Use of Consumer Wearables in Health Research: Issues and Considerations.

As wearable devices, which allow individuals to track and self-manage their health, become more ubiquitous, the opportunities are growing for researchers to use these sensors within interventions and for data collection. They offer access to data that are captured continuously, passively, and pragmatically with minimal user burden, providing huge advantages for health research. However, the growth in their use must be coupled with consideration of their potential limitations, in particular, digital inclusion, data availability, privacy, ethics of third-party involvement, data quality, and potential for adverse consequences. In this paper, we discuss these issues and strategies used to prevent or mitigate them and recommendations for researchers using wearables as part of interventions or for data collection.

How young people in Aotearoa perceive vaping and the associated oral health risks.

AIMS: The use of electronic cigarettes (EC) among young people has escalated in Aotearoa and in other jurisdictions where they are available commercially. The rise in vaping among young people for lifestyle reasons rather than for smoking cessation is of concern, given the growing evidence of the harmful effects of vaping. Specifically, there is little known about how young people in Aotearoa perceive the effect of vaping on their oral health. This study aims to explore how young people in Aotearoa perceive risks of vaping on oral health. METHODS: A cross-sectional online survey (n=237) was conducted to explore young people's (16-24 years) perceptions, current practices and attitudes regarding vaping and oral health. RESULTS: Although most participants understood that vaping posed risks to their general health, they reported lower levels of perceived risk of vaping on oral health. Current vapers held significantly lower perceptions of both the addictiveness and harms associated with vaping. Participants reported that oral health professionals seldom asked them about their vaping status. Most participants were open to discussing with oral health professionals the effects of vaping on their oral health, suggesting that they would be less likely to vape if they knew it was bad for their oral health. CONCLUSIONS: The findings indicate that there is a need for improved information for young people communicating the potential oral health risks of vaping and that oral health professionals are a way to disseminate this information.

A review of international trade and investment agreements and nutrition policy space in the Pacific.

Small Island Developing States (SIDS) in the Pacific are heavily reliant on imported foods which are often nutritionally deficient, and typically high in salt, fat, and sugar. To curb nutrition-related non-communicable diseases, nutrition policies are needed to create food environments that promote healthy diets. However, international trade and investment agreements (TIAs) may interfere with the policy space for SIDS to regulate their food environments by requiring member states to meet trade obligations that could conflict with their nutrition policy goals. In this review, we identify real examples of where TIAs have been responsible for changes in Pacific SIDS' nutrition policies alongside the potential for further constraints on healthy nutrition policies from Pacific Island participation in TIAs. In addition, we note the effects of regulatory chill from TIA obligations in Pacific SIDS, whereby healthy nutrition policies are not considered, developed, or implemented due to the threat of trade disputes or the complexity of TIA procedural requirements. Existing literature indicates that TIAs have shaped nutrition policies to fit within the global trade paradigm despite SIDS' nutrition policy imperatives. More can be done locally, regionally, and internationally to increase the importance of nutrition in the trade agenda, leverage regional institutions to champion nutrition regulation and support SIDS in navigating the trade and nutrition policy environment.

Screening, diagnosing and management of Pacific peoples with prediabetes in New Zealand primary healthcare clinics with high concentrations of Pacific peoples: an online survey.

Introduction Prediabetes is a condition of elevated blood sugar levels which can increase the risk of type 2 diabetes (T2D) if not managed effectively. Prediabetes is likely to affect about 24.6% of New Zealand (NZ) adults, with estimates of 29% of the Pacific population currently living with the condition. A prediabetes diagnosis is an opportunity for intervention from trusted primary care providers. The study aim was to describe primary healthcare clinician's knowledge and practice regarding screening, diagnosing and management of prediabetes in Pacific patients. Methods An online survey was conducted with current practicing primary healthcare clinicians between February and April 2021. Eligible participants included clinicians employed in a primary healthcare clinic with over 50% of enrolled patients identified as Pacific. Results Primary healthcare clinicians (n = 30) reported that their prediabetes screening, diagnosis and management were aligned with the NZ Ministry of Health clinical guidelines. The most common factors that prompted screening was a family history of T2D (25/30, 83%), ethnicity (24/30, 80%) weight and BMI (24/30, 80%). The initial management practices involved providing recommendations for dietary changes and physical activity (28/30, 93%) and referring patients to a diabetes prevention lifestyle change programme (16/30, 53%). Discussion Primary healthcare clinicians are the foremost point of engagement with patients and their famili (family) in their health journey. Culturally appropriate tools could be useful to assist healthcare providers to communicate to a higher risk population and most clinicians rely on up to date guidelines for screening and management.

