A cross-sectional study on alcohol and contraception use among sexually active women of childbearing age: Implications for preventing alcohol-exposed pregnancies.

BACKGROUND: A high proportion of unwanted or unplanned pregnancies may be alcohol-exposed due to contraception failure or non-use. Nevertheless, data on contraception and alcohol use in the context of the risk of alcohol-exposed pregnancies are sparse. OBJECTIVES: To describe contraception use and alcohol consumption in sexually active non-pregnant women and investigate the factors associated with less effective contraception methods. STUDY DESIGN: A cross-sectional national survey of women aged 18-35 years. METHODS: Data from non-pregnant women who were sexually active (n = 517) were analysed. Descriptive statistics were used to report demographics, consumption, and contraception measures. Logistic regression was used to investigate the factors associated with less effective contraception among drinkers. RESULTS: The majority of participants were younger (46%), of NZ European ethnicity (78%), not in a permanent relationship (54%), with some or completed tertiary education (79%), employed (81%) and not users of the community services card (82%). Twenty-five percent of women were smokers, 94% consumed alcohol, and 72% binged at least 'monthly or less'. Most women used the pill (56%), and 20% of drinking women were using a contraception method with a 10% or more annual failure rate after 1 year of use. Women who binged 'weekly or more often' had similar odds of using less effective contraception as women who 'never' binged (p > 0.05). Younger Maori or Pacific women (odds ratio = 5.99; 95% confidence interval of odds 1.15-31.2; p = 0.033) and women who had no tertiary education (odds ratio = 1.75; 95% confidence interval of odds 0.00-3.06; p = 0.052) had higher odds of using less effective contraception. CONCLUSION: With 20% of women at risk of an alcohol-exposed pregnancy, public health measures to address alcohol consumption and the effective use of contraception are critical to reducing the risk for alcohol-exposed pregnancies in NZ.

Asian migrants navigating New Zealand primary care: a qualitative study.

Introduction Information on the responsiveness of the New Zealand (NZ) health system to Asians to enable navigation of healthcare services is currently lacking. Barriers experienced by Asian patients to enable optimal navigation of, and engagement with, healthcare services are also sparse. Aim This research aimed to: (1) document and analyse resources available on the websites of general practices that aid in optimal health care navigation for NZ Asians; and (2) explore the barriers perceived by Asian migrants to navigating the NZ Health System, particularly primary care. Methods This study involved qualitative document analysis of existing resources on general practice websites. Information on perceived barriers and experiences of navigating the health system was collected through semi-structured interviews (n = 9). Results Overall, 293 general practice websites were analysed. The themes from content analysis were: availability of basic information, linguistic accessibility, and culturally appropriate support for patients. Relevant and reliable information facilitating effective navigation of the NZ health system by Asians was lacking. Interview data supported the findings about the general practices, with participants reporting significant difficulties navigating and understanding NZ primary care services. Discussion Current navigational resources presume knowledge that Asian migrants do not often possess. Participants felt this lack of accessible information acutely, and it influenced how they perceived and engaged with healthcare services. Increased accessibility through resources in Asian languages, including an overview of how Health NZ functions in providing health care and professional interpreter services, would be critical to increase appropriate engagement with healthcare services and thus contribute to better health outcomes for Asians.

Post-migration food habits of New Zealand South Asian migrants: Implications for health promotion practice.

Introduction: South Asian migrants in western countries have a high risk for diet related diseases post-migration. Hence knowledge on food habits that change post-migration, which are detrimental to health, are critical for health promotion initiatives to reduce this disease burden. Objective: to describe food consumption changes post-migration according to sex and duration of residence in New Zealand among South Asian migrants. Methods: A cross-sectional mail survey of 150 self-selected people of South Asian ethnicity aged 25-59 years in New Zealand. Results: The study achieved responses from 112 participants (75%) with a mean age of 36 (7.5) years. Consumption of green leafy vegetables reduced post-migration for females and in new migrants (P < 0.05). Fruit consumption increased in both genders and across duration of residence (P < 0.05). Only 15% of males and 36% of females met the 3 + a day recommendation for vegetable consumption. Consumption of traditional breads, breakfast items and rice (males) decreased whilst that of breakfast cereals increased (P < 0.05). Consumption of low-fat milk, cheese, ice-cream, butter (females) and margarine increased, whilst ghee decreased (P < 0.05). Consumption of fish, lentils, traditional sweets and savouries decreased, whilst meat, processed meat, chicken, potato chips, cakes and pastries (females) and alcohol (males) increased (P < 0.05), post-migration. Thirty-three percent of males and 24% of females consumed takeaways "weekly or more often", with the majority (male: 51%; female: 36%) consuming European foods such as pizzas and pastas. Thirteen percent of males and 26% of females consumed festival foods "weekly or more often." More than half the participants were obese with BMI increasing with duration of residence (P = 0.025). Conclusions: A food-based health promotion initiative focused on inadequate consumption of fruits and vegetables, increased consumption of dairy foods such as cheese and ice cream, and high fat European takeaway foods would be warranted particularly in new South Asian migrants.

