Inequities in adolescent sleep health in Aotearoa New Zealand: Cross-sectional survey findings.

OBJECTIVES: To investigate ethnic inequities in, and social determinants of, adolescent sleep health in Aotearoa New Zealand. METHODS: Analysis of self-report data from a cross-sectional survey of secondary school students (12- to 18-year-olds). Analyses included weighted prevalence estimates of good and poor sleep health stratified by ethnicity, and multivariable logistic regression models concurrently adjusted for ethnicity, school year, gender, rurality, neighborhood deprivation, school decile, housing deprivation, sleeping elsewhere due to lack of adequate housing, unsafe environment, and racism. RESULTS: Inequities in social determinants of health were evident for Maori (Indigenous peoples of Aotearoa New Zealand; n = 1528) and minoritized (Pacific n = 1204; Asian n = 1927; Middle Eastern, Latin American, and African [MELAA] n = 210; and 'Other' ethnicity n = 225) adolescents. A greater proportion of Maori, Pacific, Asian, MELAA, and 'Other' adolescents had short sleep, compared to European (n = 3070). Maori, Pacific, Asian, and MELAA adolescents were more likely to report late bedtimes (after midnight), and Maori, Pacific, and 'Other' adolescents were more likely to report early waketimes (5 AM-6 AM or earlier), on school days. Rurality, neighborhood deprivation, school-level deprivation, housing deprivation, sleeping elsewhere due to inadequate housing, unsafe environments, and racism partially, but not fully, explained associations between ethnicity and short sleep, late bedtimes, and early waketimes. CONCLUSIONS: Ethnic inequities exist in adolescent sleep health in Aotearoa New Zealand. Socio-political actions are needed to address racism and colonialism as root causes of ethnic inequities in adolescent sleep, to ensure all young people are afforded the basic human right of good sleep health and associated mental and physical well-being.

Distinct profiles of mental health need and high need overall among New Zealand adolescents - Cluster analysis of population survey data.

OBJECTIVE: The objective was to identify clinically meaningful groups of adolescents based on self-reported mental health and wellbeing data in a population sample of New Zealand secondary school students. METHODS: We conducted a cluster analysis of six variables from the Youth19 Rangatahi Smart Survey (n = 7721, ages 13-18 years, 2019): wellbeing (World Health Organization Well-Being Index), possible anxiety symptoms (Generalized Anxiety Disorder 2-item, adapted), depression symptoms (short form of the Reynolds Adolescent Depression Scale) and past-year self-harm, suicide ideation and suicide attempt. Demographic, contextual and behavioural predictors of cluster membership were determined through multiple discriminant function analysis. We performed cross-validation analyses using holdout samples. RESULTS: We identified five clusters (n = 7083). The healthy cluster (n = 2855, 40.31%) reported positive mental health across indicators; the anxious cluster (n = 1994, 28.15%) reported high possible anxiety symptoms and otherwise generally positive results; the stressed and hurting cluster (n = 667, 9.42%) reported sub-clinical depression and possible anxiety symptoms and some self-harm; the distressed and ideating cluster (n = 1116, 15.76%) reported above-cutoff depression and possible anxiety symptoms and high suicide ideation; and the severe cluster (n = 451; 6.37%) reported the least positive mental health across indicators. Female, rainbow, Maori and Pacific students and those in higher deprivation areas were overrepresented in higher severity clusters. Factors including exposure to sexual harm and discrimination were associated with increasing cluster severity. CONCLUSION: We identified high prevalence of mental health challenges among adolescents, with distinct clusters of need. Youth mental health is not 'one size fits all'. Future research should explore youth behaviour and preferences in accessing support and consider how to best support the mental health of each cluster.

Rapid and unequal decline in adolescent mental health and well-being 2012-2019: Findings from New Zealand cross-sectional surveys.

