Epidemiology and Biostatistics

The role of alcohol in Emergency Departmenrt presentations

Supervisor

Associate Professor Bridget Kool
Dr Sarah Buller

Discipline

Epidemiology and Biostatistics

Project code: MHS027

A survey in 2016 by the Australasian College for Emergency Medicine found that one out of every four patients in the Emergency Departments (EDs) at 2am in New Zealand and Australia were there as a result of the harmful use of alcohol. As well as causing harm to their own health, they also divert time and resources from other patients, placing undue strain on emergency departments. In addition, they are frequently rude, aggressive, and in the worst instances violent towards staff. The ED at Auckland Hospital has recently introduced a system to record all alcohol-related presentations.
In the first six months since the introduction of this initiative, 34,786 patients have been assessed, and of these 8.4% have had alcohol associated presentations. The aim of this project is to describe the profile of those who present to ED with a positive alcohol screen and compare them to those who screen negative.
The project will analyse anonymised routinely collected data from the ED. A review of the relevant literature will be undertaken to guide the analysis and interpretation of the data. Descriptive analyses will be used to summarise the data.

Skills taught:
•Literature searching
•Data entry
•Data cleaning
•Descriptive data analysis
•Academic writing – final report, and a publication arising from this research
•Time management

Student preferences:
•Health Sciences background desirable
•Basic statistical skills essential
•Sound academic writing skills

Maori and Pacific student pathways in Health Sciences

Supervisor

Associate Professor Bridget Kool
Elana Curtis

Discipline

Epidemiology and Biostatistics

Project code: MHS069

Providing equal opportunities to all who have the potential to succeed in a university of high international standing is a core value of the University of Auckland. Objective Four of the University’s Strategic Plan aims to have ‘A diverse student body of the highest possible academic potential’. Vision 20:20 is the Faculty of Medical and Health Sciences' commitment to increasing the number of Maori and Pacific health professionals to 10% of the health workforce by the year 2020.
In order to achieve this goal the Faculty has three initiatives:
•A Maori and Pacific Admissions Scheme (MAPAS) - a supportive programme that provides admission, academic and pastoral support for Maori and Pacific students who are studying within the FMHS
•Hikitia te Ora - Certificate in Health Sciences - a one-year foundation programme that prepares Maori and Pacific students for tertiary study in health.
•The Whakapiki Ake Project (WAP) - a recruitment programme that actively engages with rangatahi Maori enrolled in secondary schools to promote health as a career and entry into the FMHS professional programmes.

In New Zealand there is little information about the characteristics and career paths of health professionals. The University of Auckland’s Health Careers Pathways Project (formerly known as ‘The Tracking Project) aims to provide data that will enable improved knowledge of the characteristics of practitioners entering the health science of professional programmes, in order to improve our understanding of the links between education, training and professional career destinations. The Health Careers Pathways Project (HCPP) has been collecting data since 2006 on students in Medicine, Nursing, Pharmacy, Optometry and Health Sciences. This includes demographic information, and career aspirations on entry and exit.

Given the priority for optimising Maori and Pacific student success via MAPAS, the aim of this project is to describe the health sciences pathways these students have embarked on over the past decade. The specific objectives include:
1.What are the entry pathways for MAPAS students entering the health science and professional programmes in the FMHS?
2.Compared with all other students, what are the career intentions of MAPAS students entering the health science and professional programmes in the FMHS and how have these changed over the past decade?

The geography of community pharmacy access and utilisation in NZ

Supervisor

Daniel Exeter
Jeff Harrison

Discipline

Epidemiology and Biostatistics

Project code: MHS214

Previous research has shown that most New Zealanders have very good access to a community pharmacy. That research typically calculates the travel time or distance to the closest pharmacy from a patient's home or neighbourhood. However, it is plausible that patients may choose to not use the closest pharmacy for a variety of reasons. Therefore in this studentship, we will explore the geography of community pharmacy utilisation, and investigate whether there are variations socio-demographic circumstances such as age, ethnicity and deprivation.

This project will involve the manipulation of big datasets, using GIS to conduct spatial analyses and create maps, and we anticipate that the candidate will prepare a manuscript for publication.

