Psychosocial burden of inflammatory bowel disease in adolescents and young adults.

BACKGROUND: This study examined the psychosocial burden of inflammatory bowel disease (IBD) in young people aged 15-25 years attending a tertiary specialist health centre for adolescents and young adults in Brisbane. AIMS: To describe the impact of IBD on psychosocial well-being in young people and to compare well-being in the IBD cohort to well-being among young people with other chronic conditions, with a view to identifying characteristics and challenges unique to those with IBD. METHODS: Young people with IBD provided demographic information and psychosocial data through a cross-sectional self-report survey. Psychosocial data included the Kessler Psychological Distress Scale, Perceived Stress Scale, Brief Illness Perception Questionnaire, World Health Organisation Well-being Index, Paediatric Quality of Life Inventory, Short Quality of Life Questionnaire for IBD, Multidimensional Scale of Perceived Social Support, Connor Davidson Resilience Scale 2 and the Multidimensional Health Locus of Control Scale. RESULTS: Surveys were collected from 51 young people with IBD and compared with surveys from 210 young people with juvenile rheumatic disease (n = 31), phenylketonuria (n = 21), cystic fibrosis (n = 33), renal transplants (n = 14) and craniomaxillofacial conditions (n = 111). On the psychosocial domains, 41% of young people with IBD had poor well-being and 37% were at risk of depression. When assessed against the comparison group, young people with IBD reported higher depressive symptoms (P = 0.04), worse illness perceptions (P < 0.01) and lower internal locus of control (P < 0.01). CONCLUSIONS: Early recognition and treatment of depression and other psychosocial comorbidities within integrated pathways of care is crucial in adolescents and young adults with IBD and likely to improve the course of IBD and their overall health and well-being. Interventions aimed at enhancing self-efficacy and increasing public awareness are also likely to be helpful.

What explains the decline in adolescent binge-drinking in New Zealand?

BACKGROUND: Binge-drinking prevalence among New Zealand adolescents has declined sharply since 2001, as it has in many other high-income countries. Other adolescent risk behaviours (e.g. smoking, cannabis use and precocious sexual activity) have also declined, raising the possibility of common underlying drivers. This study investigates potential contributing factors - both factors that predict risk behaviours in general, and alcohol-specific factors - and the extent to which they account for the decline in binge drinking. METHODS: The study used nationally representative survey data collected in 2001 (N = 6513), 2007 (N = 5934) and 2012 (N = 5489). The outcome measure was prevalence of past month binge drinking (5+ drinks/session). Predictor variables included factors that predict risk behaviours in general (parental monitoring, family attachment, school attachment, having a part-time job, time spent hanging out with friends); alcohol-specific factors (parental alcohol use, adolescent attitude toward alcohol use); and attitude toward and current use of tobacco and cannabis. Likelihood of binge drinking was modelled for each survey year (ref=2001), adjusting for demographic factors. Predictors were added to this base model, with the degree of attenuation of the odds ratio for year indicating the extent to which the included predictor(s) accounted for the trend. RESULTS: Compared with 2001 the odds of binge-drinking in 2012 were 0.33. The strongest independent contributor to the decline was adolescent attitude toward alcohol use, followed by current cannabis use, then current tobacco use. Collectively, general factors in home, school and leisure settings did not significantly contribute to the downward trend in binge drinking. CONCLUSION: Decreasing acceptability of alcohol use among adolescents was the most important identified contributor to adolescent binge-drinking decline. Drinking, smoking and cannabis use trends were empirically linked, yet the decline in binge drinking was not significantly explained by the included predictors common to risk behaviours in general.

Declining adolescent cannabis use occurred across all demographic groups and was accompanied by declining use of other psychoactive drugs, New Zealand, 2001-2012.

