Gamification and Sugar: A School-Based Pilot Study of Social Marketing and Gamification Approaches to Reduce Sugary Drink Intake in Pasifika School Students.

The aim of this study was to investigate a social marketing-gamification intervention to reduce sugary drink intake drawing on popular culture of Pasifika secondary school students in Auckland, New Zealand. Students aged 11 to 14 years from one coeducational high school participated in the 11-week pilot study. The 9-week intervention was undertaken in assemblies and classrooms. Baseline and follow-up measures were completed by 227 and 220 students, respectively, of 298 enrolled students. Retention of the "3-6-9" teaching related to maximum daily sugar intake increased from 9% at baseline to 97% at follow-up (P < .0001). Significant increases were observed of students who correctly answered sugar content of drinks. Overall consumption of sugary drink decreased at follow-up by 0.46 glasses per day. The main conclusion from this study was that this school-based gamification educational package to convey messages about sugar content of drinks using popular modes of engagement is a promising intervention that was acceptable and well supported by school staff and students.

Pacific peoples and alcohol: a review of the literature.

AIM: To present a review of recent research exploring alcohol use by Pacific peoples in New Zealand. The review builds on a comprehensive narrative review of research and literature on Pacific peoples and alcohol use, Pearls Unlimited (2009). METHOD: We conducted a scoping review of published and grey literature written and published between 2009 and 2019. Research was included if the study population, or a clearly identified subgroup of the study population, included one or more Pacific ethnicities and addressed alcohol use. RESULTS: There were 30 relevant articles covering a large range of aspects of alcohol consumption by Pacific youth and adults. Alcohol consumption by Pacific men has declined significantly to 60% from 70% in 2006/07. However, of those who consume alcohol, 46% meet the threshold for hazardous consumption. Alcohol consumption by Pacific youth has also declined. CONCLUSION: While there has been some notable research and in-depth exploration of alcohol use and Pacific people, persistent inequity in hazardous alcohol consumption indicates that an evaluation of the current interventions to prevent and service unmet needs of Pacific peoples are overdue.

Is general practice identification of prior cardiovascular disease at the time of CVD risk assessment accurate and does it matter?

AIMS: To determine the accuracy of general practice recording of prior cardiovascular disease (CVD) at the time of CVD risk assessment and whether recording impacts on CVD management. METHODS: Prior CVD status entered at the time of a first CVD risk assessment from 2002-2015 was compared to prior ischaemic CVD hospitalisations from national datasets using anonymous linkage with an encrypted National Health Index identifier. Clinical factors associated with inaccurate recording of prior events were identified using multivariable logistic regression. The impact of recording accuracy was assessed by the dispensing of CVD preventive medications in the six months after first CVD risk assessment. RESULTS: Among 454,369 people aged 35-74 years who had CVD risk assessments, 30,924 (6.8%) had previously been admitted with ischaemic CVD. Of these people, only 61% were recorded as having prior CVD during risk assessment, with better recording for coronary and stroke events than for peripheral vascular procedures. Inaccurate primary care recording was more likely for younger people (<55 years), women, Maori, Pacific, Indian and Asian ethnic groups whereas smokers and people with diabetes were more likely to have prior CVD correctly identified. Over more than a decade, the odds of inaccurate recording during risk assessment increased [OR 1.09 (95% CIs 1.08-1.10)]. If prior CVD was entered at the time of risk assessment then dispensing of blood pressure-lowering, lipid-lowering, antiplatelet/anticoagulant medications, separately or together, was higher (86%, 85%, 83% and 69%, respectively) than if not recorded (70%, 60%, 60% and 43%). CONCLUSIONS: Overall, 39% of people with prior CVD hospitalisations were not recorded as having prior CVD when their CVD risk was first assessed in general practice. This was associated with inequities in evidence-based risk management. System-based measures are required for robust data sharing at the time of clinical decision making.

Developing and validating a cardiovascular risk score for patients in the community with prior cardiovascular disease.

