Jesse Kokaua

University of Otago · Christchurch School of Medicine and Health Sciences

The environment impacts the health of children and has lasting impacts over their life course. This is particularly important for tamariki (children, 0–14 years) and rangatahi (youth, 15–24 years) Māori who face persistent inequities and have an integral connection to the land. Yet, there is little nationwide research in this area. Using individual...

The environment, whether natural or built, is central to the health of Pacific Peoples, especially children and young people. However, little is known about health-promoting and health-constraining features of the environments where Pacific children (0–14 years) and young people (15–24 years) live in Aotearoa New Zealand. Using linked data from pop...

Studies have found early detection of autism is protective for an individual and their family. Fewer Pacific children are diagnosed with autism compared with non-Pacific children, and those who have significantly higher needs, suggesting an undercount of those diagnosed. The purpose of this study was to explore any association between parental educ...

Keynote Address ANZEA Conference, 10–12 October 2022

Objectives There is a well-established association between alcohol use, misuse, intoxication and self-harm, the latter of which is associated with suicide. This study aimed to better understand the association between proximity to alcohol outlets and the likelihood of young people presenting to hospital following self-harm. Methods This was a nati...

Aims/hypothesis Type 1 diabetes is one of the most common chronic diseases of childhood. It is hypothesised that the metabolic and psychosocial consequences of type 1 diabetes may affect educational outcomes; however, existing literature presents conflicting results. This study aimed to assess whether educational outcomes differ for young people wi...

Introduction Oral language skills are associated with children’s later self-regulation and academic skills; in turn, self-regulation in early childhood predicts successful functioning later in life. The primary objective of this study is to evaluate the separate and combined effectiveness of an oral language intervention (Enhancing Rich Conversatio...

Aims: Type 1 diabetes (T1D) is one of the most common chronic diseases of childhood. It is hypothesized that the metabolic and psychosocial consequences of T1D may affect educational outcomes, however extant literature presents conflicting results. This study aimed to assess whether educational outcomes differ for young people with and without T1D...

Young people experiencing mental health conditions are vulnerable to poorer educational outcomes for many reasons, including: social exclusion, stigma, and limited in-school support. Using a near-complete New Zealand population administrative database, this prospective cohort study aimed to quantify differences in educational attainment (at ages 15...

Aim: This study aims to provide an overview of the association between being in the custody of the chief executive of Oranga Tamariki (the child welfare agency of the New Zealand (NZ) government) and all-cause hospitalisation and mortality. Methods: This was a national retrospective cohort study using linked administrative data from the Integrat...

Aims: The combined oral contraceptive (COC) is the most commonly used hormonal contraceptive in Aotearoa New Zealand (Aotearoa/NZ). Currently there is limited data available on who uses COC in Aotearoa/NZ. The aims were to (i) define the population of reproductive-aged females in Aotearoa/NZ in 2018 and identify the rate of COC use among this grou...

Background: Mental health conditions often arise during adolescence, are multifaceted in aetiology, and may be related to the type of environment in which young people reside. This study used nationwide population-level data to investigate whether the environment a young person grows up in is associated with their mental health. Method: Data wer...

Objective: We investigated whether childhood social isolation was associated with retinal neural layer changes in adulthood, and whether this association was independent of other childhood or adulthood risk factors, including adult social isolation. Methods: Participants were members of the Dunedin Multidisciplinary Health and Development Study,...

Objective: Models of psychometric screening to identify individuals with neurodevelopmental disabilities (NDDs) have had limited success. In Aotearoa/New Zealand, routine developmental surveillance of preschool children is undertaken using the Before School Check (B4SC), which includes psychometric and physical health screening instruments. This s...

Objectives: The relationship between childhood anthropometric measurements and dental caries has an inconsistent evidence-base. This study investigated dental caries experience and body mass index (BMI) measurements of children aged 4 years in a national cohort, after accounting for key confounding variables. Methods: A near whole-population cro...

The aim of this study was to use longitudinal population-based data to examine the associations between childhood sexual abuse (CSA) and risk for adverse outcomes in multiple life domains across adulthood. In 937 individuals followed from birth to age 45y, we assessed associations between CSA (retrospectively reported at age 26y) and the experience...

