health for pregnant women in New Zealand and there is a need to increase awareness of the importance of this area amongst health practitioners particularly Lead Maternity Carers and Plunket and tamariki ora nurses.

A study of cleft lip and cleft palate was carried out in order to determine whether or not any differences in incidence between Europeans and Polynesians were accompanied by differences in recurrence risks, and to test the genetic hypotheses currently favoured as explanations of familial agggregation of these disorders. An incidence study vas undertaken on all live births in the Auckland urban area for the years 1960 to 1976.Family information was obtained from these probands and from other affected persons or their close relatives, by interview at the cleft palate clinic at Middlemore Hospital. The ascertainment probability for cleft 1ip and cleft palate probands was about 95% and was not correlated with any of the demographic characteristics measured on the probands. After correction for ascertainment, the incidence of cleft palate in Maoris was estimated to be 1.867/1000 1lve births. For Europeans the estimate was 0.643/1000. The corresponding figures for cleft lip with or without cleft palate were 0.397/1000 and 1.195/1000. The sex ratio for cleft palate was 0.485 with heterogeneity between the races. For cleft lip the sax ratio was 0.649 overall. There were no secular or seasonal trends in the incidence of facial clefts and no significant effects of maternal age, or paternal age. The mean birth rank for probands with cleft lip with or without cleft palate was higher than expected. For probands with cleft palate, mean birth rank was not significantly elevated. The pattern of additional malformations in these probands was similar to those reported in similar studies from other centres. The recurrence risk for cleft palate was 1.8% overall. Although it was s1ightly higher in polynesian families than in European families, the difference was nowhere near statistical significance. For cleft lip the recurrence risk was 2.6% overall, with the risk being slightly higher in Polynesian families, but again not significantly higher than in European families. Using current analytical techniques, no discrimination was possible between a generalized single autosomal locus model and a multifactoriar threshold model. A consideration of the parameter estimates for both models suggests that the multifactorial threshold model is the more appropriate one to use for the calculation of recurrence risks in complicated family situations. It is concluded that further family studies of this nature would no longer be warranted unless hypotheses can realistically be tested on the samples available. However, incidence studies in special populations will remain important for hypothesis testing. Following on the work using animal models, a study of face shape within and among races in New Zealand may provide clues to the aetiology of facial clefts, particularly isoleted cleft palate. It will be important to follow changes in incidence over time and discover what effects intermarriage and cultural changes might have on the incidence of facial clefts.

Whole document restricted, see Access Instructions file below for details of how to access the print copy. / Background: Giardia is a leading cause of human gastrointestinal illnesses globally and is the most commonly notified waterborne disease in New Zealand. The national incidence rate of 46.6 per 100,000 is thought to be one of the highest among developed countries, peaking in the 1-4 and the 25-44 age groups. Risk factors for infection among vulnerable groups have not been explored systematically in New Zealand, although environmental factors and person-to-person transmission have been suspected. The true burden of Giardia infecion in the community has been difficult to estimate due to suspected under-notification of the disease. An important component of disease surveillance and the validation of disease incidence rates is an estimation of the degree of undercount. AIMS: To describe the epidemiological patterns of Giardia infection in the Auckland region and in New Zealand, compare them with local and international patterns of infection, and explore environmental links. To estimate the level of completeness of giardiasis notification in the Auckland adult population by using a simple capture-recapture method. To identify risk factors for giardiasis among Auckland children under 5 years of age. Methods: Analysis of Auckland data: Anonymised giardiasis notification data from Auckland Regional Public Health Services (ARPHS) for the period of July 1996 to June 2000 were analysed by person, place and time. Infection rates and relative risks were calculated and compared with national and international information. Analysis of New Zealand data: A study of national surveillance data utilised anonymised information for 7818 notified cases throughout New Zealand between July 1996 and June 2000. A weighted average of drinking water grades was estimated using the Community Drinking Register. Pearson's coefficient was used to measure the correlation between average drinking water grades and notified cases. Daily climate data were plotted against daily case notifications and modelled, using Poisson's regression, to predict any influence of climate on infection. Data were presented by age, gender, ethnicity and area using statistical and spatial methods. Estimation of under-notification: The capture-recapture technique is now