Actigraphy is often used to measure sleep in pediatric populations, despite little confirmatory evidence of the accuracy of existing sleep/wake algorithms. The aim of this study was to determine the ...performance of 11 sleep algorithms in relation to overnight polysomnography in children and adolescents.
One hundred thirty-seven participants aged 8-16 years wore two Actigraph wGT3X-BT (wrist, waist) and three Axivity AX3 (wrist, back, thigh) accelerometers over 24-h. Gold standard measures of sleep were obtained using polysomnography (PSG; Embletta MPRPG, ST + Proxy and TX Proxy) in the home environment, overnight. Epoch by epoch comparisons of the Sadeh (two algorithms), Cole-Kripke (three algorithms), Tudor-Locke (four algorithms), Count-Scaled (CS), and HDCZA algorithms were undertaken. Mean differences from PSG values were calculated for various sleep outcomes.
Overall, sensitivities were high (mean ± SD: 91.8%, ± 5.6%) and specificities moderate (63.8% ± 13.8%), with the HDCZA algorithm performing the best overall in terms of specificity (87.5% ± 1.3%) and accuracy (86.4% ± 0.9%). Sleep outcome measures were more accurately measured by devices worn at the wrist than the hip, thigh or lower back, with the exception of sleep efficiency where the reverse was true. The CS algorithm provided consistently accurate measures of sleep onset: the mean (95%CI) difference at the wrist with Axivity was 2 min (-6; -14,) and the offset was 10 min (5, -19). Several algorithms provided accurate measures of sleep quantity at the wrist, showing differences with PSG of just 1-18 min a night for sleep period time and 5-22 min for total sleep time. Accuracy was generally higher for sleep efficiency than for frequency of night wakings or wake after sleep onset. The CS algorithm was more accurate at assessing sleep period time, with narrower 95% limits of agreement compared to the HDCZA (CS:-165 to 172 min; HDCZA: -212 to 250 min).
Although the performance of existing count-based sleep algorithms varies markedly, wrist-worn devices provide more accurate measures of most sleep measures compared to other sites. Overall, the HDZCA algorithm showed the greatest accuracy, although the most appropriate algorithm depends on the sleep measure of focus.
Aotearoa New Zealand plans to greatly reduce tobacco retail outlets, which are concentrated in areas of higher deprivation and perpetuate health inequities caused by smoking and borne particularly by ...Māori. However, we lack in-depth analyses of how this measure could affect people who smoke.
We undertook in-depth interviews with 24 adults from two urban areas who smoke. We used a novel interactive mapping approach to examine participants' current retail outlets and their views on a scenario where very few outlets would sell tobacco. To inform policy implementation, we probed participants' anticipated responses and explored the measure's wider implications, including unintended impacts. We used qualitative description to interpret the data.
Most participants anticipated accommodating the changes easily, by using alternative outlets or bulk-purchasing tobacco; however, they felt others would face access problems and increased costs, and greater stress. They thought the policy would spur quit attempts, reduce relapse among people who had quit and protect young people from smoking uptake, and expected more people to switch to alternative nicotine products. However, most foresaw unintended social outcomes, such as increased crime and reduced viability of local businesses.
Many participants hoped to become smoke-free and thought retail reduction measures would prompt quit attempts and reduce relapse. Adopting a holistic well-being perspective, such as those developed by Māori, could address concerns about unintended adverse outcomes and provide comprehensive support to people who smoke as they adjust to a fundamental change in tobacco availability.
Abstract
Background
Despite measures to reduce young people’s access to electronic cigarettes (ECs), or “vapes”, many countries have recorded rising youth vaping prevalence. We summarised studies ...documenting how underage youth in countries with minimum age sales restrictions (or where sales are banned) report accessing ECs, and outline research and policy implications.
Methods
We undertook a focused literature search across multiple databases to identify relevant English-language studies reporting on primary research (quantitative and qualitative) and EC access sources among underage youth.
Results
Social sourcing was the most prevalent EC access route, relative to commercial or other avenues; however, social sourcing dynamics (i.e., who is involved in supplying product and why) remain poorly understood, especially with regard to proxy purchasing. While less prevalent, in-person retail purchasing (mainly from vape shops) persists among this age group, and appears far more common than online purchasing.