AIM: Cannabis use declined in New Zealand adolescents between 2001 and 2012. We investigated i) whether changes in adolescent cannabis use occurred across all demographic groups, and ii) whether declining cannabis use was accompanied by increasing use of other psychoactive drugs. METHOD: We conducted secondary analysis of repeat cross-sectional data from nationally representative surveys of secondary school students (2001, 2007, 2012) to determine trends in never-use of cannabis and other psychoactive drugs by age, sex, ethnicity, deprivation, school decile and urban/rural locale. Logistic regression was used to test whether changes in cannabis non-use over time varied between demographic groups. RESULTS: Never-use of cannabis and of other psychoactive substances increased between 2001 and 2012 in all included age, ethnic, sex and socioeconomic groups. Maori, younger students and those in low decile schools demonstrated the greatest reductions in cannabis use over the study period. CONCLUSION: The decline in adolescent cannabis use between 2001 and 2012 occurred across all main demographic groups and was not accompanied by a rise in the use of other psychoactive drugs. Ethnic and socioeconomic inequities in adolescent cannabis use decreased over the study period.

Body size and weight, and the nutrition and activity behaviours of sexual and gender minority youth: findings and implications from New Zealand.

OBJECTIVE: To describe the body size and weight, and the nutrition and activity behaviours of sexual and gender minority (SGM) students and compare them with those of exclusively opposite-sex-attracted cisgender students. Male and female SGM students were also compared. DESIGN: Data were from a nationally representative health survey. SETTING: Secondary schools in New Zealand, 2012. PARTICIPANTS: A total of 7769 students, 9 % were SGM individuals. RESULTS: Overall, weight-control behaviours, poor nutrition and inactivity were common and, in many cases, more so for SGM students. Specifically, male SGM students (adjusted OR; 95 % CI) were significantly more likely to have tried to lose weight (1·95; 1·47, 2·59), engage in unhealthy weight control (2·17; 1·48, 3·19), consume fast food/takeaways (2·89; 2·01, 4·15) and be physically inactive (2·54; 1·65, 3·92), and were less likely to participate in a school sports team (0·57; 0·44, 0·75), compared with other males. Female SGM students (adjusted OR; 95 % CI) were significantly more likely to engage in unhealthy weight control (1·58; 1·20, 2·08), be overweight or obese (1·24; 1·01, 1·53) and consume fast food/takeaways (2·19; 1·59, 3·03), and were less likely to participate in a school sports team (0·62; 0·50, 0·76), compared with other females. Generally, female SGM students were more negatively affected than comparable males, except they were less likely to consume fast food/takeaways frequently (adjusted OR; 95 % CI: 0·62; 0·40, 0·96). CONCLUSIONS: SGM students reported increased weight-control behaviours, poor nutrition and inactivity. Professionals, including public health nutritionists, must recognize and help to address the challenges facing sexual and gender minorities.

Trends in weight-related attitudes and behaviours among New Zealand adolescents, between 2007 and 2012.

AIM: To explore secular trends of adolescent weight control concerns and behaviours, between 2007 and 2012, and determine if these vary by body size. METHODS: Data were drawn from two nationally representative youth health surveys, Youth'07 and Youth'12. Multiple logistic regression models were used to determine differences in the prevalence of weight control behaviours and concerns between the two time points, controlling for socio-demographic variables. RESULTS: Between 2007 and 2012, both boys and girls were significantly more likely to report concerns about their weight, though the prevalence of trying to lose weight increased for boys, but not girls. Trends in weight control behaviours varied by body size for boys and girls. Perhaps the most striking findings were the increases in proportions of underweight girls and healthy weight boys who were trying to lose weight. CONCLUSIONS: The current study highlights the growing concerns that young people are experiencing in relation to weight control. Given the persistently high rates of adolescent obesity in New Zealand and globally, greater support for young people with regards to healthy eating and weight management is warranted.

Energy drink consumption among New Zealand adolescents: Associations with mental health, health risk behaviours and body size.