Hidden figures and misnomers: a case for disaggregated Asian health statistics in Aotearoa New Zealand to improve health outcomes.

People of Asian ethnicity in Aotearoa New Zealand currently constitute 15% of the population. The majority are migrants. The current sources of data to monitor Asian health in New Zealand are routine population surveys and administrative data. This article highlights the effect of "masking" due to the use of a single "Asian" category for reporting health indicators. Issues regarding the use of the "Other Asian" category in administrative data are also discussed. This discourse provides an impetus to raise questions on how we should be developing policies, strategies and investments to make visible the hidden figures of Asian health statistics in New Zealand. Given that Asian population will become the second largest ethnic group in New Zealand, practical steps need to be taken to strengthen the New Zealand health strategy and enable equitable investment in Asian health.

Stepwise tailoring and test-retest of reproducibility of an ethnic-specific FFQ to estimate nutrient intakes for South Asians in New Zealand.

OBJECTIVE: To develop and test-retest the reproducibility of an ethnic-specific FFQ to estimate nutrient intakes for South Asians (SA) in New Zealand (NZ). DESIGN: Using culturally appropriate methods, the NZFFQ, a validated dietary assessment tool for NZ adults, was modified to include SA food items by analysing foods consumed by SA participants of the Adult Nutrition Survey, in-person audit of ethnic food stores and a web scan of ethnic food store websites in NZ. This was further refined via three focus group discussions, and the resulting New Zealand South Asian Food Frequency Questionnaire (NZSAFFQ) was tested for reproducibility. SETTING: Auckland and Dunedin, NZ. PARTICIPANTS: Twenty-nine and 110 males and females aged 25-59 years of SA ethnicity participated in the focus group discussions and the test-retest, respectively. RESULTS: The development phase resulted in a SA-specific FFQ comprising of 11 food groups and 180 food items. Test-retest of the NZSAFFQ showed good reproducibility between the two FFQ administrations, 6 months apart. Most reproducibility coefficients were within or higher than the acceptable range of 0·5-0·7. The lowest intraclass correlation coefficients (ICC) were observed for ß-carotene (0·47), vitamin B12 (0·50), fructose (0·55), vitamin C (0·57) and selenium (0·58), and the highest ICC were observed for alcohol (0·81), iodine (0·79) and folate (0·77). The ICC for fat ranged from 0·70 for saturated fats to 0·77 for polyunsaturated fats. The ICC for protein and energy were 0·68 and 0·72, respectively. CONCLUSIONS: The developed FFQ showed good reproducibility to estimate nutrient intakes and warrants the need for validation of the instrument.

Relative Validity and Reproducibility of a Short FoodFrequency Questionnaire to Assess Nutrient Intakesof New Zealand Adults.