being used in many countries to evaluate the completeness of disease ascertainment. Comparison of disease ascertainment involves two or more datasets. Two independent datasets of giardiasis cases aged 15 years or over were generated. Of them one was generated from the demographic information of cases recruited during the Auckland Giardiasis Study in 1998-99 and the other from giardiasis cases notified to the ARPHS for the same period of time. The area of residence of cases was geo-coded, mapped and overlaid by water distribution zones. Cases were matched and under-notification was estimated using a two-sample capture-recapture method. Case-control study: A case-control methodology was used to analyse the exposure history of 69 cases and 98 controls under 5 years of age in Auckland. Significant risks of infection were estimated and their attributable risks. Results: Giardiasis in Auckland: Auckland had a significantly higher rate of Giardia notification (58/100,000) than New Zealand (46/100,000) as a whole. Notification rates, which peaked during February-May, were significantly higher in Pakeha/Europeans and Asian/others, compared with Maori/Pacificans. Adjusted notification rates were higher for residents of North Shore and Auckland cities than for other areas of Auckland. The crude regional and national notification rates were almost 6 times the rate of laboratory identification of positive isolates in the UK and 4 times US reported rates. Giardiasis in New Zealand: At the national level, most cases occurred in the 1-4 year age group followed by the 25-44 year age group, and most cases were Pakeha/European. Ethnicity was not known for 18% of cases, affecting demographic calculations. Infection rates were high for a number of Health Districts (West Coast, Wanganui, Waikato and Tauranga) compared to the national average. Over 50% of the population received Aa-graded drinking water. No correlation between infection and the weighted average grades for water treatment plants (r = -0.12) or the reticulation systems (r = -0.11)) was found. A significant correlation with the mean daily maximum (r = 0.05) and minimum (r = 0.06) temperature was observed. Poisson's regression modelled minimum-temperature (chi2 = 5.40, p<0.05) and relative humidity (chi2 = 5.37, p<0.05) as predictors of a significant number of Giardia infections on a given day. Under-notification of giardiasis: The estimation of under-notification during the 12 month period, compared 413 cases who were notified to the ARPHS with 199 cases who had participated in a case-control study over the same period of time. North Auckland had slightly higher notification rates and also study participation rates. The giardiasis notification rate was higher in un-reticulated water zones (72.4/100,000 population). The capture-recapture calculation indicated that only 49% of cases were notified. Risk of giardiasis in children: In the case-control study, 95% of cases and 86% of controls used water from the Auckland Metropolitan Mains (AMM) supply for domestic purposes, 44 cases and 42 controls swam, and 59 cases and 54 controls wore nappies. Children wearing nappies were at significantly increased risk of the disease (OR=3.0, 95%CI 1.01-8.9), as were those from households which had more than one child wearing a nappy (OR=6.5, 1.8-23.4). The AMM water supply was associated with a reduced giardiasis risk compared to other drinking water sources. Significantly increased risks were associated with drinking water consumed away from home (OR=4.7, 2.2-10.1), swimming at least once a week (OR=2.4, 1.1-5.3) and travelling in side New Zealand (OR=2.5, 1.03-6.0). Conclusions: The higher rates of giardiasis observed in Auckland and New Zealand, in comparison with other developed countries, may be related to environmental or social factors. Missing ethnicity information precludes clear interpretation of variations in notification rate by ethnic group and suggests a need for improvement in data collection. There are opportunities to investigate the influence of risk factors on seasonal changes in notification rates both locally and nationally. Reported improvements in some areas could be due to local health measures or to random variation. Time-trend analysis suggests a seasonal pattern. The weighted average drinking water grading is a novel and readily available measure, and may not be truly representative of local supplies. Modelling of climate data showed an association with giardiasis but was inconclusive. Giardia notifications in Auckland are under-notified by half. This has obscured the true burden of Giardia infection. This has implications for estimates of the burden of disease in New Zealand. Notification rates vary inversely with socio-economic conditions and the presence of a reticulated water system. The case-control study identified vulnerable groups and modifiable risk factors for Giardia infection. Nappy-wearing was an independent risk factor for infection. Further study is advocated to ensure better protection of public health, especially for children. These studies identified vulnerable groups and major data-gaps. The risk of infection in children needs further attention for effective infection control measures to be developed for this disease. Recommendations for improvements in disease surveillance and data quality are discussed. GIS (Geographical Information System) is a useful tool for disease monitoring. Capture-recapture techniques are useful tools in evaluating the completeness of disease surveillance.

