Background: Smoking rates are high in indigenous populations and contribute to their poor health. In New Zealand the indigenous Maori population has a high rate of smoking, with around 50% of adults being smokers compared with 20% of the adult European population. A study was undertaken to determine whether bupropion is effective in the treatment of smoking cessation in the indigenous Maori population in New Zealand. Methods: A randomised, placebo controlled, double blind, parallel group study was performed in 134 Maori smokers aged 16–70 years who smoked more than 10 cigarettes per day. The main outcome measures were continued abstinence from smoking at 3 and 12 months. Results: At each time point continued abstinence was better for the subjects allocated to bupropion, with a risk ratio for abstinence over all time points of 2.44 (95% CI 1.22 to 4.88). The rates of continued abstinence in the bupropion and placebo groups at 3 months were 44.3% and 17.4%, respectively, with a risk ratio of 2.54 (95% CI 1.30 to 5.00). The corresponding figures at 12 months were 21.6% and 10.9%, respectively, with a risk ratio of 1.99 (95% CI 0.79 to 5.00). Conclusion: Bupropion is an effective treatment for smoking cessation in the indigenous Maori population in New Zealand.

Background: When COVID-19 emerged, there were well-founded fears that Māori (indigenous peoples of Aotearoa (New Zealand)) would be disproportionately affected, both in terms of morbidity and mortality from COVID-19 itself and through the impact of lock-down measures. A key way in which Kōkiri (a Māori health provider) responded was through the establishment of a pātaka kai (foodbank) that also provided a gateway to assess need and deliver other support services to whānau (in this case, client). Māori values were integral to this approach, with manaakitanga (kindness or providing care for others) at the heart of Kōkiri’s actions. We sought to identify how Kōkiri operated under the mantle of manaakitanga, during Aotearoa’s 2020 nationwide COVID-19 lockdown and to assess the impact of their contributions on Māori whānau. Methods: We used qualitative methods underpinned by Māori research methodology. Twenty-six whānau interviews and two focus groups were held, one with eight kaimahi (workers) and the other with seven rangatahi (youth) kaimahi. Data was gathered between June and October 2020 (soon after the 2020 lockdown restrictions were lifted), thematically analysed and interpreted using a Māori worldview. Results: Three key themes were identified that aligned to the values framework that forms the practice model that Kōkiri kaimahi work within. Kaitiakitanga, whānau and manaakitanga are also long-standing Māori world values. We identified that kaitiakitanga (protecting) and manaakitanga (with kindness) - with whānau at the centre of all decisions and service delivery - worked as a protective mechanism to provide much needed support within the community Kōkiri serves. Conclusions: Māori health providers are well placed to respond effectively in a public-health crisis when resourced appropriately and trusted to deliver. We propose a number of recommendations based on the insights generated from the researchers, kaimahi, and whānau. These are that: Māori be included in pandemic planning and decision-making, Māori-led initiatives and organisations be valued and adequately resourced, and strong communities with strong networks be built during non-crisis times.

Historical and enduring maternal health inequities and injustices continue to grow in Aotearoa New Zealand, despite attempts to address the problem. Pregnancy increases vulnerability to poverty through a variety of mechanisms. This project qualitatively analysed an open survey response from midwives about their experiences of providing maternity care to women living with social disadvantage. We used a structural violence lens to examine the effects of social disadvantage on pregnant women. The analysis of midwives’ narratives exposed three mechanisms by which women were exposed to structural violence, these included structural disempowerment, inequitable risk and the neoliberal system. Women were structurally disempowered through reduced access to agency, lack of opportunities and inadequate meeting of basic human needs. Disadvantage exacerbated risks inequitably by increasing barriers to care, exacerbating the impact of adverse life circumstances and causing chronic stress. Lastly, the neoliberal system emphasised individual responsibility that perpetuated inequities. Despite the stated aim of equitable access to health care for all in policy documents, the current system and social structure continues to perpetuate systemic disadvantage.

Introduction: Data from Aotearoa–New Zealand’s 2021 COVID-19 mass vaccination programme revealed underutilisation of longer 38 mm needles, which are recommended for big-bodied people. This raises health equity concerns because correct needle length is necessary to achieve intramuscular vaccine delivery. Aim: This study aimed to explore vaccinators’ awareness and implementation of needle-length guidance, and to identify barriers and enablers to use of long needles for big-bodied people in New Zealand. Method: Between August and October 2025, an anonymous online survey was distributed to vaccinators in New Zealand through professional organisations with links to vaccinator health professionals. Data collection included demographics, education received on needle-length guidance, barriers and enablers to use of 38 mm long needles, and opportunities to support future practice. Data were summarised using descriptive statistics, and comments summarised using a qualitative descriptive approach. Results: Of 196 respondents, 70% were aware of needle-length guidance and 48.5% recalled receipt of specific information or education about using longer needles. In total, 60% had ever used a 38 mm needle, but only 26% had used a longer needle for at least half of those they thought eligible in the past 12 months. Key barriers to long needle use included supply of vaccines with shorter needle lengths attached, information gaps and uncertainty in determining eligibility for a 38 mm long needle. A total of 62% saw a need for strategies to strengthen their implementation of needle-length guidance. Discussion: A range of strategies need to be implemented across multiple levels (from vaccinators through to policy makers) to overcome these barriers and to support safe and effective vaccine delivery to big-bodied people.