Introduction: Autism is a lifelong neurodevelopmental condition that is estimated to impact 1 in 44 children. In Aotearoa New Zealand, the rate of autism among Pasifika children and young people (38.6 per 10,000 people) is substantively lower than other ethnic groups (67.5 for European and 47.2 for Māori); however, the complexities associated with...

Introduction: Pasifika young people of Aotearoa New Zealand are known to experience higher rates of mental health and addiction conditions (especially anxiety and depression), compared with young non-Māori/non-Pasifika (NMNP). However, there is little information about how well these issues are identified by mental health services.

Aim: To examine specialist mental health service, hospital discharge, and pharmaceutical dispensing data for emotional conditions (anxiety, depression), substance use, and self-harm for Māori compared to non-Māori/non-Pasifika (NMNP) youth. Methods: A novel population-level case identification method using New Zealand's Integrated Data Infrastru...

Kaupapa Māori early years provision (KM-EYP) has underpinned efforts to revitalise Māori language and culture throughout Aotearoa New Zealand. Although many tamariki and whānau have benefited from engagement in KM-EYP, less than 20% of tamariki Māori currently participate. Kaupapa Māori psychological research is needed to better understand what fac...

Background Oral language skills are associated with children’s later self-regulation and academic skills; in turn, self-regulation in early childhood predicts successful functioning later in life. Yet research to date has not tested the combined benefits of interventions for oral language and self-regulation skills. Objective The primary objective...

Self-harm and suicide are complex issues, with a myriad of causes. However, it is clear that reductions in problematic alcohol consumption is an important, evidence based suicide prevention strategy. Given the emphasis on reducing suicide rates in NZ, any policy and law change that will reduce alcohol consumption in the population is likely to prov...

Introduction Understanding normative patterns of change in kidney function over the life course may allow targeting of early interventions to slow or prevent the onset of kidney disease, but knowledge about kidney functional change prior to middle age is limited. This study used prospective longitudinal data from a representative birth cohort to ex...

Objectives: A wide inequality in incidence and severity of childhood oral health conditions between Pasifika and non-Pasifika in Aotearoa/New Zealand (Aotearoa/NZ) persists with some evidence that the gap is widening. To develop an evidence base for strengths-based solutions, this study seeks to investigate the association between parental educati...

Unnecessary hospitalisations for preventable or treatable conditions provides an indication of the health of a country and its systems. We present data on potentially avoidable hospitalisations of Māori and non-Māori non-Pacific (NMNP) under-25-year-olds for medical conditions during the period 2000–2019, with particular focus on the magnitude of i...

For Pacific children in Aotearoa New Zealand under 20 years of age, this study investigates whether parental education is protective in terms of hospitalisations. For 139,686 Pacific and 659,055 other (non-Māori/non-Pacific) children, a population data extract for them and their parents was used from linked 2013 Census, health and demographic data....

Importance: Autistic students often experience poor educational outcomes that have implications for later life, including unemployment, interactions with the criminal justice system, increased risk for substance abuse, and low socioeconomic status. Improving educational outcomes is critical for ensuring that autistic young people can reach their p...

Aim: To examine the 20-year trends in socio-economic inequities in hospitalisations of Māori and non-Māori non-Pacific (NMNP) under-25-year olds in Aotearoa New Zealand. Methods: Hospital discharge data for Māori and NMNP taitamariki aged under-25 years were extracted from the National Minimum Dataset for the period 2000-2019. Acute or arranged...

Pacific people continue to carry a disproportionately heavy social and health burden relative to their non-Pacific peers in New Zealand, and those with less formal education are experiencing social and health declines. Improving education and educational needs is seen as being central to decreasing these health inequities. While expansive, the empi...

Importance: The retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) have been proposed as potential biomarkers for Alzheimer disease (AD). Although a number of studies have shown that knowing the thickness of RNFL and GCL can help differentiate between patients with AD and healthy controls, it is unclear whether these associations are o...

Lay abstract: Sensationalist headlines and highly publicised criminal cases lead many in the public to believe that people with autism are more likely to engage in criminal behaviour. However, recent studies present an unresolved debate, and indicate this may not necessarily be the case. The aims of this study were to examine the prevalence of cri...

Objective: Post-traumatic stress disorder following injuries unrelated to mass casualty events has received little research attention in New Zealand. Internationally, most studies investigating predictors of post-injury post-traumatic stress disorder focus on hospitalised patients although most survivors are not hospitalised. We compared the preva...