AIM: With the increase in popularity of energy drinks come multiple concerns about the associated health indicators of young people. The current study aims to describe the frequency of consumption of energy drinks in a nationally representative sample of adolescents and to explore the relationship between energy drink consumption and health risk behaviours, body size and mental health. METHODS: Data were collected as part of Youth'12, a nationally representative survey of high school students in New Zealand (2012). In total, 8500 students answered a comprehensive questionnaire about their health and well-being, including multiple measures of mental well-being, and were weighed and measured for height. RESULTS: More than one-third (35%) of young people consumed energy drinks in the past week, and 12% consumed energy drinks four or more times in the past week. Energy drink consumption was significantly associated with greater depressive symptoms, greater emotional difficulties and lower general subjective well-being. Frequent energy drink consumption was also associated with binge drinking, smoking, engagement in unsafe sex, violent behaviours, risky motor vehicle use and disordered eating behaviours. There was no association between consumption of energy drinks and student body size. CONCLUSIONS: Consumption of energy drinks is associated with a range of health risk behaviours for young people. Strategies to limit consumption of energy drinks by young people are warranted.

The Prevalence of Postgraduate Education in Youth Health Among High School Clinicians and Associated Student Health Outcomes.

PURPOSE: Despite numerous calls to improve training in adolescent health, there is little known about the prevalence or effectiveness of specialized training in adolescent health. METHODS: A two-stage random sampling cluster design was used to collect nationally representative data from 8,500 students from 91 high schools. Student data were linked to data from a survey of school health clinicians from participating schools on their level of training in youth health. Multilevel models accounting for demographic characteristics of students were used to estimate the association between nurses and physicians training in youth health and health outcomes among students. RESULTS: Almost all nurses and physicians reported some training in youth health, either having attended lectures or study days in youth health (n = 60, 80%) or completed postgraduate papers in youth health (n = 13, 17.3%). Students in schools where the nurses and physicians had received postgraduate training in youth health were less likely than students from schools with clinicians having attended lectures or study days in youth health to report emotional and behavior difficulties (11.8 vs. 12.7, p = .002) and binge drinking (19.6% vs. 24.9%, p = .03). There were no significant associations between depressive symptoms, suicide risk, cigarette, marijuana, contraception use, or motor vehicle risk behaviors among students and level of training among clinicians in their schools' health service. CONCLUSIONS: Postgraduate training in youth health among nurses and physicians in school health services is associated with fewer students reporting mental health difficulties and binge alcohol use. These findings support specialized training in youth health for clinicians working predominantly with young people.

The association between socioeconomic deprivation and secondary school students' health: findings from a latent class analysis of a national adolescent health survey.

BACKGROUND: The aims of this study were to examine indicators of socioeconomic deprivation among secondary school students and to determine associations between household poverty, neighbourhood deprivation and health indicators. METHODS: Data were from a nationally representative sample of 8500 secondary school students in New Zealand who participated in a health survey in 2012. Latent class analyses were used to group students by household poverty based on nine indicators of household socioeconomic deprivation: no car; no phone; no computer; their parent/s worry about not having enough money for food; more than two people sharing a bedroom; no holidays with their families; moving home more than twice that year; garages or living rooms used as bedrooms; and, no parent at home with employment. Multilevel generalized linear models were used to estimate the cross-level interaction between household poverty and neighbourhood deprivation with depressive symptoms, cigarette smoking and overweight/ obesity. RESULTS: Three groups of students were identified: 80 % of students had low levels of household poverty across all indicators; 15 % experienced moderate poverty; and 5 % experienced high levels of poverty. Depressive symptoms and cigarette smoking were 2-3 times higher in the poverty groups compared to student's not experiencing poverty. There were also higher rates of overweight/ obesity among students in the poverty groups compared to students not experiencing poverty, but once covariates were accounted for the relationship was less clear. Of note, students experiencing poverty and living in affluent neighbourhoods reported higher levels of depressive symptoms and higher rates of cigarette smoking than students experiencing poverty and living in low socioeconomic neighbourhoods. This cross-level interaction was not seen for overweight/ obesity. CONCLUSIONS: Measures of household socioeconomic deprivation among young people should not be combined with neighbourhood measures of socioeconomic deprivation due to non-linear relationships with health and behaviour indicators. Policies are needed that address household poverty alongside efforts to reduce socioeconomic inequalities in neighbourhoods.