Interested candidates should have an understanding of:
- GIS and spatial analysis tools including Python, SQL, ArcGIS/QGIS
- statistics packages (e.g. Stata, R)
- the health system in NZ

You will gain skills in:
#advanced spatial analysis
#cartography
#GIS
#epidemiology
#literature reviews
#manuscript preparation

Geographical inequalities in female breast cancer incidence and mortality: a systematic review

Supervisor

Dr Jinfeng Zhao
Dr Sandar Tin Tin

Discipline

Epidemiology and Biostatistics

Project code: MHS115

Breast cancer is the most common cancer in women worldwide and is a leading cause of cancer death. In New Zealand in 2016, 3,300 cases of breast cancer were diagnosed with more than 600 deaths. Geographical disparities in breast cancer incidence and mortality rates are evident worldwide. We seek to answer the following questions in this systematic review.
• Which factors predict geographical patterns of breast cancer incidence and mortality?
• How do local and regional contexts drive geographical patterns of breast cancer incidence and mortality?
• What type of spatial approaches at what geographical scales are used to examine geographical disparities in breast cancer incidence and mortality?

We hope that the review will provide important insights for a future study that will examine geographical inequalities in female breast cancer incidence and mortality in NZ.

This project will suit a student who is interested in breast cancer and geographical analysis. Skills and understanding in systematic literature reviews, spatial and spatial statistical analysis of breast cancer data, report writing and preparing manuscripts for publication will be developed through this summer project.

Unhealthy food advertising to children on television and in magazines

Supervisor

Dr Sally Mackay

Discipline

Epidemiology and Biostatistics

Project code: MHS130

Aim: To monitor the exposure to children to unhealthy food promotion on television and in popular magazines.

Food and beverage marketing is an important factor influencing children's food purchases, preferences and consumption. Two studies were conducted in 2015 assessing marketing to children in magazines and on television. Since then, a new Children and Young People’s Advertising Code has been introduced. The studies will be repeated to monitor the impact and compliance of the new Code on advertising to children on television and magazines.

The studies will involve:
• Identifying advertisements and marketing techniques for food and beverages from recordings of television advertisements and in magazines popular with children.
• Classifying advertisements as healthy/unhealthy.
• Analysing the level of food and unhealthy advertising and marketing techniques used. Comparing the level of advertising in 2018 with the previous studies.

Skills:
Basic research skills including data collection and quantitative analysis
Classification of foods and beverages by healthiness
Data interpretation and presentation
Preparing a manuscript for publication

Geographic variations in breast cancer diagnosis and treatment: a systematic review

Supervisor

Dr Sandar Tin Tin

Dr Jinfeng Zhao

Discipline

Epidemiology and Biostatistics

Project code: MHS143

Breast cancer is the most common cancer in women worldwide. Survival from breast cancer has improved over time but varies widely across regions and countries. Such survival disparities are likely to be due to variations in access to and quality of care along the cancer diagnosis and treatment pathway.

The aim of this project is to review the existing literature that has reported geographic variations in breast cancer diagnosis (mode of diagnosis and stage at diagnosis) and treatment (access to, timeliness and receipt of treatment according to the established guidelines). The findings will be published in a peer-reviewed journal article and will guide the design and analysis of a future project aiming to investigate geographic variations in breast cancer incidence, care and outcomes in New Zealand.

This project would suit a student who is interested in cancer care, health inequities and geospatial analyses. Skills taught include: systematic literature searches, critical appraisal, academic writing and preparation of a manuscript.

Systematic review of methods for integrating expected benefits and harms of aspirin to guide clinical decision-making on the use of aspirin for primary prevention

Supervisor

Dr Vanessa Selak

Discipline

Epidemiology and Biostatistics

Project code: MHS096

Aspirin reduces the risk of cardiovascular disease (and cancer) but also increases bleeding. Potential individual cardiovascular benefits of aspirin can be estimated relatively easily now in New Zealand because most eligible people have had their cardiovascular risk assessed.But there are no valid tools currently available to assess an individual’s risk of bleeding harms from aspirin. There is also considerable confusion about the role of aspirin in the primary prevention of cardiovascular disease (CVD) because of the difficulty in identifying people most likely to benefit rather than be harmed by aspirin (i.e. with “net-benefit”).Healthy adults who would gain a net-benefit from aspirin are therefore missing out on the cardiovascular benefits of aspirin, while healthy adults with net-harm (where harms outweigh benefits) are being unnecessarily subjected to the bleeding harms of aspirin.

