Objective: To describe the health status over time of Māori secondary school students in New Zealand compared to European students.

Objectives: To develop a valid rurality classification for health purposes in Aotearoa New Zealand (NZ) that is technically robust and incorporates heuristic understandings of rurality.Setting: Our Geographic Classification for Health (GCH) is developed for all of NZ.Participants: We examine the distribution of the entire NZ population across rurality classifications, and use the National Mortality Collection to examine previously masked rural-urban differences in mortality. Outcome measures: Unadjusted all-cause mortality rates and rural:urban incidence rate ratios (IRRs). Results: The GCH modifies key population and drive time thresholds in the generic rurality classifications, thereby identifying 19% of the NZ population as rural. Rural and urban all-cause mortality rates and associated rural:urban IRRs vary considerably depending on rurality classification. The GCH finds a rural mortality rate 21% higher than for urban areas.Conclusions: The GCH identifies a distinct rural population, and highlights rural-urban inequities that are masked by generic classifications.

The purpose of this study was to (1) describe risk and protective factors associated with a suicide attempt for Māori youth and (2) explore whether family connection moderates the relationship between depressive symptoms and suicide attempts for Māori youth. Secondary analysis was conducted with 1702 Māori young people aged 12–18 years from an anonymous representative national school-based survey of New Zealand (NZ) youth in 2001. A logistic regression and a multivariable model were developed to identify risk and protective factors associated with suicide attempt. An interaction term was used to identify whether family connection acts as a moderator between depressive symptoms and a suicide attempt. Risk factors from the logistic regression for a suicide attempt in the past year were depressive symptoms (OR = 4.3, p < 0.0001), having a close friend or family member commit suicide (OR = 4.2, p < 0.0001), being 12–15 years old (reference group: 16–18 years) (OR = 2.7, p < 0.0001), having anxiety symptoms (OR = 2.3, p = 0.0073), witnessing an adult hit another adult or a child in the home (OR = 1.8, p = 0.001), and being uncomfortable in NZ European social surroundings (OR = 1.7, p = 0.0040). Family connection was associated with fewer suicide attempts (OR = 0.9, p = 0.0002), but this factor did not moderate the relationship between depressive symptoms and suicide attempt (χ2 = 2.84, df = 1, p = 0.09). Family connection acts as a compensatory mechanism to reduce the risk of suicide attempts for Māori students with depressive symptoms, not as a moderating variable.

Objective-To review Indigenous infant mortality, stillbirth, birth weight, and preterm birth outcomes in Australia, Canada, New Zealand and the United States.Methods-Systematic searches of published literature and a review and assessment of existing perinatal surveillance systems were undertaken. Where possible, within country comparisons of Indigenous to non-Indigenous birth outcomes are included.Results-Indigenous/non-Indigenous infant mortality rate ratios range from 1.6 to 4.0. Stillbirth rates, where data are available, are also uniformly higher for Indigenous people. In all four countries, the disparities in Indigenous/non-Indigenous infant mortality rate ratios are most marked in the post-neonatal period. With few exceptions, the rates of leading causes of infant mortality are higher among Indigenous infants than non-Indigenous infants within all four countries. In most cases, rates of small for gestational age and preterm birth were also elevated for Indigenous compared to non-Indigenous infants.Conclusions-There are significant disparities in Indigenous/non-Indigenous birth outcomes in Australia, Canada, New Zealand and the United States. These Indigenous/non-Indigenous birth outcome disparities fit the criteria for health inequities, as they are not only unnecessary and avoidable, but also unfair and unjust. KeywordsIndigenous; birth outcomes; infant mortality; stillbirth; birth weight; and preterm birth; Canada; Australia; New Zealand; United StatesThis is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

Background New Zealand’s Bowel Screening Pilot (BSP) used a mailed invitation to return a faecal immunochemical test. As a pilot it offered opportunities to test interventions for reducing ethnic inequities in colorectal cancer screening prior to nationwide programme introduction. Small media interventions (e.g. educational material and DVDs) have been used at both community and participant level to improve uptake. We tested whether a DVD originally produced to raise community awareness among the Māori population would have a positive impact on participation and reduce the proportion of incorrectly performed tests (spoiled kits) if mailed out with the usual reminder letter. Methods The study was a parallel groups pseudo-randomised controlled trial. Over 12 months, all Māori and Pacific ethnicity non-responders four weeks after being mailed the test kit were allocated on alternate weeks to be sent, or not, the DVD intervention with the usual reminder letter. The objective was to determine changes in participation and spoiled kit rates in each ethnic group, determined three months from the date the reminder letter was sent. Participants and those recording the outcomes (receipt of a spoiled or non-spoiled test kit) were blinded to group assignment. Results 2333 Māori and 2938 Pacific people participated (11 withdrew). Those who were sent the DVD (1029 Māori and 1359 Pacific) were less likely to participate in screening than those who were not (1304 Māori and 1579 Pacific). Screening participation was reduced by 12.3% (95% CI 9.1–15.5%) in Māori (13.6% versus 25.9%) and 8.3% (95% CI 5.8–10.8%) in Pacific (10.1% versus 18.4%). However, spoiled kit rates (first return) were significantly higher among those not sent the DVD (33.1% versus 12.4% in Māori and 42.1% versus 21.9% in Pacific). Conclusion The DVD sent with the reminder letter to BSP non-responders reduced screening participation to an extent that more than offset the lower rate of spoiled kits. Trial registration Australia and New Zealand Clinical Trials Registry ACTRN12612001259831. Registered 30 November 2013.