Aim: The aims of this paper are to quantify the impact of parental education on the five-year incidence of mental health conditions (MHC) in Pacific young people and to investigate the influence of other factors. Method: The analyses in this paper used data extracted from Aotearoa/New Zealand’s Integrated Data Infrastructure (IDI). Data relating to...

Journal editorials, career features, and the popular press commonly talk of a graduate student mental health crisis. To date, studies on graduate student mental health have employed cross-sectional designs, limiting any causal conclusions regarding the relationship between entry into graduate study and mental health. Here, we draw on data from a lo...

Aim This study aimed to investigate the variability by ethnicity, socio‐economic status and location in coverage and testability of the universal B4 School Check vision screening in children aged 4–5 years in New Zealand. Methods Aggregated data from 1 July 2011 to 30 June 2015 were sourced from the Statistics New Zealand Integrated Data Infrastru...

The continued underserving of Māori and Pasifika communities by New Zealand universities has resulted in the need to hold universities and the wider tertiary education system to account through widespread data analysis. This paper analyses Māori and Pasifika enrolment in the Society and Culture and Natural and Physical Sciences fields of Aotearoa N...

Māori and Pacific academics make up less than 4% and 1% respectively of New Zealand professors. We investigated ethnic inequities in promotions and earnings in New Zealand universities. Using New Zealand’s Performance-Based Research Fund (PBRF) data (2003, 2012, 2018) we found that Māori and Pacific men and also women academics, compared with non-M...

We are drawn to this Talanoa in response to the call from Pacific Health Dialogue for frank and open discussion. Our contribution to the conversation is some reflections about our experience of academic health research as a collective of Māori and Pacific researchers trying to navigate within a large national research programme. Alongside this we w...

Background International data and guidance on prescribing for children and young people with autism spectrum disorder (ASD) are limited. National administrative datasets such as the New Zealand Integrated Data Infrastructure (IDI) may offer a cost-effective and sustainable way to monitor prescribing trends in the context of clinical and systemic ch...

Within New Zealand (NZ), Pacific people experience higher prevalence of mental disorder than non-Pacific people. Bilinguals are believed to have psychological advantages over monolinguals, although the empirical evidence base is equivocal. A prospective cohort of Pacific mothers was studied at 6 weeks (n = 1272), 1-year (n = 1135), and 2-year (n =...

Lay abstract: New Zealand has few estimates of the prevalence autism spectrum disorder and no national registry or data set to identify and track cases. This hinders the ability to make informed, evidence-based decisions relating to autism spectrum disorder. In this study, we utilised linked health and non-health data to develop a method for ident...

Aims: There is mounting concern that there is increasing severity in the oral health burden of children who have dental caries. This study aims to describe the current dentally examined rates of severe early childhood caries (S-ECC) among children aged five years within the Canterbury District Health Board (CDHB) region, overall and by major ethni...

This briefing investigates the ethnic profile of two forms of support for disabled children and young people in New Zealand using the Integrated Data Infrastructure. The two supports are the Ministry of Health’s Disability Support Services (DSS) and the Ministry of Education’s Ongoing Resourcing Scheme (ORS). We found evidence of unequal access to...

Background: In a novel endeavour we aimed to develop a clinically relevant case identification method for use in research about the mental health of children and young people in New Zealand using the Integrated Data Infrastructure (IDI). The IDI is a linked individual-level database containing New Zealand government and survey microdata. Methods:...

Using the Integrated Data Infrastructure (IDI) to investigate or research various social, cultural, health, or other related outcomes is appealing and has a lot of potential. The IDI offers sufficient numbers for researchers to investigate outcomes in Pacific communities to a level of detail not available in many studies. Additionally, it allows or...

Nakiro'anga ite au meitaki o tei 'āpi'i ia no te ora'anga pu'apinga no tātou te Vakevake a Te Moana Nui o Kiva e no'o nei i Aotearoa (Meitaki o te ‘Api'i) is a programme of research examining the benefits of education to health outcomes for Pacific families in Aotearoa using the Integrated Data Infrastructure (IDI) and it is an Health Research Coun...

Background In a novel endeavour we aimed to develop a clinically relevant case identification method for use in research about the mental health of children and young people in New Zealand using the Integrated Data Infrastructure (IDI). The IDI is a linked individual-level database containing New Zealand government and survey microdata. Methods We...