A NZ CVD risk equation has just been published, and a NZ bleeding risk equation is in development (latter work being led by Dr Selak). The next step in this programme of work is to determine how best to integrate individualised assessment of benefits (absolute risk of CVD x proportional effect of aspirin on CVD) and harms (absolute risk of bleed x proprotional effect of aspirin on bleeds) of aspirin to support clinicians and patients when considering whether or not to consider taking aspirin for the primary prevention of CVD.

This summer studentship will play a pivotal role in the research programme, as it will involve systematically searching literature to identify strategies others have used to integrate information on absolute benefits and harms of aspirin. The output of this work would be a publication (which the successful applicant could lead, with the supervisor's assistance) and the findings of the literature search would inform how the information is displayed to clinicians in electronic decision support programmes within primary care in NZ.

Further opportunities for research within this programme, after the studentship, would be available.

Epidemiology of major bleeds in NZ by ethnicity

Supervisor

Dr Vanessa Selak

Discipline

Epidemiology and Biostatistics

Project code: MHS097

Aspirin reduces the risk of cardiovascular disease (and cancer) but also increases bleeding. Potential individual cardiovascular benefits of aspirin can be estimated relatively easily now in New Zealand because most eligible people have had their cardiovascular risk assessed.But there are no valid tools currently available to assess an individual’s risk of bleeding harms from aspirin. There is also considerable confusion about the role of aspirin in the primary prevention of cardiovascular disease (CVD) because of the difficulty in identifying people most likely to benefit rather than be harmed by aspirin (i.e. with “net-benefit”).Healthy adults who would gain a net-benefit from aspirin are therefore missing out on the cardiovascular benefits of aspirin, while healthy adults with net-harm (where harms outweigh benefits) are being unnecessarily subjected to the bleeding harms of aspirin.

Dr Selak has been leading a programme of research looking at bleeding risk, to support individualised assessment of the absolute benefits and harms of aspirin in primary prevention.

The first paper from this programme of research, describing bleeding by age and sex in NZ patients who have had a CVD risk assessment in primary care using the PREDICT electronic decision support programme, has just been completed. The next step for this work, as part of this summer studentship, is to undertake a more detailed analysis of bleeding risk by ethnicity. As this is an analytical project, strong analytical skills are required. The sucessful applicant will be required to undertake analyses in R. Some training will be able to be provided. This work is expecrted to result in a publication, which the sucessful applicant could lead with the support of the supervisor.

Tobacco cessation support in the Pacific Islands

Supervisor

Judith McCool

Discipline

Epidemiology and Biostatistics

Project code: MHS032

A review of all 22 Pacific Islands Countries and Territories status with the provision of smoking cessation support.

Use of online materials only so this project can be undertaken off-site from the campus. This review will result in a publication (student-led if desired).

Traffic Congestion Mapping in Route Planning to Minimise Air Pollution Exposure of Pedestrians

Supervisor

Kim Dirks
Andrea Raith (Engineering Science)

Discipline

Epidemiology and Biostatistics

Project code: MHS181

Route planning for urban transport typically optimises by minimising travel time. Mobile apps (such as GoogleMaps) are now widely used, taking into account estimates of real-time traffic congestion. The mobile apps also extend to pedestrian journeys, with route suggestions based on the shortest path and the availability of suitable pedestrian infrastructure. They do not consider traffic congestion which ultimately impacts on the commute pollution dose.
This project investigates the reliability of mobile apps in their prediction of traffic congestion and the extent to which air pollution exposure estimates for pedestrians can be improved by incorporating real-time road congestion estimates.