OBJECTIVE: Patients with atherosclerotic cardiovascular disease (CVD) vary significantly in their risk of future CVD events; yet few clinical scores are available to aid assessment of risk. We sought to develop a score for use in primary care that estimates short-term CVD risk in these patients. METHODS: Adults aged <80 years with prior CVD were identified from a New Zealand primary care cohort study (PREDICT), and linked to national mortality, hospitalisation and dispensing databases. A Cox model with an outcome of myocardial infarction, stroke or CVD death within 2 years was developed. External validation was performed in a cohort from the UK. RESULTS: 24 927 patients, 63% men, 63% European, median age 65 years (IQR 58-72 years), experienced 1480 CVD events within 2 years after a CVD risk assessment. A risk score including ethnicity, comorbidities, body mass index, creatine creatinine and treatment, in addition to established risk factors used in primary prevention, predicted a median 2-year CVD risk of 5.0% (IQR 3.5%-8.3%). A plot of actual against predicted event rates showed very good calibration throughout the risk range. The score performed well in the UK cohort but overestimated risk for those at highest risk, who were predominantly patients defined as having heart failure. CONCLUSIONS: The PREDICT-CVD secondary prevention score uses routine measurements from clinical practice that enable it to be implemented in a primary care setting. The score will facilitate risk communication between primary care practitioners and patients with prior CVD, particularly as a resource to show the benefit of risk factor modification.

Age-specific effectiveness following each dose of acellular pertussis vaccine among infants and children in New Zealand.

BACKGROUND: Though it is believed the switch from whole cell to acellular pertussis vaccine has contributed to the resurgence of pertussis disease, few studies have evaluated vaccine effectiveness (VE) and duration of protection provided by an acellular vaccine schedule including three primary doses but no toddler-age dose. We assessed this schedule in New Zealand (NZ), a setting with historically high rates of pertussis disease, and low but recently improved immunisation coverage. We further evaluated protection following the preschool-age booster dose. METHODS: We performed a nested case-control study using national-level healthcare data. Hospitalised and non-hospitalised pertussis was detected among children 6weeks to 7years of age between January 2006 and December 2013. The NZ National Immunisation Register provided vaccination status for cases and controls. Conditional logistic regression was used to calculate dose-specific VE with duration of immunity examined by stratifying VE into ages aligned with the immunisation schedule. RESULTS: VE against pertussis hospitalisation was 93% (95% confidence interval [CI]: 87, 96) following three doses among infants aged 5-11months who received three compared to zero doses. This protection was sustained through children's fourth birthdays (VE⩾91%). VE against non-hospitalised pertussis was also sustained after three doses, from 86% (95% CI: 80, 90) among 5-11month olds to 84% (95% CI: 80, 88) among 3-year-olds. Following the first booster dose at 4years of age, the protective VE of 93% (95% CI: 90, 95) among 4-year-olds continued through 7years of age (VE⩾91%). CONCLUSIONS: We found a high level of protection with no reduction in VE following both the primary course and the first booster dose. These findings support a 3-dose primary course of acellular vaccine with no booster dose until 4years of age.

Prevalence and risk factors for tobacco smoking among pre-adolescent Pacific children in New Zealand.

INTRODUCTION: Pacific New Zealanders have a high prevalence of smoking, with many first smoking in their pre-adolescent years. AIM: To identify risk factors for tobacco smoking among Pacific pre-adolescent intermediate school children. METHODS: A cross-sectional survey of 2208 Pacific students aged between 10 and 13 years from four South Auckland intermediate schools who were asked about their smoking behaviour between the years 2007 and 2009. RESULTS: The prevalence of Pacific ever-smokers (for 2007) in Year 7 was 15.0% (95% Confidence Interval [CI] 12.0%-18.3%) and Year 8, 23.0% (95% CI 19.5%-26.7%). Multivariate modelling showed the risk factors for ever-smoking were Cook Island ethnic group (OR 1.72; 95% CI 1.26-2.36, ref=Samoan), boys (OR 1.47; 95% CI 1.14-1.89), age (OR 1.65; 95% CI 1.36-2.00), exposure to smoking in a car within the previous seven days (OR 2.24; 95% CI 1.67-3.01), anyone smoking at home within the previous seven days (OR 1.52; 95% CI 1.12-2.04) and receiving more than $NZ20 per week as pocket money/allowance (OR=1.91, 95% CI 1.23-2.96). DISCUSSION: Parents control and therefore can modify identified risk factors for Pacific children's smoking initiation: exposure to smoking at home or in the car and the amount of weekly pocket money the child receives. Primary health care professionals should advise Pacific parents to make their homes and cars smokefree and to monitor their children's spending. This study also suggests a particular need for specific Cook Island smokefree promotion and cessation resources.

