ObjectivesTo understand health disparities in cardiovascular disease (CVD) in the indigenous Māori of New Zealand, diagnosed and undiagnosed CVD risk factors were compared in rural Māori in an area remote from health services with urban Māori and non-Māori in a city well served with health services.DesignProspective cohort study.SettingHauora Manawa is a cohort study of diagnosed and previously undiagnosed CVD, diabetes and risk factors, based on random selection from electoral rolls of the rural Wairoa District and Christchurch City, New Zealand.ParticipantsScreening clinics were attended by 252 rural Māori, 243 urban Māori and 256 urban non-Māori, aged 20–64 years.Main outcome measuresThe study documented personal and family medical history, blood pressure, anthropometrics, fasting lipids, insulin, glucose, HbA1c and urate to identify risk factors in common and those that differ among the three communities.ResultsMean age (SD) was 45.7 (11.5) versus 42.6 (11.2) versus 43.6 (11.5) years in rural Māori, urban Māori and non-Māori, respectively. Age-adjusted rates of diagnosed cardiac disease were not significantly different across the cohorts (7.5% vs 5.8% vs 2.8%, p=0.073). However, rural Māori had significantly higher levels of type-2 diabetes (10.7% vs 3.7% vs 2.4%, p<0.001), diagnosed hypertension (25.0% vs 14.9% vs 10.7%, p<0.001), treated dyslipidaemia (15.7% vs 7.1% vs 2.8%, p<0.001), current smoking (42.8% vs 30.5% vs 15.2%, p<0.001) and age-adjusted body mass index (30.7 (7.3) vs 29.1 (6.4) vs 26.1 (4.5) kg/m2, p<0.001). Similarly high rates of previously undocumented elevated blood pressure (22.2% vs 23.5% vs 17.6%, p=0.235) and high cholesterol (42.1% vs 54.3% vs 42.2%, p=0.008) were observed across all cohorts.ConclusionsSupporting integrated rural healthcare to provide screening and management of CVD risk factors would reduce health disparities in this indigenous population.

In New Zealand (NZ) and other western countries, 1,2,3 tobacco taxation has lagged in addressing roll-your-own cigarettes and loose tobacco and has focused on increasing the relative cost of factory-made cigarettes, which has made roll-your-owns comparatively less costly and unintentionally created an incentive for smokers to switch to them. In NZ, roll-your-own use has increased since 1990. 4 Almost half of smokers report using roll-your-owns, and this includes approximately 61% of 15-19 year olds and 60% of Māori smokers. 4 These rates are greater than those reported in other countries. 2Young people may use roll-your-owns because they are cheaper than factory-made cigarettes, as smaller amounts of tobacco can be rolled in individual cigarettes, potentially to significantly less than the weight of a standard 0.7 gram manufactured cigarette.3 By 2010, in NZ there was a 14% difference in taxation between factory-mades versus loose tobacco, making roll-your-owns comparatively cheaper. 5,6 This study investigated roll-your-own use and implications for tobacco taxation. Methods are published elsewhere. 8 Of those who had ever smoked, 35% used roll-your-owns and a further 17% said they smoked them but also factory-mades when offered. For this research, they were combined into one category. Analysis used SPSS version 17. Statistical tests included Pearsons chi-square and logistic regression.Roll-your-own use was significantly more prevalent in the Māori samples (70% of Wairoa Māori current smokers, 71% of Christchurch Māori and 44% of Christchurch non-Māori, p=0.006). This was particularly evident in men (80% of Wairoa Māori men were current smokers, 76% of Christchurch Māori men and 36% of Christchurch non-Māori men, p=0.001). However, approximately 65% of women in the Māori samples also used roll-your-owns.Roll-your-own use tended to be more prevalent in Māori younger than 40 years (approximately 76% of current smokers in both Māori samples). However, more than 63% of Māori aged 40 and older also used them. In Wairoa Māori, 91% of current smokers in households with annual incomes under $30,000 used roll-your-owns (compared with 60% in households with incomes of NZ$30,000 and over) (p=0.001, 1 df). In Christchurch Māori, approximately 70% of smokers in both lower and higher income households used them.With Christchurch non-Māori as the reference group, logistic regression analysis of current smokers, predicting roll-your-own use, confirmed the existence of statistically significant differences between the samples (0.03). Other significant predictors were age (0.02), and total household income (0.01). The relationship between roll-yourown use and income was statistically significant, independent of age. Gender was not significant.Limitations include small sample and that the study was not designed to investigate why smokers chose roll-your-owns nor the use of cannabis rolled with loose tobacco. It also did not include the 15-19 year age group, however, we consider that if this age group had been included the results ...

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