Background In a novel endeavour we aimed to develop a clinically relevant case identification method for use in research about the mental health of children and young people in New Zealand using the Integrated Data Infrastructure (IDI). The IDI is a linked individual-level database containing New Zealand government and survey microdata. Methods We...

Objective: To determine the extent to which ethnic differences in BMI Z-scores and obesity rates could be explained by the differential distribution of demographic (e.g. age), familial (e.g. family income), area (e.g. area deprivation), parental (e.g. immigration status), and birth (e.g. gestational age) characteristics across ethnic groups. Meth...

Technological advancements, a changing demography, and labour market demands mean that it is increasingly important to have a skilled Māori labour workforce. Māori students are graduating from universities in increasing numbers but little is known about their careers post-graduation. Our aim was to describe the early career aspirations and destinat...

The Integrated Data Infrastructure (IDI) incorporates national data collected by many of New Zealand’s government agencies, some non-government organisations, Census and other national surveys. Using the IDI for research into social, cultural, health, or other outcomes has become much more common, reflecting its research potential. The primary aim...

Background In a novel endeavour we aim to develop a clinically relevant case identification method for research into the mental health of children and young people in New Zealand using the Integrated Data Infrastructure (IDI). The IDI is a linked individual-level database containing New Zealand government and survey microdata. Methods We draw on di...

Literacy success lays the foundation for children's later educational, health, and well‐being outcomes. Thus, early identification of literacy need is vital. Using data from New Zealand's national preschool health screening program for fiscal years 2010/2011–2014/2015, demographic and health variables from 255,090 children aged 4 years were related...

Literacy success is critical to unlocking a child's potential and enhancing their future wellbeing. Thus, the early identification and redressing of literacy needs is vital. Pacific children have, on average, the lowest literacy achievement levels in New Zealand. However, this population is very diverse. This study sought to determine whether the c...

Increasing the numbers of Pacific Island students who graduate from New Zealand universities is important for the students’ futures, their families, communities and society in general. In this study, Pacific graduates (N = 365) who are participants in the Graduate Longitudinal Study New Zealand were asked to describe what factors helped or hindered...

Aims: To explore associations between experiences of mental illness, migration status and languages spoken among Pacific adults living in NZ. Methods: SURVEY FREQ and SURVEY LOGISTIC procedures in SAS were applied to data from Te Rau Hinengaro: The New Zealand (NZ) Mental Health Survey, a survey of 12,992 New Zealand adults aged 16 and over in 2003...

Aim. To describe the top five causes of preventable health conditions among Pacific children (Cook Island, Fijian, Niuean, Samoan, Tongan, Tokelauan) aged 0-4 years living in New Zealand (NZ), and to make comparisons of these rates with NZ’s population who were of neither Maori nor Pacific ethnicity (NMNP). Method. This study is a retrospective ana...

Higher education confers significant private and social benefits. Māori and Pacific peoples are under-represented within New Zealand universities and have poorer labour market outcomes (e.g., lower wages, under-represented in skilled professions). A New Zealand tertiary education priority is to boost Māori and Pacific success in an effort to improv...

Success in the first year of higher education is important for students’ retention beyond their first year and for completion of their undergraduate degree. Institutions therefore typically front-load resources and interventions in the first year. One such intervention is the Peer Assisted Study Sessions (PASS) program. This program is known in the...

Pacific peoples are a minority under-represented ethnic group in higher education in New Zealand. This article explores the effectiveness of a specific programme, which sought to improve outcomes of Pacific students in the tertiary environment. The aim of the evaluation was to determine the effectiveness of an intervention programme (2013-2015) to...

Māori (Indigenous New Zealand) university graduates are role models for educational success and are critical for the social and economic wellbeing of Māori whānau (extended family) and communities. In this study, Māori graduates (N = 626) from all eight New Zealand universities participated in the Graduate Longitudinal Study New Zealand between Jul...

Background The growing demand for a competent health workforce to meet the needs of increasingly diverse societies has been widely acknowledged. One medical school in New Zealand explored the integration of the commonly used patient-centred model approach, with an intersectional framework in the development of a cultural competency training program...

New Zealand tertiary institutions building medical capacity in the Pacific Islands

Acne is a highly prevalent condition during adolescence and young adulthood worldwide, with rates between 12% and 99%.[1-4] Rates in adulthood range up to 50%.[5] The effects of acne, regardless of severity, can be debilitating, affecting many life domains.[6-10]. Cross-sectional studies report associations between acne and anxiety, depression symp...