Background Road traffic injury is projected to rank as the third largest contributor to the global burden of disease by 2020. Disability is a significant component of the burden of disease ranking. Most published data on traffic crash outcomes, however, focus primarily on deaths and hospitalisations. Reliable estimates of post-crash disability and information on factors that modify the disabling process are essential to prioritise and allocate appropriate resources for road traffic injury prevention and interventions that reduce the risk of secondary disability. Aims To quantify the risk of disability associated with serious injury crashes in car drivers in a defined population; to explore the extent to which this risk is modified by chronic alcohol abuse; and to critically review methodological approaches that can redress the inadequate epidemiological attention to injury-related disability. Methods Systematic reviews were conducted to examine the available epidemiological evidence quantifying the association of car crashes with disability and the effect of alcohol on the risk of post-injury disability. Studies published or presented between January 1980 and April 2003 were reviewed. No language restriction was imposed. A population-based prospective cohort study conducted in the Auckland region of New Zealand recruited drivers exposed to serious injury crashes (identified through a surveillance system monitoring hospital admissions of injured car occupants). A representative sample of car drivers in the region was identified through roadside surveys (controls). The participants were interviewed at recruitment (to obtain pre-crash information from crash drivers and baseline data from controls) and re-interviewed at five and eighteen-months follow-up. Structured interviews on all three occasions included the Short Form-36, a global health change indicator, and the Alcohol Use Disorders Identification Test. Information on a range of potential confounders was sought at baseline through the interview, alcohol measurements and clinical records. Results Studies identified in the systematic reviews revealed that published estimates of the risk of post-crash disability ranged from 2% to 57%. The evidence regarding the effect of alcohol on post-injury disability is inconclusive largely because none examined this association directly. Most studies identified in the reviews were limited by several methodological problems including the absence of appropriate comparison groups, inadequate or no adjustment for confounding, significant potential for selection bias due to the study setting, high levels of loss to follow-up, and missing data. In the prospective cohort study, 215 crash drivers (75% follow-up) and 254 controls (69%) completed the 18-month interview. Overall, 40% of the drivers who were hospitalised, 20% of the crash drivers not hospitalised, and 7% of the controls reported deteriorated health at 18 months relative to their baseline health. This represents a tenfold excess risk of disability among hospitalised drivers and a three-fold excess risk among non-hospitalised crash drivers, relative to drivers in the general population. Among crash drivers reporting an overall decline in health, clinically important reductions in general and mental health were apparent over the follow-up period despite improving physical health and function. This trend was more evident among non-hospitalised than hospitalised crash drivers. Compared with drivers who were neither involved in a crash nor defined as hazardous drinkers, crash drivers who were hazardous drinkers had a seven-fold excess risk of a clinically significant (≥ 10%) decline in the SF-36 general health score (OR 6.85; 95% CI: 1.84-25.43). Crash drivers who were not hazardous drinkers had a three-fold risk (OR: 3.00; 95% CI: 1.14-7.89). The results indicated an important interaction between crash involvement and chronic alcohol abuse in potentiating the risk of disability. Conclusion Serious traffic crashes are associated with significant longer-term disability in a substantial proportion of survivors with an apparent worsening of mental health over time. Definitions of disability and estimates of the burden of disability following traffic injury remain highly variable in the published literature and it is timely for the international research community to develop a more systematic and consistent approach to this major and increasing component of the global burden of disease. By addressing the main methodological limitations of previous studies, this study revealed that chronic alcohol abuse potentiates the risk of post-crash disability. The findings suggest that measures for preventing road traffic crashes as well as efforts to identify problem drinkers among crash survivors should be intensified. The thesis highlights the need for robust indicators of non-fatal injury to monitor the impact of road safety programs and large-scale epidemiological studies to investigate the spectrum and determinants of post-injury disability.

The primary aim of the study was to validate the short and long form of the recently-created NZ physical activity questionnaires (NZPAQ-SF and NZPAQ-LF, respectively) in a multi-ethnic sample in Auckland. An international physical activity questionnaire (IPAQ-long) was also validated and compared to the NZ instruments. Objective PA measures were used to create a NZ compendium of PA intensities, providing baseline data for culturally-specific PAs. Secondary aims included an examination of the relationship between PA and CRF, and their associations with cross-sectional measures of cardiovascular (CV) risk factors. The study sample consisted of 186 apparently healthy males (n=90) and females (n=96) aged 19-86 yrs, classified as European/Other (n=60), Māori (n=61), and Pacific (n=65). Heart rate monitoring (HRM) with individual calibration was used to objectively measure the duration, frequency, and intensity of at least moderate-intensity PAs performed over 3 consecutive days. Type of PA and the context in which it was performed was simultaneously recorded by participants on daily PA logs. Correlations between HRM and self-reported levels of brisk walking, moderate-intensity, vigorousintensity, were poor for each questionnaire, and correlations were lower for Māori and Pacific ethnic groups than for European/Other. The NZPAQ-SF (r=0.3, p<0.001) and NZPAQ-LF (r=0.3, p<0.001) performed better than the IPAQ-long (r=0.1, p=0.37). The culturally-specific list of PA intensities showed strong correlation (R2=0.68) to an internationally-accepted compendium of PA intensities, and provided baseline energy cost data for 13 PAs performed by Māori and Pacific people in NZ. CRF levels were primarily influenced by gender, ethnicity, obesity, and performing at least 15 min/day of vigorous-intensity PA, and showed stronger associations with fasting blood lipids and glucose, while PA was more strongly related to SBP and DBP. The validated NZPAQs are acceptable for measuring population level PA prevalence in NZ adults, although accuracy is lower for Māori and Pacific people. However, the availability of a culturallyspecific list of PA intensities could potentially increase the accuracy of self-reported PA by Māori and Pacific people. Results from this study highlight the importance of vigorous-intensity PA for CV health, and identifies NZ Pacific people as high risk in terms of PA, obesity, and CRF.