The WERO group stop smoking competition: main outcomes of a pre- and post- study.

BACKGROUND: One potential promising strategy for increasing smoking cessation for Maori (Indigenous New Zealanders) and New Zealand resident Pacific Island people is Quit and Win competitions. The current uncontrolled pre and post study, WERO (WERO in Maori language means challenge), differs from previous studies in that it aims to investigate if a stop smoking contest, using both within team support, external support from a team coach and cessation experts, and technology, would be effective in prompting and sustaining quitting. METHOD: Fifteen teams, recruited from urban Maori, rural Maori and urban Pacific communities, competed to win a NZ$5000 (about € 3,000, £ 2600) prize for a charity or community group of their choice. People were eligible if they were aged 18 years and over and identified as smokers. Smoking status was biochemically validated at the start and end of the 3 month competition. At 3-months post competition self-reported smoking status was collected. RESULTS: Fourteen teams with 10 contestants and one team with eight contestants were recruited. At the end of the competition the biochemically verified quit rate was 36%. The 6 months self-reported quit rate was 26%. The Pacific and rural Maori teams had high end of competition and 6 months follow-up quit rates (46% and 44%, and 36% and 29%). CONCLUSION: WERO appeared to be successful in prompting quitting among high smoking prevalence groups. WERO combined several promising strategies for supporting cessation: peer support, cessation provider support, incentives, competition and interactive internet and mobile tools. Though designed for Maori and Pacific people, WERO could potentially be effective for other family- and community-centred cultures.

Parental and retail supply of tobacco to minors: findings from a community-based social supply intervention study.

AIM: We report on findings from a quasi-experimental community trial of a complex intervention aimed at reducing social and commercial supply of cigarettes to young people. MATERIALS AND METHODS: The intervention comprised a package of school, community and home-based smokefree strategies implemented over three years from 2007 to 2009 in a low-income area of Auckland, New Zealand, with another area serving as the control population. The main outcome measures were relative change in parental and retailer behaviour and in attitudes to the provision of tobacco to youth. We analysed baseline and follow-up data from questionnaires administered to parents and children living in the intervention and control areas using PASW Statistics 18. RESULTS: No difference was found between groups in parents' permissiveness of smoking and in retailer compliance to the tobacco sale legislation over the course of the study, either because our intervention had no or only a limited effect, or alternatively because limitations in the study design diluted any effect. CONCLUSIONS: Nevertheless, a key finding was that parents and retailers persisted as important sources of cigarettes for young people. Further study is required to identify effective interventions to address this issue.

Awareness and perceived effectiveness of smoking cessation treatments and services among New Zealand parents resident in highly deprived suburbs.

AIM: To describe the awareness and perceived effectiveness of smoking cessation treatments and services among a population of mainly Maori and Pacific parents in South Auckland, New Zealand. METHOD: Parents of pre-adolescent children from 4 schools were surveyed from 2007-2009 using a self-complete questionnaire. Awareness and perceived effectiveness of cessation treatments and services were analysed by smoking status, ethnicity, gender and age. Relative risks were calculated using log-binomial regression to establish differences between smokers and non-smokers. RESULTS: Awareness of Quitline, nicotine gum, and nicotine patch was higher among smokers (94%, 91%, 90%) than non-smokers (87%, 73%, 64%). Low percentages of smokers reported cessation interventions as effective (only 41% for Quitline--the intervention perceived effective by most). Awareness of varenicline, bupropion and nortriptyline was the lowest among both smokers and non-smokers (<31%). CONCLUSION: Poor awareness and low perceived efficacy of smoking cessation treatments and services among priority groups are barriers to accelerating the reduction of smoking prevalence in New Zealand.

Parent versus child reporting of tobacco smoke exposure at home and in the car.