Conclusions
Further research examining how social supply routes operate, including interaction and power dynamics, is crucial to reducing youth vaping. Given widespread access via schools and during social activities and events, exploring how supply routes operate and evolve in these settings should be prioritized. Inadequate compliance with existing sales regulations suggest greater national and local policy enforcement, including fines and licence confiscation for selling to minors, is required at the retailer level.
Abstract Introduction Young people who use nicotine‐containing electronic cigarettes, or ‘vapes’, risk becoming addicted to these products. While several studies document dependency symptoms, few ...report in‐depth qualitative analyses of addiction. Methods We explored experiences of self‐reported vaping addiction using in‐depth interviews with 22 young people aged 16–20 years who vaped and lived in Aotearoa New Zealand. Our semi‐structured interview guide probed participants' early experiences and how they progressed from experimentation to addiction and explored how addiction affected their perceptions and daily routines. We used an inductive reflexive thematic analysis approach to interpret the data. Results Vaping's pervasiveness piqued participants' curiosity and encouraged trial. Most transitioned from experimentation to addiction within a couple of months; while a minority described a slower progression, nearly all felt irritable, angry or uncomfortable if they had to delay vaping. Intense cravings disrupted school and work routines and dictated how they spent their time. Many deeply regretted vaping and some suffered shame and embarrassment. These participants saw vaping as a threat to the well‐being of younger youth, which they tried to shield from addiction. Discussion and Conclusions We go beyond earlier studies by probing the burden vaping comes to represent, offering new insights into young people's everyday experiences of vaping addiction. In addition to informing health promotion campaigns, our findings could inform policy directions. Understanding the speed with which addiction can occur, its impact on daily life, and the considerable regret many felt could help inform a more strategic and sorely needed approach to reducing youth vaping.
Abstract
Introduction
Tobacco companies claim that substantially reducing tobacco retail outlets in Aotearoa New Zealand will increase illicit tobacco trade and crime. However, we know little about ...whether people who smoke anticipate using illicit tobacco once this measure is implemented. Exploring current illicit tobacco use and expected market development would clarify the likely scale of this potential problem.
Aims and Methods
We undertook online in-depth interviews with 24 adults who smoke and explored their experiences of illicit tobacco, perceptions of illicit market growth once legal tobacco became less available, intentions to engage in this market, and potential measures that could curb illicit market development. We interpreted the data using a qualitative descriptive approach.
Results
Few participants had purchased illegally imported or stolen tobacco. While most did not know how to access illicit tobacco products, many expected illicit trade and crime would increase, if legal tobacco became difficult to access. While cheaper tobacco appealed to many, most perceived illicit supply routes as unsafe and saw products obtained via these sources as likely to be of poor quality. Few suggested measures to control illicit markets, though a minority called for social reforms to reduce poverty, which they thought fueled illegal practices.
Conclusions
Although illicit trade may appear to threaten new policy initiatives, participants’ limited knowledge of these markets and concerns regarding product safety suggest illegal tobacco may pose less of a threat than tobacco companies have claimed. Policy makers should not be deterred from reducing tobacco availability by industry arguments.
Implications
Although participants believed illicit trade would increase if the number of tobacco retailers was substantially reduced, few anticipated purchasing illegal tobacco. They viewed supply routes as unsafe and product quality as likely to be low. Industry predictions that illicit tobacco trade will grow if tobacco becomes less available do not reflect how people who smoke expect to engage with these markets and should not deter the introduction of retail reduction measures.
Despite policies setting a minimum legal sales age, youth continue to access electronic cigarettes (ECs). Evidence of rising youth vaping prevalence in many countries suggests existing measures have ...serious loopholes and raise important questions about how youth source vaping products.
We explored how youth source ECs using in-depth interviews with 30 adolescents aged 16-17 who vaped at least once a month and lived in Aotearoa New Zealand. Our semi-structured interview guide probed participants' vaping experiences and how they developed and used social, quasi-commercial, and commercial supply routes to access ECs. We used an inductive reflexive thematic analysis approach to interpret the data.
Nearly all participants shared ECs with peers and sharing was the sole access route for some. Many used proxies, often older relatives or people they knew socially, to purchase ECs on their behalf; however, others recruited proxies by approaching previously unknown people they identified on social media. Participants also sourced ECs via quasi-commercial networks that existed within schools and on social media, and some purchased in their own right, usually from smaller retail outlets that did not ask for ID.