Introduction: Access to effective vaccination is an important way to protect against infectious diseases. The Aotearoa–New Zealand immunisation handbook on safe and effective vaccination practice recommends a 38-mm needle length for intramuscular deltoid injections in very large individuals, using clinical judgment to ensure needle length is appropriate to reach muscle. It is not clear how vaccinators implement this guidance in practice. Aim: This study aimed to explore vaccinators’ needle-length selection practice for big-bodied people and their views on a prototype arm circumference tool to guide needle choice. Method: Vaccinators working with Māori and Pacific communities were recruited via researchers’ networks to take part in one of six in-person focus groups in the Wellington region, Horowhenua district, and Tairāwhiti region (August–October 2025). Data were analysed qualitatively using a reflexive thematic approach. Results: Twenty-five primary care-based vaccinators with varied roles and experience participated. Themes identified in the discussion included prioritisation of patient-centred care, influences on decision making (familiarity with guidance, training, workflow and equipment), and strengthening practice in these areas. The prototype tool was viewed positively, with discussion highlighting its potential to improve familiarity with arm size and needle-length criteria. Practical, workflow, and patient-centred considerations were raised, with particular focus on the importance of communicating use of the tool in a sensitive manner. Discussion: Ensuring adequate supply and availability of 38-mm needles, along with clear guidance and education, are essential to support vaccinators’ clinical judgement and effective vaccine delivery to big-bodied people. Use of an arm circumference assessment tool could strengthen vaccinators’ decision making and help standardise needle length.

BACKGROUND It is well known that breastfeeding provides favorable health outcomes for both mother and baby. However, many mothers struggle to meet global recommendations to exclusively breastfeed for 6 months. Of those who cease breastfeeding early, one third attribute this to perceived insufficient milk supply. Currently, it is uncertain how the perception of insufficient milk supply relates to physiological milk volume or nutrient composition. OBJECTIVE The Māmā and Baby Breastfeeding Study aims to estimate human milk volumes produced by a diverse sample of breastfeeding mothers at 3 months post partum with differing perceptions of milk supply and to investigate human milk composition in relation to milk volume. METHODS We plan to recruit a sample of 150 mother–infant dyads in this observational study in Dunedin, Aotearoa New Zealand. Participants will represent a diverse range of ethnicities and socioeconomic backgrounds. Human milk volume will be assessed using the dose-to-mother stable isotope (deuterium oxide) technique. Mother participants will consume an accurate dose (30 g) of deuterium oxide after baseline saliva samples are collected from both mother and infant. Subsequent postdose samples will be collected over 3 time points to determine deuterium enrichment over a 14-day period using Fourier transform infrared spectrometry. Human milk macronutrient (energy, fat, carbohydrate, crude protein, and true protein) and mineral and trace element (sodium, magnesium, phosphorus, potassium, calcium, iron, copper, zinc, selenium, and iodine) composition of 1 full milk expression from 1 breast will be analyzed using the MIRIS Human Milk Analyzer (Miris AB) and inductively coupled plasma mass spectrometry, respectively. Potential predictors and maternal perception of milk supply will be assessed via questionnaire. Infant BMI will be calculated from measures of weight and length at 3 different time points over 4 weeks, using standard techniques. These, alongside anthropometric measurements collected at the infant’s Well Child Tamariki Ora visits, will be used to assess infant growth trajectory in the first 6 months of life. Regression models will be used to assess the associations between maternal perception of milk supply, human milk volumes, and composition. RESULTS This study was funded in April 2023 by the Health Research Council of New Zealand (grant 23/461). Recruitment for this study began in February 2025 and is anticipated to conclude in June 2026, with analysis expected to be completed by February 2027. As of January 17, 2026, a total of 91 participants have been enrolled. Final results are anticipated to be disseminated in late 2027 following completion of data analysis. CONCLUSIONS This research will provide new knowledge on whether maternal perception of milk supply aligns with actual human milk volume or nutrient composition. Such information will be extremely useful for health professionals working with breastfeeding mothers with milk supply concerns and for informing the design of breastfeeding support programs and resources. CLINICALTRIAL Australian and New Zealand Clinical Trial Registry ACTRN12625000180415; https://www.anzctr.org.au/ACTRN12625000180415.aspx INTERNATIONAL REGISTERED REPORT DERR1-10.2196/84776