This project would suit someone with an interest in environmental health and active mode commuting. It will require the researcher to collect real-time traffic congestion information and air pollution data on selected (easily accessible) locations in Auckland during morning rush hour and link these data with real-time congestion information provided by mobile apps. It would suit a student interested in learning about field data collection, and basic data analysis (using Excel and a statistical package such as SPSS). Familiarity with GIS preferable but not essential. The work will inform a larger study aimed at using real-time traffic congestion information in route optimisation for pedestrians.

Heating and Ventilation for Healthy Homes

Supervisor

Kim Dirks
Engineering Science staff

Discipline

Epidemiology and Biostatistics

Project code: MHS182

Poor quality and old housing in New Zealand is associated with poor health outcomes due to cold and damp homes, despite the country's relatively mild climate. Individuals have a role to play in how they ventilate their homes and decisions around where in the house and when to heat. The University owns two state houses that have been relocated to the Ardmore field station for the purpose of testing various retrofitting strategies for improving the indoor environment of such houses to gain a better understanding into which are the most effective. As part of an MBIE-funded grant awarded to the Faculty of Engineering, the houses will be fitted with humidifiers and heaters to simulate human occupancy and behaviour and investigate the effectiveness of proposed strategies.

This summer project will involve the development of a literature review investigating what is currently known about human behavior in the home as it relates to heat and humidity, such as window opening, shower usage, cooking habits, etc. so that realistic simulations can be devised. The literature review will also help to identify the ways in which the behaviours of New Zealanders are similar to other cultures around the world (in which case we can make use of current international literature) and also the ways in which such behaviour differs.

This project will suit someone interested in environmental health and housing in particular, and who is keen to develop their literature searching and writing skills. It would be most suitable for a BHSc or MPH student.

Incentivising active transport: How might we encourage people to try an ebike?

Supervisor

Kirsty Wild
Alistair Woodward

Discipline

Epidemiology and Biostatistics

Project code: MHS100

This project aims to explore what types of policies or incentives might encourage people to start using an e-bike for daily transport. E-bikes are an important new form of 'active transport' that show promise in encouraging diverse groups of people to lift their levels of physical activity. However, existing research suggests that cost in particular is a barrier to use, especially amongst lower-income people, who potentially have the most to benefit from having access to a bike.

In this project we will review the international evidence about different ways to make it possible for all sorts of people in the community to have access to an e-bike.

This will involve a small literature review looking for overseas examples of what is working and why and how we could adapt that to a New Zealand context, and potentially one or two interviews with bicycle policy makers who specialise in this area.

What’s in a name - How do Bachelor of Health Science graduates know what health sector roles they should be applying for?

Supervisor

Monique Jonas

Bridget Kool

Discipline

Epidemiology and Biostatistics

Project code: MHS067

UK research suggests that graduates perceive their academic qualifications as having a declining role in shaping their employment outcomes. (Tomlinson, 2008) And yet one universities under pressure to deliver ‘employability-driven curricula’.(Morrison, 2012) A study by Buckham (1998) found that one of the perceived barriers to graduates perceived employability was the ‘contrast between the rhetoric and reality of work described in the language used in job advertisements’.
The Bachelor of Health Sciences (BHSc) is a three year non-clinical degree offered by the University of Auckland that prepares graduates for a broad range of health-related careers. The degree provides a multidisciplinary understanding of health, healthcare and its services in New Zealand. Students gain an in depth understanding of the role governments play in determining health policy, how wealth systems function, and how the biological and social bases of ill-health exist in our communities. BHSc graduates are sought after for roles in the public, private and charitable sectors.
However, anecdotally students say that they are uncertain what sort of roles they should be applying for when they first leave university because the job titles or role descriptions are unfamiliar to them. Echoing the findings of the study by Buckham et al. mentioned previously.

