George Thomson’s research while affiliated with University of Otago and other places

aim: Armed conflict remains a tragic feature of the modern world and so it is necessary to continue to study its health impacts. Even the study of historical conflicts is relevant given that certain health impacts are common to most wars e.g., post-traumatic stress disorder (PTSD). methods: This study built on a previous quantitative analysis of a randomly selected group of 200 New Zealand veterans from the First World War (WWI). From this sample we selected 10 cases that illustrated particular themes around morbidity impacts. results: The theme of severity of impacts was illustrated with a case who was severely wounded and died from suicide when back in New Zealand, and another case with severe PTSD. The theme of the high frequency of non-fatal conditions was revealed with cases illustrating new diagnoses (a case with n=8 diagnoses), hospitalisations for new conditions (n=6), non-fatal injury events (n=3) and for sexually transmitted infections (n=3). The theme of chronic debility as a consequence of various conditions was illustrated with cases who had suffered from being gassed or having gastroenteritis, malaria or pandemic influenza. conclusion: These 10 selected cases reiterate how severe and extensive the morbidity burden for military personnel in WWI could be. Also illustrated is how the morbidity could contribute to adverse impacts on some of their lives after returning to New Zealand.

Introduction There remains uncertainty around the impact of war on the lifespan of First World War (WW1) veterans. Methods We obtained lifespan data on a random sample of 857 war-exposed New Zealand WW1 veterans and compared this with lifespans of a non-war military cohort (n=1039). This comparison was possible as the non-war-cohort arrived in Europe too late to participate in the war, allowing a natural experiment that avoided the healthy solider effect. Results The lifespan comparisons indicated lower mean lifespan in the war-exposed veteran cohort compared to the non-war veteran cohort (69.7 vs 71.1 years; p=0.0405). This gap persisted (range: 0.8 to 1.1 years) but was no longer statistically significant when only considering the non-Maori ethnic grouping (nearly all European/Pakeha; personnel), when excluding additional deaths in the immediate post-war period up to 31 December 1923, and when excluding participation in any other wars. Within the war-exposed cohort there were suggestive patterns of increasing lifespan with increasing occupational status and military rank (eg, 69.5, 70.0 and 70.7 mean years as group-level occupational status progressively increased). There were also stark differences in lifespan of 8.3 years between Maori (Indigenous) and non-Maori veterans (p=0.0083). Conclusions The pattern of reduced lifespan in war-exposed vs non-war-exposed veterans, was compatible with a smaller previous New Zealand study. There are a number of feasible avenues to further improve this type of work with existing data sources.

BACKGROUND Aotearoa New Zealand (NZ) is a country with a tobacco endgame plan that includes denicotinisation of tobacco. Because of concerns these measures could increase tobacco smuggling, we aimed to provide new baseline data on such smuggling. We studied littered tobacco packs during a ‘natural experiment’ when no international tourists and relatively few NZ travelers arrived due to COVID-19-related border controls (eg, typically requiring 2weeks of facility-based quarantine for NZ citizens only). That is, we assumed that during this period, the proportion of littered packs which were foreign was likely to reflect levels of smuggling. Evidence suggests tobacco smuggling into NZ occurs mainly via shipping containers, the postal system and international airline staff.

We aimed to conduct a nationwide survey of outdoor statues of military personnel in New Zealand (NZ), to describe patterns in attacks on these, and to assess trends in their militaristic features. A literature search followed by a field survey of the statues with detailed photographs taken. Documented attacks were analysed, as were trends in objective militaristic features of the statue (eg, number of weapons). A total of 118 outdoor statues of military personnel were identified, with 11 (9%) of these having been attacked. The highest identified risk for statue attack was if it represented a named strategic military leader, compared to all other statues, at 41% vs 4% risk of attack respectively (risk ratio [RR] = 6.81; 95%CI: 3.25 to 14.3; p=0.00005). Another risk factor was the statue being linked to the NZ Wars (a colonial conflict) vs any other specific war (75% vs 8%; RR = 9.66; 95%CI: 4.03 to 23.1; p=0.0032). When considering militaristic features of the statue and associated structure, there were a number of downward trends over the four consecutive time periods studied eg, for any weapon on the statue figure: 100%, 95%, 75% and 54% (p-trend = 0.0000001). In terms of statue demographics and contribution to war efforts (at home or abroad), there was marked under-representation of women and Pasifika. In conclusion, this national survey of military statues provides evidence for attacks on statues being related to statue features (military leadership) and a particular colonial war. The decline over time of warfare-related iconography may be an objective measure of one component of militarism.

Introduction There is still uncertainty around the impact of combat exposure on the life span of war veterans. Therefore we made use of a natural experiment to study the impact on veteran life span of combat versus non-combat exposure in World War II (WW2). Methods The combat-exposed military personnel were derived from a random (10%) sample of the military roll of the 28th (Māori) Battalion from New Zealand. One non-combat cohort was the 15th Reinforcements of this same Battalion, since the war ended before they reached the front line. The other non-combat cohort were Māori personnel who were only involved in Jayforce, which occupied Japan at the end of the WW2. Data on life span were mainly derived from an official repository of birth and death records, but supplemented with other sources, including military files. Results When comparing life spans of service veterans, there was no statistically significant reduction for the average life span of the 234 combat-exposed veterans in our sample from the 28th (Māori) Battalion (66.7 years), relative to the Māori veterans from two non-combat cohorts: the 132 personnel in the 15th Reinforcements (67.2 years) and the 147 personnel in Jayforce (66.9 years). Conclusions Despite a very high level of wounding in the combat-exposed group (48%), there were no statistically significant reductions in life span between this group and comparable non-combat exposed veterans. This finding contrasts to life span reductions found in a similar study of New Zealand veterans of WW1.