Exposing young people to cooking and new foods: findings from a feasibility study in an alternative education setting.

OBJECTIVE: The current study describes a feasibility study of an experiential cooking program for alternative education students. The aims were to identify potential areas for measuring impact (beyond nutrition) and to identify issues threatening the feasibility and evaluation of the program. MATERIALS AND METHODS: Weekly cooking sessions were conducted in one alternative education center over a school term. Data were collected through weekly observations, a youth focus group, and staff interview. RESULTS: Observational data confirmed high levels of participation by students, willingness to try new foods, and enjoyment of foods prepared. Comments from the teacher and students emphasized the wider impact of the cooking sessions on positive youth development and cultural engagement, including opportunities for socio-emotional learning, team work, socializing with peers, and cultural blessings of food. CONCLUSION: Future studies should consider measures of positive youth development along with cooking skills and eating behaviors as potential outcomes.

Family meals and the well-being of adolescents.

AIM: The current study describes the relationships between family meals and family connectedness, parental monitoring and parent-child communication and determines if frequent family meals are associated with better mental well-being and fewer risk-taking behaviours among adolescents. METHODS: Data were collected as part of Youth'07, a nationally representative survey of the health and well-being of secondary school students in New Zealand (n = 9107). RESULTS: Frequent family meals were positively associated with better indicators of family relationships (P < 0.001). Likewise, frequent family meals were significantly associated with higher well-being scores (P < 0.001), lower depression scores (P < 0.001) and fewer risk-taking behaviours (P < 0.001), even after controlling for age, sex, ethnicity, deprivation, family connectedness, parental monitoring and parental communication. CONCLUSIONS: Our findings suggest that family meals may provide a unique opportunity for building stronger families and young people. Creating environments where frequent family meals are normative, valued and feasible for families may result in benefits for young people that extend beyond good nutrition.

Health and well-being of secondary school students in New Zealand: trends between 2001, 2007 and 2012.

AIM: To describe indicators of health and well-being for New Zealand secondary school students; explore changes between 2001, 2007 and 2012; and compare these findings to international estimates. METHODS: Three national health and well-being surveys of randomly selected New Zealand secondary school students were conducted. Data are presented as prevalence and variation over time (adjusted odds ratio (aOR)). Comparisons with international estimates were made with subsets of the data. RESULTS: Between 2001 and 2012, students reported reductions in cigarette use (aOR 0.27, 95% confidence interval (CI) 0.23-0.32), alcohol use (aOR 0.39, 95% CI 0.33-0.46), marijuana use (aOR 0.37, 95% CI 0.31-0.43), sexual abuse (aOR 0.52, 95% CI 0.46-0.58), fighting (aOR 0.63, 95% CI 0.55-0.73), seatbelt use (aOR 1.47, 95% CI 1.31-1.65) and risky driving behaviours (aOR 0.39, 95% CI 0.33-0.45). Positive connections to school (perception that the school cares, aOR 1.22, 95% CI 1.10-1.35; liking school, aOR 1.55, 95% CI 1.33-1.82) and family (good family relationship, aOR 1.83, 95% CI 1.70-1.97) also improved. Indicators that did not improve and compared poorly with international estimates were protected sex (condom use at last sexual intercourse, aOR 0.77, 95% CI 0.68-0.87) and healthy life-style (daily physical activity, aOR 0.88, 95% CI 0.78-0.99; overweight/obese, aOR 1.09, 95% CI 0.92-1.31). Exposure to family violence (aOR 1.37, 95% CI 1.11-1.68) and depressive symptoms (aOR 1.03, 95% CI 0.91-1.17) also did not improve. CONCLUSIONS: There have been important improvements in the health and well-being of New Zealand adolescents over a relatively short period. These findings demonstrate that population rates of adolescent risk behaviours are amenable to change. Current policy efforts should not lose momentum, while identified priority areas must be adequately resourced to ensure young people have opportunities to thrive now and in the future.