AIMS: To compare self-reported exposure to tobacco smoke in the home or in cars between parents and their pre-adolescent children. METHODS: We analysed data on self-reported exposure to secondhand smoke from 3,645 matched pairs of children at baseline (aged between 10 and 13 years) and their parents whether smokers or not, who were participants in Keeping Kids Smokefree (KKS), a community-based study in South Auckland, New Zealand from 2007-2009. The study aimed to reduce children's smoking initiation through parental behaviour change. The responses of the parent-child pairs were analysed using proportions, Kappa scores, and McNemar's Chi-squared test. Additionally, 679 children were biochemically tested for smoking exposure using exhaled carbon monoxide. RESULTS: There was approximately a 30% discordance between the self-reports of children and their parents, with parents reporting less smoking in homes or cars than their children. Kappa scores for parent-child agreement by ethnicity ranged from 0.15 to 0.41 for smoking at home and 0.17 to 0.54 for smoking in cars. Biochemical testing suggested that around 30% of children had been exposed to secondhand smoke, corroborating their self-reported proportion of 37% (baseline in the home) whereas few parents (11%) reported smoking in home or cars. CONCLUSION: Parents were significantly less likely than children to report smoking inside the home or car. Biochemical testing indicated that children's reporting is more accurate. This has implications for future studies relying on self-reporting by children and/or their caregivers.

Is serum urate causally associated with incident cardiovascular disease?

OBJECTIVE: With studies reporting both positive and negative associations, the influence of serum urate on incident cardiovascular disease (CVD) is uncertain. We sought to determine whether serum urate is causally associated with incident CVD. METHODS: Participants were aged 30-80 years and were screened for CVD risk in primary care between 2006 and 2009. Participants had blood pressure, lipids, age and ethnic group recorded at assessment, with record linkage providing drug dispensing, hospital diagnoses and laboratory test results. Outcomes were derived from hospital diagnoses and mortality records until December 2009. Cox models were used to assess the influence of exposures on outcomes. RESULTS: A total of 78 707 people, free of CVD, were enrolled, and 1328 CVD events occurred during follow-up. Serum urate was recorded before baseline assessment in 43% (34 008/78 707) of participants. After adjustment for confounding factors, a 2 s.d. difference in serum urate (0.45 vs 0.27 mmol/l) was associated with a hazard ratio (HR) of 1.56 (95% CI 1.32, 1.84). This was more than double that of the equivalent distributional change in high-density lipoprotein cholesterol (adjusted HR 1.22) and one-third greater than that for HbA1c (adjusted HR 1.41). CONCLUSION: Serum urate is likely to be causally associated with CVD. This supports public health action to reduce urate levels in populations with significant burdens of the disease.

Markedly different clustering of CVD risk factors in New Zealand Indian and European people but similar risk scores (PREDICT-14).

OBJECTIVE: To compare the cardiovascular disease (CVD) risk profiles of Indian and European patients from routine primary care assessments in the northern region of New Zealand. METHOD: Anonymous CVD risk profiles were extracted from PREDICT (a web-based decision support program) for Indian and European patients aged 35-74 years. Linear regression models were used to obtain mean differences adjusted for age, gender and deprivation. RESULTS: At recruitment, Indian participants (n=8,830) were younger than Europeans (n=47,091), in keeping with national guidelines that recommend earlier CVD risk assessment for Indians. Compared with Europeans, a greater proportion of Indian participants lived in areas of higher deprivation and had a two to four-fold greater burden of diabetes in all age groups. Indian participants had a significantly lower proportion of smokers and a lower mean systolic blood pressure. The respective cardiovascular risk factor profiles lead to similar age-adjusted Framingham five-year CVD risk scores. CONCLUSIONS AND IMPLICATIONS: National data sources indicate that there are higher rates of hospitalisations and deaths from CVD in Indians compared with Europeans. Our study found similar predicted CVD risk in these two populations despite markedly different clustering of risk factors, suggesting that the Framingham risk equation may underestimate risk in Indians. There is a need for better ethnicity coding to identify all South Asian ethnicities.

Sociodemographic differences in prevalence of diagnosed coronary heart disease in New Zealand estimated from linked national health records.

