Vili Nosa

Aims: Cardiovascular disease (CVD) is the leading cause of death in Aotearoa New Zealand (NZ), including for Māori, the Indigenous population. Sodium intake is a modifiable CVD risk factor. In 2021, the World Health Organization (WHO) released sodium reduction benchmarks for 58 packaged food categories. We aimed to estimate the health, health-sector cost, and equity impacts of mandating these benchmarks in NZ. Methods: Nationally representative data on household food purchases, packaged food sodium content, and dietary intake were used to estimate baseline sodium consumption (2011) and changes following implementation of the WHO benchmarks. A dietary multi-state life-table model estimated impacts on health-adjusted life years (HALYs) and health system costs (2011 NZ$, 3% discount rate) over the remaining lifetime of the 2011 NZ population (n = 4.4 million). Analyses examined impacts by sex and for Māori. Results: Mandatory reformulation was estimated to reduce sodium intake by 470 mg/day per person (1.18 g salt), a 22% reduction from baseline. Across population groups, age-standardised reductions ranged from 380 to 660 mg/day (22-23%), generating an estimated 55,600 HALYs (95% uncertainty interval 19,100-90,000) and NZ$535.2 million in health-system cost savings (95% UI: 183.0-914.6 million) over the population lifetime. Māori gained 11,600 HALYs (95% UI: 4,900-17,700), equivalent to 17.2 HALYs per 1,000 population, compared with 11.8 per 1,000 among non-Māori. Conclusion: Mandating WHO sodium benchmarks in NZ could substantially reduce sodium intake, improve population health, reduce health sector costs, and advance health equity. Findings support adoption of this strategy in Aotearoa NZ. Lay summary: Requiring food manufacturers in Aotearoa New Zealand to meet World Health Organization sodium (salt) targets could reduce salt intake, prevent disease, save health sector costs, and improve health equity for Māori. Mandatory sodium reformulation of packaged foods was estimated to reduce average sodium intake by 470 mg per person per day (equivalent to 1.18 g of salt), a 22% reduction from current levels, resulting in health benefits across the population. The policy was estimated to generate 55,600 health-adjusted life years and save NZ$535 million in healthcare costs over the population’s lifetime, with greater health gains per person for Māori than non-Māori, helping reduce health inequities.

Purpose of Review: This scoping review synthesises existing evidence from systematic reviews on the effectiveness and implementation of digital mental health interventions among community-dwelling older adults. Recent Findings: Twenty-one systematic reviews were included. Results showed that a range of digital tools demonstrate potential to improve common mental health and psychosocial symptoms among older adults, with most evidence concentrating on digital tools to improve depressive symptoms. However, reviews’ findings were frequently mixed and accompanied with cautions that primary evidence under-reported key elements such as theoretical underpinnings, intervention design process, participant demographics, intervention acceptability and usability, participant retention, adverse events, and long-term outcomes. Summary: More rigorous research and reporting are needed to understand the mechanisms underpinning effective digital mental health interventions for older adults and how they might mitigate the age-related digital divide in mental health services.

Background: Article 5.3 of the WHO Framework Convention on Tobacco Control requires Parties to protect policies from tobacco industry interference, yet implementation remains weak internationally. Aotearoa New Zealand’s (Aotearoa NZ) is seen as a leader in tobacco control, yet little is known about its implementation of Article 5.3 protections. This study examines these protections as well as existing transparency measures in light of the 2024 repeal of world-leading tobacco control policies. Methods: Interviews with current and former: public health experts, politicians, officials and political journalists, and analysis of key texts. Results: Aotearoa NZ’s Article 5.3 implementation and scope is constrained, leaving invisible and exploitable paths of influence. Public health experts argued protections have been neglected from the start. Politicians were unaware of Article 5.3 obligations, and reported limited guidance on industry interactions. These gaps are compounded by non-existent lobbying laws and ill-equipped transparency measures. Conclusion: Despite the country’s reputation for strong tobacco controls, structural policy and implementation failures leave Aotearoa NZ’s health policies vulnerable to industry interference. Aotearoa NZ and other Parties should consider institutionally embedding comprehensive Article 5.3 protections to safeguard policy decisions from tobacco industry influence. WHAT THIS PAPER ADDS: What is already known on this topic: Tobacco industry interference remains the biggest barrier to tobacco control policies, with evidence consistently identifying gaps in Parties implementation of Framework Convention on Tobacco Control Article 5.3 protections. Parties often rely on pre-existing measures such as lobbying laws. What this study adds: This is the first study examing Aotearoa NZ’s implementation of Article 5.3. It shows that despite its reputation as a tobacco control leader, implementation is severely limited and pre-existing measures are inadequate, enabling a system in which industry interference can go on unseen. How this study might affect research, practice or policy: By identifying how structural policy gaps enable industry interference, this study highlights the need for comprehensive institutional embedding of Article 5.3 protections across government, and consideration of its codification into law.