Predictors of cigarette use amongst Pacific youth in New Zealand.

BACKGROUND: Despite progressive population health policies to reduce tobacco harm, smoking prevalence continues to be inequitable amongst key ethnic groups in New Zealand. The purpose of this study is to describe the predictors of cigarette use amongst Pacific youth in New Zealand. METHODS: Data were collected as part of Youth'07, a nationally representative survey of the health and well-being of New Zealand adolescents. The study sample comprised 5471 students and this includes 1,178 were Pacific youth. RESULTS: The smoking prevalence rate for Pacific youth was twice that of New Zealand European youth. Pacific girls and older age groups, ages 16-17, smoked more than Pacific boys and younger adolescents. Pacific youth from higher and mid-deprivation neighbourhoods smoked at twice the rate of youth from low deprivation areas. Local neighbourhood stores (dairies) were the most used location for purchasing cigarettes, and only 12.7% of under-aged adolescents were asked "most of the time" for age identification. Pacific adolescent smoking was associated with parental smoking, peer-group smoking and binge drinking. Parents not knowing the whereabouts of adolescents during after-school hours and night-times were also associated with adolescent smoking. A majority of Pacific adolescent smokers (70.2%) had tried to quit smoking. CONCLUSION: The strategies for addressing ethically the issue of equal health for all is to allocate increased public health investments towards targeted quit-smoking treatment programmes for Pacific youth in New Zealand. Further qualitative studies with Pacific youth to inform the development of culturally-appropriate youth-focused quit-substance interventions is recommended.

Pacific secondary school students' access to primary health care in New Zealand.

AIM: Previous research states Pacific peoples' experience barriers to primary care. A better understanding of young Pacific peoples' experiences and perspectives on health services can improve responsiveness to young Pacific New Zealanders' health needs. This study identifies primary health (including dental care) barriers in access, utilisation and unmet need for Pacific youth ages 13-17 years. METHODS: Data were collected as part of Youth'07, a nationally representative survey of the health and wellbeing of New Zealand (NZ) adolescents. 1178 Pacific students who identified any of their ethnicities as Samoan, Cook Islands, Tongan, Niue, Tokelauan, Fijian, or Other Pacific Peoples were included. RESULTS: Compared to their NZ European peers, Pacific youth accessed primary health care services, including dental care less often in the previous year; Pacific students were twice more likely to forego accessing health care and dental care when needed; were more likely to find it difficult to get healthcare for specific health issues like injuries/accident; to stop smoking, alcohol/drugs use and for chronic conditions. Not knowing how to access healthcare and rating unfair treatment by health professionals due to their ethnicity were significant factors impacting access. CONCLUSION: Good access and utilisation of primary care services is an important resource of preventable health for Pacific New Zealanders. This study finds that Pacific youth are an underserved group experiencing inequitable access within the current primary healthcare sector. Innovative approaches to specialist youth-oriented healthcare services, professional training and increasing the Pacific health workforce are recommended interventions.

Forgone health care among secondary school students in New Zealand.

INTRODUCTION: Perceived lack of confidential health care is an important barrier for young people accessing health care services in New Zealand (NZ). AIM: To determine the prevalence of forgone health care among a nationally representative sample of NZ secondary school students and to describe the health concerns and specific health issues for which young people had difficulty accessing health care. METHODS: Random sample of 9107 NZ secondary school students participated in a 2007 health survey using internet tablets. Questions about access to health care included whether there had been a time when they had not accessed health care when needed, reasons for difficulty in accessing health care, current health concerns and health risk behaviours. RESULTS: One in six students (17%) had not seen a doctor or nurse when needed in the last 12 months. Female Maori and Pacific students and those living in neighbourhoods with high levels of deprivation were more likely to report forgone health care. Students with chronic health problems, those engaging in health risk behaviours or experiencing symptoms of depression were more likely to report being unable to access health care when needed. Students reporting privacy concerns were more likely to report difficulty accessing health care for sensitive health issues, such as sexual health, emotional problems, pregnancy-related issues, stopping cigarette smoking, or alcohol or drug use. DISCUSSION: NZ secondary school students who forgo health care are at increased risk of physical and mental health problems and in need of accessible and confidential health services.