Use of e-cigarettes among young queer men living in Aotearoa New Zealand.

Introduction Queer-identifying (non-heterosexual) men report higher rates of tobacco and e-cigarette use than the general population. The advent of e-cigarettes as a commercial product in Aotearoa New Zealand has been accompanied by aggressive marketing and a sharp uptake in use, especially among young people. Recent evidence suggests that e-cigarettes are widely used for purposes other than smoking cessation. Aim This study investigated how vaping is perceived and the role e-cigarettes play in the daily lives of young queer users. Methods Using focus groups with a semi-structured interview proforma, we interviewed twelve young queer men between July and August 2021. Interviews were queer-led, conducted via Zoom, and lasted up to 2 h. Interviews were audio-recorded and transcribed verbatim for subsequent inductive and thematic analysis. Results Of the twelve participants, 10 were daily users, and two described themselves as 'social vapers'. We found strong evidence for minority and intra-minority stress as a driver to uptake and continued use of e-cigarettes. E-cigarettes were also used to navigate new social and cultural spaces and as currency for integration into various social milieux, including both mainstream and gay community spaces. There was little support for queer-targeted cessation initiatives. Discussion Vaping is highly socially acceptable within queer communities where it is a facilitator of social integration, managing stress and quitting tobacco.

An analysis of key stakeholder policy perspectives in the proposed e-cigarette regulations in New Zealand.

ISSUE ADDRESSED: The use of e-cigarettes is increasing; New Zealand (NZ) has witnessed a rapid rise in consumption. Policymakers face a challenge to balance the impacts of regulation on those who use e-cigarettes as a smoking cessation tool while protecting people who do not smoke from the harms of e-cigarette use, particularly young people. Previous research has demonstrated varying perspectives on e-cigarette regulation according to different stakeholders and interest groups. This study examined key stakeholders' positions on the drafted legislation to regulate e-cigarettes in NZ. METHODS: Using written submissions made during public consultation in 2020, we conducted a content analysis to determine levels of support for e-cigarette regulations. Submissions made by the e-cigarette industry and the health sector were included for analysis. RESULTS: The tobacco industry is heavily invested in ensuring that e-cigarettes continue to be promoted and available in NZ with minimal restrictions. On the contrary, health organisations supported the introduction of regulations to reduce marketing to, and use of e-cigarettes by youth and people who do not smoke. CONCLUSIONS: The industry opposes restrictions using similar approaches employed against tobacco control measures. Despite perceptions of division, the health sector is generally unified in support of e-cigarette restrictions. SO WHAT?: Policymakers must protect public health policies from commercial interests and be cautious of opposition framed as public health concerns.

The Use of Sensors to Detect Anxiety for In-the-Moment Intervention: Scoping Review.

BACKGROUND: With anxiety a growing issue and barriers to accessing support services, there is a need for innovative solutions to provide early intervention. In-the-moment interventions support individuals to recognize early signs of distress and use coping mechanisms to prevent or manage this distress. There is potential for wearable sensors linked to an individual's mobile phone to provide in-the-moment support tailored to individual needs and physiological responses. OBJECTIVE: The aim of this scoping review is to examine the role of sensors in detecting the physiological signs of anxiety to initiate and direct interventions for its management. METHODS: Relevant studies were identified through searches conducted in Embase, MEDLINE, APA PsycINFO, ProQuest, and Scopus. Studies were identified if they were conducted with people with stress or anxiety or at risk of anxiety and included a wearable sensor providing real-time data for in-the-moment management of anxiety. RESULTS: Of the 1087 studies identified, 11 studies were included in the review, including 5 randomized controlled trials and 6 pilot or pretesting studies. The results showed that most studies successfully demonstrated improvements in their target variables. This included overall anxiety and stress levels, and the implementation of in-the-moment stress and anxiety management techniques such as diaphragmatic breathing. There was wide variation in the types of sensors used, physiological measures, and sensor-linked interventions. CONCLUSIONS: This review indicates that sensors are potentially a useful tool in detecting anxiety and facilitating the implementation of a known control mechanism to reduce anxiety and improve mood, but further work is needed to understand the acceptability and effectiveness of this type of intervention.