AIM: To estimate sociodemographic differences in the prevalence of coronary heart disease (CHD) in New Zealand from linked health records. METHODS: We combined records of hospital treatment for CHD, dispensing of selected anti-anginal drugs and mortality to estimate the national point prevalence of coronary heart disease in New Zealand in December 2008. Stratified estimates are presented by gender; age; Maori, Pacific, Indian and 'Other' (mainly New Zealand European) ethnic groups; and socioeconomic status. RESULTS: Among a "health contact" population of adults (greater than and equal to 15 years), about one in twenty (6.5% of men and 4.1% of women) had indicators of a past diagnosis or treatment for CHD or both. Substantial differences in prevalence occurred by gender, ethnic group and socioeconomic status. For example, among New Zealanders aged 35 to 74 years, Indian men had the highest age-adjusted prevalence (7.78%; 95%CI 7.43 to 8.15), almost double the prevalence of 'Other' males. Among women, Maori had the highest adjusted prevalence (4.03%; 95% CI 3.89 to 4.17), just over twice that of 'Others.' CONCLUSION: Major sociodemographic disparities in the national burden of CHD persist. Our results are similar to previous studies of ethnic disparities in CHD incidence, but also confirm concerns about the emerging CHD burden among South Asians. Indian males have the highest CHD prevalence of any gender-specific ethnic group. Of equal concern, Maori women have a similar prevalence to European males.

Overweight and obesity prevalence among adult Pacific peoples and Europeans in the Diabetes Heart and Health Study (DHAHS) 2002-2003, Auckland New Zealand.

AIM: This paper describes and compares proportions of overweight, obese, and average BMI and their relationship with physical activity for Pacific ethnic groups (Samoan, Tongan, Niue, Cook Islands) and European New Zealanders by gender who participated in the 2002-03 Diabetes Heart and Health Study (DHAHS). METHODS: The DHAHS was a cross-sectional population based study of people age 35-74 years carried out in Auckland between 2002-03. A total of 1011 Pacific people comprising of 484 Samoan, 252 Tongan, 109 Niuean, 116 Cook Islanders and 47 'Other Pacific' (mainly Fijian) and 1745 European participants took part in the survey. Participants answered a self-administered questionnaire to assess their participation in physical activity, perceived weight, and their perception of their current weight. Following this participant's height and weight was measured for calculation of BMI. Ethnic-specific cut offs were used for classification of overweight (Pacific > or = 26.0-<32.0, European > or = 25.0-<30.0) and obesity (Pacific > or = 26.0, European > or = 32.0). RESULTS: Approximately 95% of Pacific men and 100% Pacific women were 'overweight or obese'. Proportions of obesity were for men: all Pacific 53%, Samoan 58%, Cook Island 23%, Tongan 60%, and Niuean 49%; and for women: all Pacific 74%, Samoan 75%, Cook Island 69%, Tongan 78%, and Niuean 76%. Pacific people were as accurate at estimating their body weight as Europeans, and included similar proportions who under-estimated their weight. The Cook Islands group were most likely to accurately report their weight and were significantly less likely to underestimate their weight. A significantly higher proportion of Pacific people reported that they were heavier than a year ago (22.7%) compared to Europeans (17.2%), but significantly fewer Pacific people (55.6%) reported thinking that they were overweight compared to Europeans (64.9%). After adjustment for possible confounding variables, older Pacific adults were over 11 times more likely to be obese than their Europeans counterparts. CONCLUSION: The continued rise in overweight and obesity in older Pacific adults means that almost all are now overweight or obese. This raises concerns about interventions focussed on overweight and obesity, and will require the adoption of a total Pacific population 'environmental change' approach rather than dietary or physical activity interventions targeted to overweight individuals.

A comparative analysis of the cardiovascular disease risk factor profiles of Pacific peoples and Europeans living in New Zealand assessed in routine primary care: PREDICT CVD-11.

