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Item Occupational/environmental and lifestyle risk factors for motor neurone disease in New Zealand : a thesis with publications presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health (epidemiology) at Massey University, Wellington, New Zealand(Massey University, 2022) Chen, Grace XiaMotor Neurone Diseases (MND) are a group of progressive, irreversible, and terminal neurodegenerative diseases, with death usually resulting about three years after first symptoms of weakness. No cure is available. Whilst the aetiology of MND is largely unknown, some occupations, occupational exposures, and lifestyle factors have been associated with elevated risks, but evidence has been mixed. This thesis describes a case-control study that assessed associations with MND for a range of potentially modifiable risk factors, including specific occupations; occupational exposures (extremely low frequency-magnetic fields (ELF-MF), electric shocks, and a range of chemicals including pesticides); physical and emotional trauma; and leisure sports. A total of 321 cases and 605 population controls participated in the study. Elevated risks for MND were observed for several horticultural occupations, including field crop and vegetable growers, fruit growers, gardeners and nursery growers, crop and livestock producers. Employment as a builder, electrician, caregiver, forecourt attendant, plant and machine operator and assembler, and telecommunications technician was also positively associated with MND. Having ever worked in an occupation with potential for electric shocks was positively associated with MND, but no association was observed for occupational exposure to ELF-MF. Occupational exposure to pesticides, in particular insecticides, fungicides, and fumigants was associated with MND, with longer exposure duration associated with higher risk. Elevated odds for MND were also found for exposure to petrol/diesel fuel, unspecified solvents, disinfectants, and cleaning products. Having had multiple head injuries with concussion was associated with increased odds of MND; spine injury was not associated with MND. Playing sports throughout childhood and adulthood increased the risk of MND compared to never engaging in sports. Playing football (soccer) for >12 years was also positively associated with MND. Reporting emotionally traumatic events in more than three specific categories of trauma was positively associated with MND, with physical childhood abuse, the only specific emotional trauma category associated with MND risk. In conclusion, this research identified a range of occupational (pesticides, electric shocks, fumigants, unspecified solvents, cleaning products) and non-occupational (repeated head injury and physical child abuse) risk factors for MND, which provide promising opportunities for interventions to prevent MND.Item Occupational risk factors for ischaemic heart disease : differences among males and females in the Māori and general populations of New Zealand : a thesis with publications presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health (Epidemiology) at Massey University, Wellington, New Zealand(Massey University, 2021) Barnes, LucyOccupation is a poorly characterised risk factor for cardiovascular disease, a leading cause of death worldwide, with females and indigenous peoples underrepresented in research. This thesis assessed associations between occupation/occupational exposures and cardiovascular risk factors and ischaemic heart disease (IHD), for males and females of the Māori and general populations of New Zealand. Two previous New Zealand Workforce Surveys (NZWS) in the general (NZWS; n=3003; 2004-2006) and Māori (Māori NZWS; n=2107; 2009-2011) populations were linked to Ministry of Health data in Statistics New Zealand’s Integrated Data Infrastructure. Age-adjusted logistic regression was used to assess associations between occupational groups and cardiovascular risk factors (high blood pressure, high deprivation, high cholesterol, diabetes, smoking and obesity). Cox proportional hazard regression, adjusted for age, deprivation and smoking, was used to assess associations between ever working in an occupational group and incident IHD, over a 7-14 year follow-up period. Associations with occupational exposures were also assessed. Cardiovascular risk factors were disproportionately experienced by blue-collar workers, particularly plant and machine operators and assemblers and elementary workers. In contrast, professionals were less likely to experience risk factors. Similarly, having ever worked as a plant and machine operator and assembler or elementary worker was positively associated with IHD for Māori females. Having ever worked as a technician and associate professional was inversely associated with IHD. Associations were not consistent between Māori and the general population or between males and females, with differences observed for clerks, agriculture and fishery workers and sales and service workers. Occupational exposure to dust, tools that vibrate, smoke or fumes, oils and solvents, and high frequency exposure to repetitive tasks, loud noise, working at high speeds and awkward grip or hand movements, common in blue-collar occupations, was positively associated with IHD. Associations were not consistent across all populations, with no positive associations observed among Māori males. In conclusion, this thesis shows a role of occupation in IHD risk, presenting an opportunity for IHD interventions, particularly for blue-collar occupations. However, findings suggest that occupational risk factors cannot be generalised across all populations and future research and intervention development therefore requires consideration of sex and ethnicity.