E-Cigarette Retailers' Use of Instagram in New Zealand: A Content Analysis.

E-cigarette companies claim their products are key to improving health outcomes by providing smokers with lower-risk alternatives. However, the rapid uptake of e-cigarettes among young people has prompted concern about company marketing practices. In 2019, there was no legislation to govern e-cigarette marketing in New Zealand. This period provides an ideal context for examining how e-cigarette companies promoted their products before the introduction of marketing regulations. We conducted a content analysis of the Instagram accounts of five prominent e-cigarette retailers based in New Zealand during 2019-2020. We assessed health- and risk-related claims and marketing techniques. Less than 10% of Instagram posts refer to smoking alternatives or risk of nicotine addiction. E-cigarette devices were more likely to be promoted for stylistic features such as colours and ease of use (29.7%). Music festival sponsorship (19.1%), social media influencers (9.2%), and lifestyle marketing (41.5%) were identified as youth-oriented promotional strategies. E-cigarette retailers claim to promote harm-reduction tools to smokers, yet this study finds few references to smoking alternatives in any content. Instead, retailers utilised strategies to engage with a young audience, including festival sponsorship and stylish influencers. This youth-oriented marketing, in combination with weak and delayed government action, may have contributed to the high use of e-cigarettes among young New Zealanders.

Navigating digital inclusion and the digital va among Niue mamatua through the provision of mobile phones during COVID-19.

Technology and digital platforms have become essential for people and communities to interact because of COVID-19. Despite its benefits, digital exclusion disproportionately affects Pacific communities living in New Zealand. This article provides insights into how Niue mamatua (older adults) used their gifted mobile phones and mobile data as part of a COVID-19 digital inclusion initiative. It begins with an overview of the digital inclusion needs of older adults, followed by a description of the digital va (relational space) and negotiating a new way of maintaining connection in an online world. The tutala (a Niue method of conversation anchored on respect) with 12 mamatua highlighted the benefits, support factors, and challenges of how they were able to use their mobile phone. Importantly, mobile phones provided the necessary access and connectivity to interact in a digitally connected world, namely the digital va, when in-person connections were disrupted because of COVID-19.

Ear and hearing health in Niue: a qualitative study on the worldviews, knowledge, beliefs and use of health care.

Introduction Hearing is a primary sense that facilitates the development of spoken language, social connection and an appreciation of sounds within the natural world. Hearing loss has multiple adverse effects across the life course. Understanding the worldviews of ear and hearing health in Pacific peoples is crucial to inform responsive and appropriate hearing health and primary healthcare services. Aim To understand the worldviews, knowledge and beliefs held by the Niuean community in Niue towards ear and hearing health, and the use of healthcare methods to contribute to service development. Methods Twenty semi-structured interviews were conducted with Niuean community members. Interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis methods. Results Niuean people value hearing health as an important way to communicate and connect with each other. They are proactive health seekers, have good knowledge about ear disease and hearing health and use mainstream medicines alongside spiritual practices and traditional remedies to maintain good ear and hearing health. The hospital system is responsive and accessible to the community's needs, contrasting with Pacific people's access to hearing health services in New Zealand. Discussion There is a high level of awareness of the importance of hearing health amongst the Niuean community and good accessibility and utilisation of healthcare services. There is potential to implement locally focused ear and hearing health strategies in Niue and conduct hearing health research among the New Zealand-based Niuean community to improve primary healthcare services delivery.

Use of supporting evidence by health and industry organisations in the consultation on e-cigarette regulations in New Zealand.

OBJECTIVES: Scientific evidence to support the development of appropriate policy for electronic cigarette use is limited by rapidly changing technology and a lack of long-term data. Perceptions of risk and benefits determine diverse framings of the e-cigarette debate and complicate policy decisions. E-cigarette use by smokers who are attempting to quit may result in improved health outcomes, while their use among young people and non-smokers may lead to adverse health consequences. The purpose of this study was to identify the types of evidence used during public consultations on proposed revisions to New Zealand's e-cigarette legislation in 2020. METHODS: Using submissions to parliament made by the tobacco/e-cigarette industry and the health sector, we assessed the cited evidence for quality and independence measured by publication type and tobacco industry connections. We identified themes from a sub-sample of frequently cited evidence to understand how stakeholders and organisations used evidence. RESULTS: The sample consisted of 57 submissions from the e-cigarette and tobacco industry (n = 21) and health organisations (n = 36). A total of 442 pieces of evidence were cited at least once. Health organisations were more likely to cite peer-reviewed evidence (OR = 2.99). The industry was more likely to cite evidence outside of peer review and sources with tobacco industry connections (OR = 4.08). In the sample of frequently cited evidence, youth prevalence and flavours were the most common themes. In some cases the same evidence was used by both groups to support opposing policy positions. CONCLUSIONS: The industry continues to rely more heavily on evidence published outside of the peer-review process, which is, therefore, subjected to less scientific scrutiny. By using a smoking-cessation or harm-reduction narrative, the industry could be seen as a legitimate stakeholder in policy development.