Family support and weight-loss strategies among adolescents reporting sustained weight loss.

OBJECTIVE: The current research aims to describe the weight-control strategies and family support for young people reporting sustained weight loss in a large, population-based sample. DESIGN: Data were collected as part of Youth'07, a nationally representative survey of the health and well-being of New Zealand youth. SETTING: New Zealand secondary schools, 2007. SUBJECTS: Secondary-school students (n 9107). RESULTS: Among young people who attempted weight loss in the previous year, 51% reported long-term weight loss (lost weight and maintained weight loss for 6 months). Students reporting long-term weight loss were more likely to be male, but did not differ by age, ethnicity, socio-economic deprivation or measured weight status from students who reported temporary/recent weight loss or no weight loss. Students with long-term weight loss also reported healthier weight-control strategies (e.g., exercising, eating fewer fatty foods, eating fewer sweets), high parental support for healthy eating/activity and were less likely to report being teased about their weight by their family and having junk food available at home than students with temporary/recent weight loss or no weight loss. CONCLUSIONS: Approximately 50% of young people attempting weight loss reported sustained weight loss. Young people who reported sustained weight loss appeared to have more family support than those who did not achieve this, suggesting the importance for weight-control services and interventions in adolescents of actively engaging the family.

Immigrant status and acculturation influence substance use among New Zealand youth.

OBJECTIVE: To investigate the associations between generational status, acculturation and substance use among immigrant and non-immigrant secondary school students in New Zealand. METHODS: A nationally representative sample of secondary school students in New Zealand was selected using a two-stage cluster sample design. Of the 8,999 students in the sample, 23.81% were first-generation immigrants and 20.90% were second-generation immigrants; the remaining 55.29% students are collectively referred to as 'non-immigrant' peers. Logistic regression models adjusted the associations of interest for age, gender, ethnicity, socioeconomic status and experience of ethnic discrimination. RESULTS: First and second-generation immigrants showed significantly lower risks of smoking cigarettes compared with their non-immigrant peers. Similar trends were apparent for consuming alcohol and marijuana weekly. The inclusion of some characteristics suggestive of acculturation in multivariable models did not influence the relationship between generational status and smoking cigarettes, but attenuated the apparent protective effect of being a first-generation immigrant with regard to alcohol and marijuana use. CONCLUSIONS AND IMPLICATIONS: The study shows the lower likelihood of substance use among newer immigrants in a nationally representative sample of New Zealand youth. Policies and health programs that build on this positive profile and reduce the risk of adverse changes over time require attention.

A theory-based video messaging mobile phone intervention for smoking cessation: randomized controlled trial.

BACKGROUND: Advances in technology allowed the development of a novel smoking cessation program delivered by video messages sent to mobile phones. This social cognitive theory-based intervention (called "STUB IT") used observational learning via short video diary messages from role models going through the quitting process to teach behavioral change techniques. OBJECTIVE: The objective of our study was to assess the effectiveness of a multimedia mobile phone intervention for smoking cessation. METHODS: A randomized controlled trial was conducted with 6-month follow-up. Participants had to be 16 years of age or over, be current daily smokers, be ready to quit, and have a video message-capable phone. Recruitment targeted younger adults predominantly through radio and online advertising. Registration and data collection were completed online, prompted by text messages. The intervention group received an automated package of video and text messages over 6 months that was tailored to self-selected quit date, role model, and timing of messages. Extra messages were available on demand to beat cravings and address lapses. The control group also set a quit date and received a general health video message sent to their phone every 2 weeks. RESULTS: The target sample size was not achieved due to difficulty recruiting young adult quitters. Of the 226 randomized participants, 47% (107/226) were female and 24% (54/226) were Maori (indigenous population of New Zealand). Their mean age was 27 years (SD 8.7), and there was a high level of nicotine addiction. Continuous abstinence at 6 months was 26.4% (29/110) in the intervention group and 27.6% (32/116) in the control group (P = .8). Feedback from participants indicated that the support provided by the video role models was important and appreciated. CONCLUSIONS: This study was not able to demonstrate a statistically significant effect of the complex video messaging mobile phone intervention compared with simple general health video messages via mobile phone. However, there was sufficient positive feedback about the ease of use of this novel intervention, and the support obtained by observing the role model video messages, to warrant further investigation. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry Number: ACTRN12606000476538; http://www.anzctr.org.au/trial_view.aspx?ID=81688 (Archived by WebCite at http://www.webcitation.org/5umMU4sZi).