There is no recent validated short food frequency questionnaire (FFQ) for use in NewZealand (NZ) adults. This study aimed to evaluate the relative validity and reproducibility of a shortFFQ in free-living NZ adults aged 30-59 years. A 57-item, semi-quantitative FFQ was developedand pre-tested. During a 12-month study period the FFQ was administrated twice with a 9-monthinterval between administrations. Four two-day diet records were collected at months 0, 3, 6, and 9and a blood sample was taken at month 9. Spearman correlations were used to evaluate the validityof the FFQ with the eight-day diet records and selected biomarkers. Cross-classification analysisand the Bland-Altman method were used to assess the agreement between the FFQ and the dietrecord. Reproducibility over nine months was assessed using intra-class correlations. A total of 132males and females completed both FFQs, the eight-day diet record, and provided a blood sample.The highest energy-adjusted correlation coefficients were observed for alcohol (0.81), cholesterol(0.61), and carbohydrate (0.61), with the lowest for sodium (0.29), thiamin (0.33), and niacinequivalents (0.34). More than three quarters of the participants were correctly classified into thesame or adjacent quartile for most nutrients, with a low proportion of participants being grosslymisclassified (< 10%). For most nutrients, the limits of agreement from the Bland-Altman analyseswere between 50% and 250%. A positive correlation was observed between dietary intakes andplasma biomarkers for all selected nutrients. The FFQ showed moderate to good reproducibility,with almost all reliability coefficients ranging from 0.60 to 0.80. This short FFQ was shown to validlyand reliably rank individuals by their habitual intake of most major nutrients, indicating that theFFQ will offer a time-efficient way to assess the nutrient intake of NZ adults in future research.

Diet quality, nutrient intakes and biochemical status of New Zealand women of childbearing age according to alcohol consumption patterns.

OBJECTIVE: To investigate associations between alcohol consumption patterns and diet quality, nutrient intakes and biochemical profile of women of childbearing age. DESIGN: Nutrient intake data from 24 h diet recalls, alcohol consumption data and diet quality from the Dietary Habits Questionnaire, and biochemical analyses from the cross-sectional 2008/09 Adult Nutrition Survey in New Zealand. SETTING: New Zealand households. PARTICIPANTS: New Zealand women aged 18-45 years (n 1124). RESULTS: All analyses were completed using Stata and survey weights were used to allow for the complex survey design to produce population estimates. Multinomial logistic regression models were used to examine the associations between drinking patterns and the variables of interest, with 'infrequent moderate/light' drinkers being the reference category. The findings indicate that alcohol-consuming women of childbearing age tend to replace food energy with alcohol energy (P = 0·022). 'More frequent heavy' and 'more frequent moderate/light' drinkers had higher intakes of total, mono- and polyunsaturated fats with the latter group also consuming higher levels of saturated fats (P < 0·05). Women who were 'infrequent moderate/light' drinkers had relatively better diet quality, nutrient intakes and adequate biochemical status in comparison to other drinkers and abstainers. 'Infrequent heavy' drinkers, who were predominantly younger in age, had lower serum vitamin B12 levels (P = 0·01) with a higher proportion of women in this category having below-recommended levels of serum folate (P < 0·05). CONCLUSIONS: Alcohol consumption, especially heavy drinking patterns, may compromise nutritional status of women of childbearing age.

Associated Factors of Drinking Prior to Recognising Pregnancy and Risky Drinking among New Zealand Women Aged 18 to 35 Years.

Nearly half of all pregnant women in the Western world drink prior to recognising pregnancy. The current study aimed to investigate the factors associated with drinking prior to recognising pregnancy among pregnant women and factors associated with risky drinking among nonpregnant sexually active women. The study was a cross-sectional survey of a random sample of women aged 18 to 35 years (n = 1062) selected from the New Zealand electoral roll. Pregnant women (currently pregnant: n = 65; previously pregnant: n = 202) who were risky drinkers and who smoked in the year prior to pregnancy had five times the odds (p < 0.01) and women who planned their pregnancy (p = 0.05) and who used a community service card (p = 0.004) had less than half the odds to drink prior to recognising pregnancy than their respective counterparts. Among sexually active nonpregnant women who consumed alcohol, those who smoked in the year prior to the survey and those who drank for social reasons, for mood enhancement or coping reasons had higher odds of being risky drinkers (p < 0.05). Addressing risky drinking, especially in social settings, and smoking among women of peak childbearing age may mitigate the potential risk of drinking prior to recognising pregnancy.

A renewed media-mix, based on the dynamic transactional model, for communicating the harms of alcohol to women in New Zealand.