Disrupting social supply will be challenging, though reducing ECs' availability, appeal, and affordability could make social supply, including sharing and proxy purchasing, more difficult. Reports that youth purchase ECs from commercial retailers known to waive age verification suggests stronger monitoring and enforcement, along with escalating retailer penalties, is required.
Vaping access routes sit on a continuum from informal, spontaneous sharing to carefully planned commercial purchases.While supply via friends, siblings and other social contacts is an important means of access, nicotine dependence drives some to use riskier access routes, including approaching unknown people to act as proxy purchasers.Evidence young people identify non-compliant retailers suggests policy makers should monitor and enforce existing measures more stringently and consider additional penalties for recidivist under-age suppliers.A more comprehensive response that reduces the appeal, addictiveness, affordability, and availability of vaping products would address factors fostering and maintaining youth vaping.
New Zealand is considering a change in law to permit euthanasia and/or assisted dying (EAD). We reviewed 20 years of research to investigate New Zealanders' attitudes towards EAD, including those of ...health professionals. A systematic search was conducted using relevant databases. We identified 21 quantitative and 5 qualitative studies. For quantitative data, descriptive analyses were used to examine any demographic patterns that influenced attitudes. We reviewed the circumstances under which people think that EAD should be accessible, and which forms of EAD they support. All public attitude studies reported that the majority (68%) of respondents support EAD. There are few statistically significant demographic associations with attitudes toward EAD; exceptions include religiousity, educational attainment, and some ethnic groups. Health professionals' attitudes varied by speciality. Qualitative research was analysed for reoccurring themes; 'feeling like a burden' was evident across most studies. We conclude from the quantitative research that public attitudes are stable and a majority are open to legislative change. However, the qualitative research reveals the complexity of the issue and indicates a need for careful consideration of any proposed law changes. It is unclear what safeguards people expect if the law changes. We found little research involving vulnerable and marginalised populations.
The World Health Organization has identified the school community as a key setting for health promotion efforts, laying out its priorities in the Health-Promoting Schools (HPS) framework. This ...framework offers a comprehensive approach that has been adopted in countries around the globe, with defining characteristics focused around the school curriculum and environment. Nova Scotia (NS) adopted the HPS framework at a provincial level in 2005, but it has been variably implemented. We aimed to identify, categorize, and broadly describe the environment for HPS policies in NS. Four iterative steps were employed: (1) a scan of government and regional school websites to identify publicly available policies; (2) consultations with provincial departments with respect to policy relevance and scope; (3) cross-comparison of policies by two reviewers; (4) compilation of policies into an online database. Seventy policies at the provincial level and 509 policies across eight public school regions were identified. Policies focusing on a 'safe school environment' were most common; those addressing mental health and well-being, physical activity, nutrition and healthy eating, and substance use were among those least commonly identified. This scan provides a comprehensive overview of HPS-relevant policies in NS, along with relative proportions and growth over time. Our findings suggest areas of policy action and inaction that may help or hinder the implementation of HPS principles and values.
Purpose: Through active participant engagement, this project aimed to better comprehend the spiritual care needs of New Zealand cancer patients and their families and friends, and to gain further ...insight from others, including healthcare practitioners. Methods: A co-design process was undertaken, which involved presentations and interactive group workshops on the topic of spirituality and spiritual care. A facilitated, semi-structured discussion centred around three main topic areas: the meaning of spirituality; the documentation of spirituality in healthcare settings; current spiritual care development needs; and areas for improvement. The Framework Method was used to undertake an inductive analysis of the qualitative data in order to develop key themes according to topic area. Results: Key concepts constructed from our analysis of the three main topic areas include: Participants broadly understood spiritualty to be characterized by core values, expressions of love and kindness, and connectedness with others and/or with the environment; participants felt as if documentation of spiritual beliefs had the potential to inform others about their needs and wishes participants also recommended that opportunities be created for people to engage in conversation about spirituality, and that this should be undertaken purposefully. Importantly, responses often alluded to the great diversity of need when it comes to spiritual care. Conclusions: Integration of spiritual care into health system policies, intake and assessment processes, care plans, and training and professional development opportunities, are all required in order to reflect relevant national guidelines and strategies more effectively.
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