Pacific students are from a minority group in New Zealand who like minority groups in other countries find transition to university difficult and success elusive. Nowhere is that successful transition more important at the University of Otago than in Health Sciences First Year (HSFY) which is a competitive entry pathway to health professional cours...

To describe Pacific students in the first year of health sciences at tertiary level, their academic performance, and factors associated with academic outcomes. Routinely collected data for students who enrolled in the Health Sciences First Year (HSFY) programme at the University of Otago between 2007 and 2011, including their school National Certif...

Aim To describe Pacific students in the first year of health sciences at tertiary level, their academic performance, and factors associated with academic outcomes. Method Routinely collected data for students who enrolled in the Health Sciences First Year (HSFY) programme at the University of Otago between 2007 and 2011, including their school Nati...

Objectives: To: describe pre-injury characteristics of Pacific (n=239) and non-Pacific (n=2,611) participants and compare their outcomes three months after injury. Methods: Participants were New Zealand residents aged 18-64 years referred to the Accident Compensation Corporation's injury entitlement claims register. Univariate and multivariable...

To validate the EPDS as a screening tool for postnatal depression in Samoan and Tongan women living in New Zealand. 85 Samoan and 85 Tongan women who delivered babies at Middlemore Hospital from February 2009 to June 2010 completed the EPDS questionnaire and from 4 weeks after delivery followed by an interview using a Composite International Diagno...

The comorbidity of mental disorders with chronic physical conditions is known to have important clinical consequences, but it is not known whether mental-physical comorbidity influences mental health treatment seeking. This study investigates whether the presence of a chronic physical condition influences the likelihood of seeking treatment for a m...

To investigate whether children in sole-parent families in New Zealand bear excess risks of poor mental and physical health relative to children in two parent families. DATA SOURCES AND STATISTICAL METHODS: The data source was the 2006/07 New Zealand Health Survey, a nationally representative household survey that sampled 502 children (5-14 years)...

Most information about the lifetime prevalence of mental disorders comes from retrospective surveys, but how much these surveys have undercounted due to recall failure is unknown. We compared results from a prospective study with those from retrospective studies. The representative 1972-1973 Dunedin New Zealand birth cohort (n=1037) was followed to...

Onset and lifetime use of drugs have not previously been reported for all adult ages in New Zealand. This paper reports such results and, for people born in New Zealand, compares age of onset across ethnic groups. A nationally representative cross-sectional survey was carried out in 2003-2004, with oversampling of Māori and Pacific people. Particip...

To quantify the excess risk of specific, diagnosable mental illnesses experienced by sole parents in New Zealand, and to estimate the contribution of socioeconomic position (SEP), co-residence with other adults (as a proxy for social and practical support) and physical health status to this excess risk. Data used in the present study were from the...

To investigate differences in 12-month prevalences of mental disorders and 12-month treatment contact among New Zealand born and migrants in separate ethnic groups in Te Rau Hinengaro: The New Zealand Mental Health Survey (NZMHS). The NZMHS is a nationally representative face-to-face household survey, carried out in 2003-2004 with a response rate o...

To show the 12 month prevalences of mental disorders, 12-month treatment contact and use of mental health services among Cook islanders resident in New Zealand. (A) The New Zealand Mental Health Survey (NZMHS) is a nationally representative face-to-face household survey, carried out in 2003-2004. It surveyed 12,992 New Zealand adults aged 16 or mor...

Pacific peoples (mostly of Samoan, Tongan, Niuean, or Cook Islands origin) have a higher proportion of reported household crowding than any other ethnic group in New Zealand. However, there are multiple ways crowding can be measured. This paper reports the prevalence and concordance of Pacific peoples' own perception of household crowding together...

To estimate the prevalence and severity of anxiety, mood, substance and eating disorders in New Zealand, and associated disability and treatment. A nationwide face-to-face household survey of residents aged 16 years and over was undertaken between 2003 and 2004. Lay interviewers administered a computerized fully structured diagnostic interview, the...

To estimate the 12 month prevalence of DSM-IV disorders in New Zealand, and associated interference with life and severity. A nationally representative face-to-face household survey carried out in 2003-2004. A fully structured diagnostic interview, the World Health Organization World Mental Health Survey Initiative version of the Composite Internat...