Public health messages are traditionally disseminated using mass media that typically are unidirectional or one-way communication. Consequent to the current media proliferation, two-way communication channels are also available for publishing health messages. Though they differ in operation, they co-exist which is explained by the media complementarity theory. This study reports research that identified the sources that women of childbearing age in New Zealand prefer when seeking information concerning alcohol and pregnancy. Service-dominant logic provided a framework for simultaneously examining the media that were fundamentally different. The information sources were formulated into a media-mix based on the theory of dynamic transactional model (DTM). DTM accounted for media complementarity, combining the one-way and two-way communication channels into a unified communication process and is recommended for use in health promotion.

The Use of Facebook Advertising for Communicating Public Health Messages: A Campaign Against Drinking During Pregnancy in New Zealand.

BACKGROUND: Social media is gaining recognition as a platform for delivering public health messages. One area attracting attention from public health researchers and professionals is Facebook's advertising channel. This channel is reported to have a broad reach and generate high user engagement with the disseminated campaign materials. However, to date, no study has examined the communication process via this channel which this study aimed to address. OBJECTIVE: The specific objectives of the study were to (1) examine user engagement for a public health campaign based on the metadata provided by Facebook, (2) analyze comments generated by the campaign materials using text mining, and (3) investigate the relationship between the themes identified in the comments and the message and the sentiments prevalent in the themes that exhibited significant relationships. METHODS: This study examined a New Zealand public health pilot campaign called "Don't Know? Don't Drink," which warned against drinking alcohol during pregnancy. The campaign conveyed the warning through a video and three banner ads that were delivered as news feeds to women aged 18-30 years. Thematic analysis using text mining performed on the comments (n=819) identified four themes. Logistic regression was used to identify meaning-making themes that exhibited association with the message. RESULTS: The users' engagement was impressive with the video receiving 203,754 views. The combined likes and shares for the promotional materials (video and banner ads) amounted to 6125 and 300, respectively. The logistic regression analysis showed two meaning-making themes, namely, risk of pregnancy (P=.003) and alcohol and culture (P<.001) exhibited association with the message. The sentiment analysis carried out on the two themes revealed there were more negative than positive comments (47% vs 28%). CONCLUSIONS: The user engagement observed in this study was consistent with previous research. The numbers reported for views, likes, and shares may be seen as unique interactions over the fixed period of the campaign; however, survey research would be required to find out the true evaluative worth of these metadata. A close examination of the comments, employing text mining, revealed that the message was not accepted by a majority of the target segment. Self-identity and conformity theories may help to explain these observed reactions, albeit warrant further investigations. Although the comments were predominantly negative, they provide opportunities to engage back with the women. The one-way communication format followed in this campaign did not support any two-way engagement. Further investigation is warranted to establish whether using a two-way communication format would have improved the acceptability of such public health messages delivered via social media. The findings of this study caution using a one-way communication format to convey public health messages via Facebook's advertising channel.

Exploring reasons for ethnic disparities in diet- and lifestyle-related chronic disease for Asian sub-groups in New Zealand: a scoping exercise.

OBJECTIVES: The current study aimed to explore if the impact of various risk factors for chronic disease differed for people of Chinese, Indian and New Zealand European and Other (NZEO) ethnicities. DESIGN: Data analysed for this paper was extracted from the 2003-04 and the 2006-07 NZ Health surveys for adults aged 25-70 which used a cross-sectional survey design. Data from both the survey waves were combined and all statistical analysis was done using SAS version 9.2 or 9.3. Ethnicity of participants was coded using a priority-based classification system as (1) Indian, (2) Chinese, (3) Other Asian, (4) NZEO, (5) Maori and (6) Pacific. Only data for Indians, Chinese and NZEO were used for the current study. Prevalence estimates and 95% confidence intervals for chronic disease and the associated risk factors were generated to describe the sample. Logistic regression analysis was used to examine whether the difference in the change in risk of chronic disease with different exposures was different according to ethnicity. RESULTS: Higher deprivation resulted in increased risk of chronic disease in Indian and Chinese males but not in NZEO males (p = .03). There was a weak evidence for a differing effect of physical activity (p = .10) on chronic disease with the protective effect not seen in Indian or Chinese participants. CONCLUSION: The results of the current study indicate that some factors such as socio-economic deprivation and physical activity may impact differently on the prevalence of chronic disease according to ethnicity. The authors recommend further investigation of these factors using improved and innovative methodology and high-quality ethnicity data to better understand the factors underpinning ethnic disparities in disease prevalence among Asian sub-groups.