Therefore the aim of this project is to identify the potential roles BHSc graduates have the knowledge and skills to apply for and align the necessary capabilities with the skills and knowledge gained during their degree. An analysis of non-clinical health related roles advertised in Seek (an online job platform), Trademe, and District Health Board websites will be undertaken to identify the potential roles, attributes and skills that employers are looking for. These will be mapped against the skills and knowledge gained in the core BHSc courses.
The findings of this project in the immediate term will be used to develop a tool to aid graduates in identifying roles they could consider applying for. In addition, the findings could inform future research which maps longitudinally the early work-pathways and career trajectories (over the first five years) of BHSc graduate entrants to the labour market in different sector. This information could provide the basis for the development of new conceptual patterns to describe a typical BHSc career.

Skills taught:
• Data extraction
• Data entry
• Descriptive data analysis
• Academic writing – final report, and a publication arising from this research
• Time management

Student preferences:
• Health Sciences background desirable
• Basic statistical skills essential
• Sound academic writing skills

Community solutions to increasing fruit and vegetable intake in children

Supervisor

Dr. Sarah Gerritsen
Professor Boyd Swinburn

Discipline

Epidemiology and Biostatistics

Project code: MHS046

Just over half of New Zealand children currently meet the Ministry of Health’s dietary recommendation of two serves of fruit and three serves of vegetables each day. This project synthesises knowledge collected in community workshops held in September 2018 to identify systemic barriers and potential solutions to improve fruit and vegetable consumption in children. Workshop participants were from a low-income West Auckland community and included local growers, supermarket and other food retailers, health promoters, educators, students and parents. Over three consecutive workshops, the participants created collective ‘mental maps’ (known as a causal loop diagrams in systems science research) about children’s fruit and vegetable consumption.

The aim of this project is to refine and assist with interpretation of the map(s) to identify a list of potential interventions that would be acceptable and feasible to the workshop participants. The student will be guided to consider causal pathways, feedback loops, reinforcing loops and points of leverage in the ‘system’ presented in the maps.

Skills taught: • Literature searching and summary of similar research • Systems science methods for population health research, including refinement and interpretation of causal loop diagrams using appropriate computer software • Writing for publication – in addition to the final report, this project will result in a published research paper to which the student will contribute and receive authorship

Key skills required: • An interest in child health/nutrition, the food environment and public health • An interest in complexity and systems science • Excellent written communication skills

Ethics approval is not required. Data (the causal loop diagrams) and the computer software will be obtained prior to the student beginning the summer project.
This summer project is part of a larger piece of research funded by the Health Research Council, in partnership with Healthy Families Waitakere.

Fruit and vegetable intake among New Zealand preschool children

Supervisor

Dr. Sarah Gerritsen

Discipline

Epidemiology and Biostatistics

Project code: MHS047

Eating fruit and vegetables in childhood provides valuable nutrients for growth and development, strengthens immunity, aids digestion and decreases the risk of obesity and obesity-related illnesses. Healthy dietary patterns can track from early childhood, through to late childhood, adolescence and into adulthood, conferring protection against some cancers, cardiovascular disease, and other chronic diseases.

Using data collected in the Growing Up in New Zealand longitudinal study (www.growingup.co.nz) of over 6,500 children, this research answers the following questions:
1. What are the most common types of vegetables and fruits consumed by New Zealand preschool children?
2. How many serves of vegetables and fruits do children usually consume at 2 and 4 years of age?
4. What inequalities exist in New Zealand preschool children’s fruit and vegetable intake and diet variety?

A review of the relevant literature will be undertaken to guide the analysis and interpretation of the data. Descriptive analyses will be used to summarise the data.

Skills taught: • Literature searching • Use of a large dataset – data cleaning and confidentiality • Descriptive data analysis. The student will be given assistance to analyse data in the STATA statistical package and produce graphs in STATA and Excel • Writing for publication – in addition to the final report, this project will result in a published research paper to which the student will contribute and receive authorship.

Key skills required: • An interest in child health/nutrition and public health • Basic statistics (tabulations, t-tests, chi square, regression etc).

Ethics approval is not required. Access to the Growing Up in New Zealand external dataset will be obtained prior to the student beginning the summer project.
Secondary supervision/advice will be provided by Professor Boyd Swinburn and Associate Professor Clare Wall.

Barriers and enablers of commuter cycling: The role of the weather in mode choice