AIM: To investigate the differences in the baseline cardiovascular disease (CVD) risk profiles of Pacific peoples and Europeans assessed in routine primary care practice by PREDICT, a web-based clinical decision support programme for assessing and managing CVD risk. METHODS: PREDICT has been implemented in primary care practices from nine consenting PHOs in Auckland and Northland. Between 2002 and January 2009, over 70,000 CVD risk assessments were conducted. These analyses compare CVD risk factors for Pacific and European patients. RESULTS: Baseline risk assessments were completed for 39,835 Europeans and 10,301 Pacific peoples aged 35-74 years. Over 85% of the Pacific cohort was comprised of the four main Pacific ethnic groups in New Zealand (Samoan, Tongan, Cook Island Maori and Niuean). Fijians (n=1341) were excluded from the analyses because of a likely misclassification error with Indian Fijians. On average, Pacific peoples in the PREDICT cohort were 4 years younger at the time of risk assessment than Europeans, and were overrepresented in areas of high socioeconomic deprivation. At risk assessment, Pacific men were 1.5 times as likely to be current smokers as European men, whereas similar or lower proportions of Pacific women smoked compared with European women. Pacific peoples were approximately three times more likely to have diabetes as Europeans. Pacific peoples had higher diastolic blood pressures and Pacific women had higher total cholesterol/HDL ratios. Both Pacific men and women had a significantly higher predicted risk of CVD in the next 5 years than Europeans, based on the Framingham risk score. CONCLUSIONS: The PREDICT programme has already generated the largest cohort of Pacific peoples ever to be studied in New Zealand. This comparative analysis of patients who have been screened highlights significant disparities in CVD risk factors for Pacific peoples particularly for diabetes in both sexes and for smoking in men. Targeting these modifiable risk factors will be important in addressing the widening inequalities in CVD outcomes between Pacific peoples and Europeans.

A comparative analysis of cardiovascular disease risk profiles of five Pacific ethnic groups assessed in New Zealand primary care practice: PREDICT CVD-13.

BACKGROUND: Data on the cardiovascular disease risk profiles of Pacific peoples in New Zealand is usually aggregated and treated as a single entity. Little is known about the comparability or otherwise of cardiovascular disease (CVD) risk between different Pacific groups. AIM: To compare CVD risk profiles for the main Pacific ethnic groups assessed in New Zealand primary care practice to determine if it is reasonable to aggregate these data, or if significant differences exist. METHODS: A web-based clinical decision support system for CVD risk assessment and management (PREDICT) has been implemented in primary care practices in nine PHOs throughout Auckland and Northland since 2002, covering approximately 65% of the population of these regions. Between 2002 and January 2009, baseline CVD risk assessments were carried out on 11,642 patients aged 35-74 years identifying with one or more Pacific ethnic groups (4933 Samoans, 1724 Tongans, 1366 Cook Island Maori, 880 Niueans, 1341 Fijians and 1398 people identified as Other Pacific or Pacific Not Further Defined). Fijians were subsequently excluded from the analyses because of a probable misclassification error that appears to combine Fijian Indians with ethnic Fijians. Prevalences of smoking, diabetes and prior history of CVD, as well as mean total cholesterol/HDL ratio, systolic and diastolic blood pressures, and Framingham 5-year CVD risk were calculated for each Pacific group. Age-adjusted risk ratios and mean differences stratified by gender were calculated using Samoans as the reference group. RESULTS: Cook Island women were almost 60% more likely to smoke than Samoan women. While Tongan men had the highest proportion of smoking (29%) among Pacific men, Tongan women had the lowest smoking proportion (10%) among Pacific women. Tongan women and Niuean men and women had a higher burden of diabetes than other Pacific ethnic groups, which were 20-30% higher than their Samoan counterparts. Niuean men and women had lower blood pressure levels than all other Pacific groups while Tongan men and women had the highest total cholesterol to HDL ratios. Tongan men and women had higher absolute 5-year CVD risk scores, as estimated by the Framingham equation, than their Samoan counterparts (Age-adjusted mean differences 0.71% [95% CI 0.36% to 1.06%] for Tongan men and 0.52% [95% CI 0.17% to 0.86%] for Tongan women) although these risk differences were only about 10% higher in relative terms. CONCLUSION: The validity of the analyses depend on the assumption that the selection of participants for CVD risk assessment in primary care is similar between Pacific groups. The ethnic-specific CVD risk profiles presented do not represent estimates of population prevalence. Almost all previous Pacific data has been aggregated with Pacific peoples treated as a single entity because of small sample sizes. We have analysed data from the largest study to date measuring CVD risk factors in Pacific peoples living in New Zealand. Our findings suggest that aggregating Pacific population data appears to be reasonable in terms of assessing absolute CVD risk, however there are differences for specific CVD risk factors between Pacific ethnic groups that may be important for targeting community level interventions.