Implication of alcohol consumption on aggregate wellbeing.

AIMS: The effects of drinking alcohol extend beyond the individuals concerned to the wider community. While there is recognition of such a global implication, currently no study has quantified the impact of alcohol consumption on aggregate wellbeing. This study aims to address this gap and attempts to investigate the impact of various levels of alcohol consumption on aggregate happiness. METHODS: The study was carried out on a random selection of participants ( n = 1,817) drawn from the 3Di consumer panel, comprising over 170,000 New Zealanders aged 18 and above. Using a subjective happiness scale (SHS) in conjunction with the Alcohol Use Disorders Identification Test (AUDIT), investigation was carried out to find whether drinking behaviour affected aggregate happiness. RESULTS: SHS and AUDIT scores were negatively correlated and the strength of the correlation increased with the intensity of problematic drinking. Regression analysis showed that the beta coefficient was positive for the low-risk (.074) and negative for the high-risk (-.081) category, suggesting approaches to intervene with the growing problem of alcohol consumption in modern societies. CONCLUSION: Measurements of happiness can explain the global implication of alcohol in wellbeing terms. The findings of this study indicated that low-risk drinkers affected aggregate happiness positively, whereas high-risk drinkers affected aggregate happiness negatively. While the latter observation is not new, the former raises the need to promote moderation in drinking alcohol for the common good of everyone.

Dietary Transition in the South Asian Diaspora: Implications for Diabetes Prevention Strategies.

BACKGROUND: South Asians (SA) have a four to five fold higher risk for type 2 diabetes mellitus (T2DM) in comparison to other Asian migrant groups. Dietary patterns have been attributed as an important independent modifiable risk factor. OBJECTIVE: The aim of this review is to document the dietary patterns of SA migrants in Western countries and to summarize the evidence for the association of dietary patterns with T2DM and its predisposing factors. METHODS: Using key search words articles from 1990 onwards were sourced from MEDLINE Pro- Quest and PubMed (not MEDLINE) databases for this narrative review. RESULTS: A significant shift in meal pattern with frequent dining out and eating fast foods, traditional festival foods and Western desserts and snacks was common among SA. Consumption of potatoes, dairy, oil, meat and fish increased and beans, lentils, fruits and vegetables decreased post-migration. "Animal protein" and "fried snacks, sweets and high-fat dairy" were associated with greater insulin resistance and lower HDL cholesterol. A "mixed" dietary pattern was associated with obesity and hypertension and a "western" dietary pattern was associated with overall risk for Metabolic Syndrome. A 70% increase in the odds of diabetes per standard deviation in gram of protein intake was also observed. CONCLUSION: Dietary patterns pave the way to develop diabetes and other obesity related diseases among SA as duration of residence increases. The first five years since migration maybe a window of opportunity to provide targeted interventions to ensure maintenance of healthy dietary habits.

A profile of New Zealand 'Asian' participants of the 2008/09 Adult National Nutrition Survey: focus on dietary habits, nutrient intakes and health outcomes.

OBJECTIVE: To investigate similarities and differences in dietary habits, nutrient intakes and health outcomes of South Asians (SA) and East and South-East Asians (ESEA) and the New Zealand European and Other (NZEO) group, and to examine differences within 'Asian' subgroups according to duration of residence. DESIGN: Nutrient intake data from 24 h diet recalls and data from the dietary habits questionnaire, anthropometry and biochemical analyses from the cross-sectional 2008/09 Adult National Nutrition Survey in New Zealand were compared for participants categorized as SA, ESEA and NZEO. SUBJECTS: Adults aged 15 years and older (n 2995). SETTING: New Zealand households. RESULTS: SA were more likely to 'never' eat red meat in comparison to NZEO (P<0.001) and among females also in comparison to ESEA (P<0.05). Intakes of fats and some micronutrients (riboflavin, vitamin B6, B12, Se) were lower among SA than NZEO (P<0.05). Lower intakes of Zn and vitamin B12 were reported by SA females compared with ESEA and NZEO females (P<0.05). A higher percentage of SA were obese using ethnic-specific cut-offs, had lower indices of Fe status and reported diagnosed diabetes compared with NZEO and ESEA. Recent SA male migrants had higher intakes of ß-carotene, vitamin C and Ca compared with long-term migrants (P<0.05). CONCLUSIONS: The results of the present study indicate that dietary habits, nutrient intakes, blood profile and body size differ significantly between Asian subgroups. It also provides some evidence for changes in dietary intakes according to duration of residence especially for SA males.