Getting there together: highlights, challenges and opportunities for tobacco control in the Oceania region.

BACKGROUND: The paper focuses on the geographical region of Oceania. We highlight the tobacco control leadership demonstrated in this region and describe the challenges and opportunities to achieving country-specific smoke-free goals. RESULTS: Significant achievements include smoke-free nation goals, world-leading initiatives such as plain packaging, and a bold plan by New Zealand to reduce the retail availability of smoked tobacco products and remove virtually all the nicotine from cigarettes and rolling tobacco. There are significant challenges and opportunities before reaching smoke-free status including implementation pathways requiring strong governance and leadership and compliance monitoring and enforcement. CONCLUSIONS: We conclude that achieving a smoke-free Oceania is possible through already existing bold country and regional smoke-free goals, excellent tobacco control leadership, experience and resources, and an understanding of how to work collectively. However, a commitment to focus tobacco control efforts regionally is required to achieve a smoke-free Oceania together.

Online retail promotion of e-cigarettes in New Zealand: A content analysis of e-cigarette retailers in a regulatory void.

ISSUE ADDRESSED: This study explores online e-cigarette retailer marketing in the absence of regulations. METHODS: New Zealand-based online e-cigarette retailer websites were identified using a keyword search. Ten New Zealand-based retailer websites were selected based on top results from Google. The four leading tobacco companies operating in New Zealand were also included. A content analysis of the online marketplace was performed. RESULTS: Price was variable, with disposable devices sold from as little as $9.99 (NZD). Online e-cigarette retailers frequently presented health (79%) and smoking cessation (71%) messages. Nicotine addiction warnings were explicit in less than half of retailer sites (43%) and only 29% of retailers stated that the use of devices may pose health risks. Marketing techniques with potential youth appeal included sweet flavours (80%) and cartoon characters on e-liquid products (20%). Only one retailer had an age verification procedure to purchase a product. CONCLUSION: The findings suggest that online marketing is likely to appeal to young people despite industry assurances that e-cigarettes are only promoted to adult smokers who want to quit. Regulations for online retailers are urgently needed. SO WHAT?: This study adds to the surveillance research on the online marketing of e-cigarette retailers. Study findings may help inform future decisions on the regulation of e-cigarette marketing in New Zealand.

Mobile Health (mHealth) in Low- and Middle-Income Countries.

This article reflects on current trends and proposes new considerations for the future of mobile technologies for health (mHealth). Our focus is predominantly on the value of and concerns with regard to the application of digital health within low- and middle-income countries (LMICs). It is in LMICs and marginalized communities that mHealth (within the wider scope of digital health) could be most useful and valuable. Peer-reviewed literature on mHealth in LMICs provides reassurance of this potential, often reflecting on the ubiquity of mobile phones and ever-increasing connectivity globally, reaching remote or otherwise disengaged populations. Efforts to adapt successful programs for LMIC contexts and populations are only just starting to reap rewards. Private-sector investment in mHealth offers value through enhanced capacity and advances in technology as well as the ability to meet increasing consumer demand for real-time, accessible, convenient, and choice-driven health care options. We examine some of the potential considerations associated with a private-sector investment, questioning whether a core of transparency, local ownership, equity, and safety is likely to be upheld in the current environment of health entrepreneurship.

Takore i te Kai Ava'ava (Quit smoking), a mCessation Program Adapted for the Cook Islands: Indicators of Potential for Tobacco Control.