Introduction: Sociocultural determinants are pivotal in influencing the health of I‐Kiribati women in New Zealand, shaping behaviours, ideals and attitudes related to obesity risk. Although obesity is driven by lifestyle factors deeply embedded within a sociocultural context, the research area remains relatively unexplored. The aim of this study is to explore the sociocultural factors of obesity and its implications on health. Methods: This qualitative study employed te maroro model as a culturally appropriate research guide. Data were collected through 16 one‐on‐one semi‐structured interviews, which were offered in person or online. Interviews were transcribed, translated and analysed using te maroro model. Relevant themes were highlighted and explored further in the findings. Findings: The findings revealed that Kiribati body size ideals, stigma against thinness and food etiquette contribute to behaviours associated with obesity risk. The influence of these sociocultural factors varied among participants, shaped by their experiences with migration, exposure to western culture and teachings from communities and Elders in New Zealand. While there is growing awareness that larger body sizes are linked to poor health, the preservation of traditional cultures and beliefs, such as te riring , a Kiribati massage practice, was prominent, as it remains closely tied with maintaining cultural identity. Conclusion: The study builds on existing knowledge around food insecurity and offers new insights highlighting the importance of sociocultural context when exploring health behaviours pertinent to obesity risk.

Hazardous drinking behaviours have manifested among Pacific male populations, but the available literature is scarce. This study explored the cultural and environmental influences on alcohol consumption amongst Tongan males aged between 18–24 years, enrolled at the University of Auckland. This explored risk and protective factors and recommendations to address hazardous drinking behaviours among Tongan males and among university students. This qualitative research carried out 12 face-to-face, one-on-one, semi-structured interviews with Tongan male students from the university. The interviews were analysed thematically adopting the Kakala model of teu (to prepare), toli (to pick), tui (to weave), and luva (to gift) to ensure processes were culturally meaningful. This study found males expressed their desire to fakafeohi (socialise) drove their alcohol consumption. Traditional values including anga fakatonga (the Tongan way of life), and the role of the fahu (eldest paternal aunt) and the faifekau (church minister) were cultural factors that steered them away from alcohol consumption. The influence of kava was twofold, both driving alcohol consumption and serving as a culturally appropriate alternative. The facilitation of family-centred strategies can also strengthen support systems and encourage abstinence through high-ranking family members within a Tongan context. The Tongan males acknowledged they were exposed to “alcogenic environments” at the university, with peer pressure and parental drinking habits supporting hazardous drinking behaviours. This study highlights the need to reshape hazardous behaviours among Tongan male students to promote healthier alternatives, develop cultural competence, establish support systems, and foster environmental resilience within the university environment and student experiences.

The perspectives of parental involvement among Pacific and minority populations with hearing loss are influenced by a variety of social, economic, and cultural factors. This review utilised Arksey and O'Malley's [(2005). Scoping studies: towards a methodological framework. International Journal of Social Research Methodology. 8(1):19–32. https://www.tandfonline.com/doi/full/10.1080/1364557032000119616 .] protocol to (1) scope peer‐reviewed and grey global literature regarding parental involvement among Pacific and minority populations with hearing loss and (2) identify research gaps. The review showed that poverty, religion, socioeconomic status, and stigma are important factors in the beliefs and actions surrounding parental involvement and manifestation of hearing loss among minority populations. Societal and family culture were significant determinants in how parental behaviours and practices developed. The role of family, and of women were pivotal in the perceptions of hearing loss and the hearing experiences of children. Parents reported that hearing care services were not family‐centred and had limited social and parental support. Parental involvement operates as a risk or protective factor in the health of their children. The complexity of cultural understandings of hearing loss and strong cultural ideals surrounding Pacific children, parents and family means parental involvement provides an important perspective. Parental involvement could be utilised as an avenue to address inequitable outcomes in hearing health service provision among Pacific and minority populations.