Warning labels on alcohol containers as a source of information on alcohol consumption in pregnancy among New Zealand women.

BACKGROUND: The addition of a warning label on alcohol containers is a policy measure yet to be adopted in New Zealand. The current study aims to report the rating of a national sample of 16-40-year-old non-pregnant New Zealand women on a warning label on alcohol containers as a source of information on risks associated with alcohol consumption in pregnancy. METHODS: A nationwide, cross-sectional survey was conducted in 2005 on a random sample of 1129 non-pregnant women aged 16-40 years. Data were collected via an interviewer-administered questionnaire using a Web-assisted telephone interviewing system. RESULTS: Overall, the survey achieved a response rate of 65%. Just over half of the women surveyed (53%; 95% CI 50.2-56.0) gave a high rating for a warning label as a source of information on alcohol consumption in pregnancy. Women below 30 years of age and who were of non-European ethnicity were more likely to give a high rating compared with older women and European women, respectively (p<0.05). CONCLUSIONS: Introduction of a warning label on alcohol containers in New Zealand may be effective in increasing awareness of the risks associated with alcohol consumption in pregnancy among at-risk drinkers, namely, younger women and New Zealand women of Maori and Pacific ethnicities. However, to accentuate behavioural change, other prevention approaches within a health promotion framework may be needed to complement this approach.

Opinions of non-pregnant New Zealand women aged 16-40 years about the safety of alcohol consumption during pregnancy.

INTRODUCTION AND AIMS: Premenopausal women's opinions on the safety of alcohol consumption during pregnancy are not well documented. This study aims to assess the opinions of New Zealand women on the safety of alcohol consumption in pregnancy and the sociodemographic and lifestyle factors associated with these opinions. DESIGN AND METHODS: A nationwide, cross-sectional survey was conducted in 2005 on a random sample of 1109 non-pregnant women aged 16-40 years. Data were collected via an interviewer-administered questionnaire using a web-assisted telephone interviewing system. RESULTS: Overall, 44% (95% confidence interval 41-47) of women surveyed were of the opinion that no alcohol is safe in pregnancy. Those who stated that no alcohol is safe in pregnancy were more likely to be of Pacific Island ethnicity (P < 0.05) and abstainers (P < 0.001). Women who drank more than two standard drinks of alcohol on a typical occasion and/or who binged were more likely to be of the opinion that 'more than one standard drink' of alcohol is safe on a typical drinking day during pregnancy (P < 0.001). DISCUSSION AND CONCLUSIONS: The association of drinking style with opinions about the safety of alcohol consumption in pregnancy accentuates the need for public health education to reduce risky drinking behaviours in this population. Such efforts may also address the risk associated with many women unintentionally drinking in early pregnancy, especially if the pregnancy is unplanned.

Alcohol and tobacco consumption among 6-24-months post-partum New Zealand women.

Maternal alcohol or tobacco consumption may negatively impact the fetus and breastfeeding infants. Maternal tobacco consumption is also known to negatively affect exposed young children. The current study therefore aimed to assess the prevalence of these lifestyle behaviours in a sample of 6-24-months post-partum women and to elucidate socio-demographic and maternal factors associated with these behaviours. A community-based cross-sectional survey was conducted on 6-24-months post-partum women (n = 318) in three cities in the South Island of New Zealand. Self-reported data on current alcohol and tobacco consumption were collected from these women using a self-administered questionnaire. The results showed that nearly 72% and 23% of these women consumed alcohol and tobacco, respectively. Being Caucasian, having a higher level of education and higher household income were significant factors for alcohol consumption, while being of younger age and of lower educational status were significant factors for tobacco consumption. Pregnancy was associated with lower odds for alcohol consumption (0.07; P < 0.001), but not with lower odds for tobacco consumption. In contrast, breastfeeding was not associated with lower odds of alcohol consumption (0.08; P = 0.075). In conclusion, younger women with lower levels of education and household income must be targeted for public health education on the negative effects of tobacco consumption on their own health and on the health of their children.