Do schools influence student risk-taking behaviors and emotional health symptoms?

PURPOSE: Many schools engage in health promotion, health interventions, and services aimed at improving the health and well-being outcomes for students. The purpose of this study was to examine the effects of schools on student health risk-taking behaviors and depressive symptoms. METHOD: A nationally representative sample (n = 9,056) of students from 96 secondary schools completed a health and well-being survey using Internet Tablets that included questions on school climate, health risk-taking behaviors, and mental health. Teachers (n = 2,901) and school administrators (n = 91) completed questionnaires on aspects of the school climate which included teacher well-being and burnout, the staff work environment, health and welfare services for students, and school organizational support for student health and well-being. Multilevel models were used to estimate school effects on the health risk-taking behaviors and depression symptoms among students. RESULTS: Schools where students reported a more positive school climate had fewer students with alcohol use problems, and fewer students engaging in violence and risky motor vehicle behaviors. Schools where teachers reported better health and welfare services for students had fewer students engaging in unsafe sexual health behaviors. Schools where teachers reported higher levels of well-being had fewer students reporting significant levels of depressive symptoms. CONCLUSIONS: More positive school climates and better school health and welfare services are associated with fewer health risk-taking behaviors among students. However, the overall school effects were modest, especially for cigarette use and suicidal behaviors.

Health and well-being of young people who attend secondary school in Aotearoa, New Zealand: what has changed from 2001 to 2007?

AIM: To describe the changes in the health and well-being of secondary school students from 2001 to 2007. METHODS: A total of 9107 secondary school students were randomly selected to participate in a comprehensive health and well-being survey using Internet tablets conducted in 2007. Comparisons are made with the first health and well-being survey conducted in 2001. RESULTS: Students from 2007 reported good relationships with their families, people in their schools and neighbourhoods. Compared with the 2001 survey, students surveyed in 2007 were more likely to report positive mental health, better nutritional habits and higher levels of physical activity, and were less likely to report using tobacco and marijuana than students in 2001. In addition, the proportion of students who reported significant depressive symptoms and suicidal behaviours had decreased since 2001. However, concerning proportions of students in 2007 reported: binge drinking, experience of physical and sexual abuse, and witnessing violence in their homes. CONCLUSION: While students' health and well-being have significantly improved from 2001 to 2007, there remain significant areas of concern.

Socio-economic differences in eating-related attitudes, behaviours and environments of adolescents.

OBJECTIVE: The aim of the present study was to investigate the relationship between area-level socio-economic status and healthy and less healthy eating behaviours among adolescents and to determine whether the relationship between area-level socio-economic status and dietary behaviours was related to the relevant attitudes and environments. DESIGN: Data were collected as part of Youth'07, a nationally representative survey of the health and well-being of New Zealand youth. SETTING: New Zealand secondary schools, 2007. SUBJECTS: A total of 9107 secondary-school students in New Zealand. RESULTS: Students from more deprived areas perceived more supportive school environments and cared as much about healthy eating as students in more affluent areas. However, these students were significantly more likely to report consuming fast food, soft drinks and chocolates. CONCLUSIONS: Addressing area-level socio-economic disparities in healthy eating requires addressing the availability, affordability and marketing of unhealthy snack foods, particularly in economically deprived areas.