Introduction: Pacific peoples experience inequity in accessing hearing health care and are disproportionately exposed to the underlying determinants impacting ear and hearing health in Aotearoa New Zealand. Understanding community members’ worldviews, including perspectives, beliefs and values, is essential in developing appropriate and responsive hearing healthcare services to meet the needs of Pacific peoples. Aim: The purpose of this paper is to understand the worldviews, knowledge and beliefs held by Pacific peoples regarding hearing health in Aotearoa New Zealand. Methods: A mixed-methods approach was used. Twelve semi-structured face-to-face interviews were conducted with Pacific community members. Twenty-five participants completed an online questionnaire. A simultaneous, integrated mixed-methods approach was used to analyse the qualitative and quantitative data. Results: Five main themes were established, which were: The Meaning of Hearing; Causes of hearing loss; Consequences of hearing loss and Disability; and Improving health care for ear disease and hearing loss. Discussion: Pacific peoples value hearing health to communicate and connect with their families and communities. Participants highlighted the importance of hearing health across the life course. Although the study findings revealed there is potentially less stigma and shame around hearing loss in New Zealand, denial and fatalistic attitudes towards hearing loss may delay some people from seeking healthcare services. Participants expressed key ways in which the health system can be more responsive to the hearing health needs of Pacific peoples in Aotearoa New Zealand.

Background: New Zealand was one of the first countries to adopt an elimination strategy based on a four-tier Alert Level system that included strict lockdowns at levels three and four. The lockdowns meant shutting out external social networks and being confining to individual household ‘bubbles’ only. This presented challenges for minority Pasifika communities in New Zealand as their cultural values are based on social bonding, interconnectedness, community engagement and caring for each other. The aim of this research was to conduct a small-scale pilot study to test and refine the study design and identify the major challenges faced by Pasifika communities in relation to accessing health, social and mental services while in lockdown. Methods: This exploratory study was designed using an online anonymous questionnaire survey targeting people who identified as Pasifika. A total of eighty-seven respondents were included in our analyses following the questionnaire survey. Results: Five main barriers to accessing health, social and mental health services during lockdowns were identified; (1) unavailability of or limited services; (2) fear of contracting the virus; (3) perception of high costs associated with seeking medical assistance; (4) transportation difficulties; and (5) lack of time. Almost a quarter of the respondents reported losing their jobs, 80% indicated a decline in their household income and more than half experienced some form of psychosocial distress while in lockdown. Conclusions: The findings of this research highlight existing challenges faced by Pasifika communities in adequately accessing essential services. Future research can focus on the key barriers to access identified in this research to gain a deeper understanding of services and its interaction with Pasifika communities during lockdowns.

Background: The Pacific community in New Zealand experienced an increased risk of COVID-19 transmission due to delayed contact tracing, along with a disproportionate prevalence of health challenges. The community is representative of a diverse population who proudly identify with the vibrant Pacific Island nations of Samoa, Tonga, Cook Islands, Niue, Fiji, etc. Pacific communities in New Zealand face a higher burden of health challenges compared to other groups. These challenges include obesity, high blood pressure, diabetes, mental health disorders, respiratory issues, smoking, excessive alcohol consumption, disabilities, and chronic conditions. Concerns were raised regarding the oversight of Pacific community views in the initial pandemic response planning. Pacific healthcare professionals expressed concerns about inadequate state support and the need for active involvement in decision making. Methods: This article reports thematic analyses of text data gained from open-ended questions from a purposive anonymous online survey completed by Pacific healthcare professionals in New Zealand. Results: The participants shared their experiences and opinions, which generated four major themes highlighting priority health needs and challenges. These themes included the necessity for a culturally appropriate healthcare plan, adequate resourcing, addressing discrimination, and emphasising a united and collaborative effort for consistency. The research’s limitation is the narrow scope of open-ended questions in the questionnaire survey. However, conducting semi-structured face-to-face interviews can provide more in-depth data and offer further insights beyond the four broad themes identified in the analysis. Conclusions: The findings can inform the development of future research to provide more in-depth data and offer further insights beyond the four broad themes identified in the analysis. This will help develop future tailored healthcare delivery plans that address specific Pacific community needs.

By Vili Nosa, Atefeh Kiadarbandsari & 2 more. This study explored the health profile of Niuean tertiary students in NZ. Findings showed a high risk of cardiovascular disease, reported health care unavailability, domestic violence, and mental health problems.