Aims: To identify the extent of the provision of handwashing amenities in public toilets at the time of the COVID-19 pandemic, and also to make comparisons with a related pre-pandemic survey. Methods: We collected data from 400 toilet facilities that were open to the public: all those in three contiguous city council territories (228) and a further convenience sample of 172 around other parts of New Zealand. Comparisons were made with the data on the same facilities included in a 2012/2013 survey. Results: Of the toilets in this survey, 2.5% had no water for handwashing and 14.8% had no soap. There was COVID-19-related health messaging signage in 19.5% of toilets, with posters of the COVID-19 QR code used for contact tracing in 12.3%, and generic handwashing signage in 1.8%. The handwashing water had 'no-touch' activation at 28.0% of toilets, and 18.5% of toilets had no-touch bowl flushing. Toilet bowl lids were not present at 32.8%, and 2.3% of toilets had damage that would impair their functionality (eg, broken toilet seats). This new survey found significantly increased provision of soap (risk ratio = 1.47; 95%CI: 1.25 to 1.72), but no increased provision of water, at the 128 sites that had also been examined in the previous survey. Conclusions: Although handwashing is probably a much less critical COVID-19 control intervention than reducing aerosol transmission, it should still be strongly supported. Yet this survey found multiple deficiencies with handwashing amenities at public toilets and only modest improvements since a previous survey.

Objectives We aimed to describe the epidemiology of statue attacks along with statue representativeness relative to modern day demographics in one case study country: New Zealand. Methods We performed Internet searches for the existence of outdoor statues of named individuals and historical attacks in New Zealand (NZ), combined a national survey with field visits to all identified statues to examine for injuries and repairs. Results Of the 123 statues identified, nearly a quarter (n = 28, 23%) had been attacked at least once (total of 45 separate attack events), with the number of attacks increasing from the 1990s. Attacks involved paint/graffiti (14% of all statues at least once), nose removal/damage (7%), decapitation (5%), and total destruction (2%). The risk of attack was relatively higher for statues of royalty (50%), military personnel (33%), explorers (29%), and politicians (25%), compared to other reasons for fame (eg, 0% for sports players). Statue subjects involved in colonialism or direct harm to Māori (Indigenous population), had 6.61 (95%CI: 2.30 to 19.9) greater odds (adjusted odds ratio) of being attacked than other subjects. Most of the statue subjects were of men (87%) and Europeans (93%). Other ethnicities were 6% Māori (comprising 15% of the population) and 1% each for Asian and Pacific peoples, who comprise 12% and 7% of the population respectively. Conclusions This national survey found an association between statue attacks and the role of statue subjects in colonialism or direct harm to the Indigenous population. Furthermore, the demography of the statue subjects may represent historical and current social power relationships—with under-representation of women and non-European ethnic groups.

Aim: We aimed to update and provide more complete epidemiological information on the health impacts of the South African War on New Zealand military personnel. Methods: Mortality datasets were identified and analysed. Systematic searches were conducted to identify additional war-attributable deaths in the post-war period. To estimate the morbidity burden, we analysed a random sample of archival military files of 100 military personnel. Lifespan analyses of veterans included those by level of combat exposure (eg, a non-combat sample came from a troopship that arrived at the time the war ended). Results: We identified 10 additional war-attributable deaths (and removed three non-attributable deaths) to give a new New Zealand total of 239 war-attributable deaths. Given the average age of death of 26 years, this equates to the loss of 10,300 years of life. Most deaths (59%) were from disease rather than directly from the conflict (30%). Over a third (39%; 95%CI: 30%-49%) of personnel were estimated to have had some form of reported illness (26%) or injury (14%). The lifespan analysis of veterans suggested no substantive differences by exposure to combat (68.5 [combat] vs 69.1 years [non-combat]) and similarly when compared to a matched New Zealand male population. Conclusions: The mortality burden was larger and the morbidity impacts on the New Zealand military personnel in this war were much more substantive than revealed in the prior historical literature. There is a need to more fully describe historical conflicts so that their adverse health impacts are properly understood.

In this viewpoint we briefly review the evidence for smoke-free car legislation. We find that this legislation has been consistently associated with reduced secondhand exposure in cars with children/youth in all nine jurisdictions studied. Despite this, there are various aspects of this intervention that warrant further study-especially determining its impact on reducing tobacco-related ethnic inequalities. So we argue that the New Zealand Ministry of Health should invest in a thorough evaluation of this important upcoming public health intervention. This could both help the country in further refining the design of the law (if necessary) and would also be a valuable contribution to advancing the knowledge base for international tobacco control.