Mobile phone-based smoking cessation interventions (mCessation) are an established evidence-based intervention designed to support smokers to quit. Evidence of impact to date is modestly positive but skewed in favor of high-resourced countries, with less evidence of value added to low-resourced settings. Takore i te Kai Ava'ava, a text message-based smoking cessation program, was delivered to smokers living on the island of Rarotonga in 2019. Eighty-eight smokers consented to take part. Participants completed a baseline questionnaire about current smoking behavior and previous quit attempts; follow-up measures at 2 months assess quit attempts feedback on the program. Thirty-two people completed the follow-up interviews; 10 (31%) had not smoked in the past 7 days, 23 (72%) reported a serious quit attempt, and 29 (91%) felt the program was effective for the Cook Islands. Takore i te Kai Ava'ava was deemed to be highly acceptable and potentially cost-effective.

Mobility restrictions were associated with reductions in COVID-19 incidence early in the pandemic: evidence from a real-time evaluation in 34 countries.

Most countries have implemented restrictions on mobility to prevent the spread of Coronavirus disease-19 (COVID-19), entailing considerable societal costs but, at least initially, based on limited evidence of effectiveness. We asked whether mobility restrictions were associated with changes in the occurrence of COVID-19 in 34 OECD countries plus Singapore and Taiwan. Our data sources were the Google Global Mobility Data Source, which reports different types of mobility, and COVID-19 cases retrieved from the dataset curated by Our World in Data. Beginning at each country's 100th case, and incorporating a 14-day lag to account for the delay between exposure and illness, we examined the association between changes in mobility (with January 3 to February 6, 2020 as baseline) and the ratio of the number of newly confirmed cases on a given day to the total number of cases over the past 14 days from the index day (the potentially infective 'pool' in that population), per million population, using LOESS regression and logit regression. In two-thirds of examined countries, reductions of up to 40% in commuting mobility (to workplaces, transit stations, retailers, and recreation) were associated with decreased cases, especially early in the pandemic. Once both mobility and incidence had been brought down, further restrictions provided little additional benefit. These findings point to the importance of acting early and decisively in a pandemic.

I Keep Looking at What I'm Doing to My Organs: Samoans' Responses to Adapted Anti-Tobacco Television Advertisements.

There has been an increase of adapted tobacco control media campaigns in low- and middle-income countries. Adapting existing material offers many benefits especially to countries with limited resources. We adapted 3 television advertisements for the Tu'u Nei Loa Le Ulaula Tapa'a (Stop Smoking Now) campaign in Samoa. Adaption included rigorous efforts to ensure advertisements were culturally appropriate. To determine audiences' perception of anti-tobacco television advertisements to promote smoking cessation, we conducted 8 talanoa, a Pacific Islands research methodology, among 54 smokers and nonsmokers in Apia, Samoa. The talanoa were transcribed, translated, and thematically coded. Results suggest that the advertisements raised awareness on the negative health impacts of tobacco use, especially to the internal organs. Graphic and emotionally evocative advertisements, especially those that have an impact on the family, have greater potential to motivate Samoans to quit.

The characteristics of behaviour change interventions used among Pacific people: a systematic search and narrative synthesis.

BACKGROUND: Pacific people living in New Zealand, Australia, United States, and the Pacific region continue to experience a disproportionately high burden of long-term conditions, making culturally contextualised behaviour change interventions a priority. The primary aim of this study was to describe the characteristics of behaviour change interventions designed to improve health and effect health behaviour change among Pacific people. METHODS: Electronic searches were carried out on OVID Medline, PsycINFO, PubMed, Embase and SCOPUS databases (initial search January 2019 and updated in January 2020) for studies describing an intervention designed to change health behaviour(s) among Pacific people. Titles and abstracts of 5699 papers were screened; 201 papers were then independently assessed. A review of full text was carried out by three of the authors resulting in 208 being included in the final review. Twenty-seven studies were included, published in six countries between 1996 and 2020. RESULTS: Important characteristics in the interventions included meaningful partnerships with Pacific communities using community-based participatory research and ensuring interventions were culturally anchored and centred on collectivism using family or social support. Most interventions used social cognitive theory, followed by popular behaviour change techniques instruction on how to perform a behaviour and social support (unspecified). Negotiating the spaces between Eurocentric behaviour change constructs and Pacific worldviews was simplified using Pacific facilitators and talanoa. This relational approach provided an essential link between academia and Pacific communities. CONCLUSIONS: This systematic search and narrative synthesis provides new and important insights into potential elements and components when designing behaviour change interventions for Pacific people. The paucity of literature available outside of the United States highlights further research is required to reflect Pacific communities living in New Zealand, Australia, and the Pacific region. Future research needs to invest in building research capacity within Pacific communities, centering self-determining research agendas and findings to be led and owned by Pacific communities.