Estimating diabetes prevalence in South Auckland: how accurate is a method that combines lists of linked health datasets?

AIMS: To assess the accuracy of a method for estimating adult diabetes prevalence that combines linked, routine health datasets in South Auckland, New Zealand. METHODS: We used a simple algorithm that combined records of laboratory testing, drug dispensing and hospital diagnoses applied to National Health Index-linked health data in South Auckland to estimate the prevalence of diabetes in 2007. We investigated the sensitivity of this 'combined list' algorithm against a gold standard of individuals with diagnosed diabetes enrolled in a Chronic Care Management programme (CCMP). We also assessed the sensitivity of this algorithm against an estimated diabetes population generated using capture-recapture methods. RESULTS: From the combined-list algorithm, 25,797 (7.2%) South Aucklanders aged 15 years and over had diabetes. During this period, 10,725 patients were enrolled in the CCMP. The combined list algorithm correctly identified (sensitivity) 10,351/10,725 (96.5%) of those enrolled. When we used the capture-recapture estimated diabetes population as an alternative gold standard, 34,418 [9.5%] of South Aucklanders 15 years and over had diabetes, with the sensitivity of the combined list method falling to about 75% (25,797/34,418). CONCLUSION: Linked health data provide reasonably accurate estimates of diabetes prevalence in a New Zealand population; particularly for cases with longstanding or complicated disease.

'From Kava to Lager'--alcohol consumption and drinking patterns for older adults of Pacific ethnic groups, and Europeans in the Diabetes Heart and Health Study (DHAHS) 2002-2003, Auckland New Zealand.

AIM: This paper describes and compares alcohol consumption and drinking patterns for Pacific ethnic groups (Samoan, Tongan, Niue, Cook Islands) and European New Zealanders by gender participating in the 2002-03 Diabetes Heart and Health Study (DHAHS). METHODS: The DHAHS was a cross-sectional population based study of people age 35-74 years carried out in Auckland between 2002-03. A total of 1011 Pacific people comprising of 484 Samoan, 252 Tongan, 109 Niuean, 116 Cook Islanders and 47 'Other Pacific' (mainly Fijian) and 1745 European participants took part in the survey Participants answered a self-administered questionnaire to assess whether they consumed alcohol, their drinking patterns and consumption levels and reasons for stopping drinking. RESULTS: Approximately half (51.3%) of all Pacific people did not currently drink compared to 6.2% of the European population. Of 'non-drinkers'--never Drinking'was significantly more common in Pacific (40%) compared to Europeans (13%) p < 0.0001. Ex-drinkers comprised 6.3% of the 'ever-drank' population for European compared to 27.6% for Pacific. The majority of Pacific men and women drinkers (>60%) consumed alcohol 'weekly' or 'less than weekly'. In contrast the majority of European men and women drinkers (>60%) consumed alcohol '2-3 days per week' or 'daily'. European men were significantly more likely to drink wine and spirits, and European women were significantly more likely to drink wine than their Pacific counterparts. Pacific drinkers consumed an average of 6.9 drinks on a typical occasion and 82 mls of pure alcohol per week, compared to 3.6 drinks and 126 mls per week for Europeans. CONCLUSION: Middle-aged and older Pacific adults are less likely to consume alcohol than Europeans however those who drink consume more on a typical occasion but drink less regularly resulting in lower weekly consumption of pure alcohol. Drinking patterns in these Pacific adults tend to show substantial diversity by age (older are less likely to drink), sex (women less likely to drink), and financial deprivation (middle groups consume more than least and most financially deprived). For Europeans a more homogenous drinking style prevailed by age, sex, and deprivation. Pacific drinkers were also approximately five times more likely to stop drinking compared to Europeans, citing family and social reasons as their main motivation for stopping drinking.