OBJECTIVE: To investigate prevalence and trends in key mental health and well-being indicators among New Zealand secondary school students. METHODS: Representative cross-sectional youth health surveys with 2-4% of the New Zealand secondary school population were conducted in 2001, 2007, 2012 and 2019 (total n = 34,548). RESULTS: In 2019, 69.1% reported good well-being (95% confidence interval = [67.6, 70.6]; World Health Organization 5-item), 22.8% reported clinically significant depression symptoms (95% confidence interval = [21.4, 24.1]; Reynolds Adolescent Depression Scale-Short Form) and 41.8% reported possible anxiety symptoms (95% confidence interval = [40.5, 43.2]; Generalized Anxiety Disorder 2, adapted). Past-year prevalence of periods of low mood (38.3%, 95% confidence interval = [36.6, 40.1]), deliberate self-harm (24.1%, 95% confidence interval = [22.8, 25.4]), suicide thoughts (20.8%, 95% confidence interval = [19.2, 22.4]) and suicide attempts (6.3%, 95% confidence interval = [5.5, 7.0]) were observed. After relative stability from 2001 to 2012, there were large declines in mental health to 2019. The proportion reporting good well-being decreased (odds ratio 0.71, 95% confidence interval = [0.65, 0.78], p < 0.001), depression symptoms increased (odds ratio 1.96, 95% confidence interval = [1.75, 2.20], p < 0.001) and past-year suicide thoughts and suicide attempts increased (odds ratio 1.41, 95% confidence interval = [1.25, 1.59], p < 0.001; odds ratio 1.60, 95% confidence interval = [1.32, 1.92], p < 0.001). Past-year deliberate self-harm was largely stable. Declines in mental health were unevenly spread and were generally greater among those with higher need in 2012 (females, Maori and Pacific students and those from higher deprivation neighbourhoods), increasing inequity, and among Asian students. CONCLUSION: Adolescent mental health needs are high in New Zealand and have increased sharply from 2012 among all demographic groups, especially females, Maori, Pacific and Asian students and those from high-deprivation neighbourhoods. Ethnic and socioeconomic disparities have widened.

Debate: Supporting the mental health of school students in the COVID-19 pandemic in New Zealand - a digital ecosystem approach.

The pandemic is creating unprecedented demand for mental health support for young people. While schools often facilitate mental health support for their students, the demands for online teaching and the uncertainty created by the pandemic make traditional delivery of support through schools challenging. Technology provides a potential way forward. We have developed a digital ecosystem, HABITS, that can be integrated into school and healthcare systems. This has allowed us to deploy specific evidence-based interventions directly, and through schools, to students and to parents in New Zealand during the current pandemic. Chatbot architecture is particularly suited to rapid iteration to provide specific information while apps can provide more generalised support. While technology can provide some solutions, it is important to be aware of the potential to increase current inequities, with those facing the greatest challenges to health and well-being, also least able to afford the resources to access digital interventions. Development of an integrated and equitable digital system will take time and collaboration.

Using the Internet to access health-related information: results from a nationally representative sample of New Zealand secondary school students.

Objective To determine if secondary school students in New Zealand who report greater health concerns (e.g. significant depressive symptoms) are more likely to use the Internet to access health-related information. Methods A nationally representative health and wellbeing survey was undertaken in 2012 (n = 8500). Multiple regression models were used to examine the associations between students' use of the Internet to access health-related information and selected outcomes or indicators. Results Over 90% of students used the Internet on a daily basis, with 15.4% of students reporting that they had used the Internet to access health-related information. Students experiencing household poverty were more likely to report not using the Internet daily (17.4% compared to 4.2%). Odds ratios (ORs) for accessing the Internet for this sort of information were highest for students who reported self-harm [OR 2.7, 95% confidence interval (CI) 2.3-3.3], disordered eating (OR 2.7, 95% CI 2.4-3.2), or a suicide attempt (OR 2.5, 95% CI 1.9-3.3). Conclusion Our findings suggest that Internet-based health interventions may be a viable way to reach young people with high health needs, but consideration needs to be given to those with limited Internet access.

Dietary behaviours and the mental well-being of New Zealand adolescents.

AIM: To examine the associations between diet and mental health indicators in adolescents. METHODS: Data were drawn from the Youth 2012 survey, a national survey of the health and well-being of adolescents in New Zealand (n = 8500). Multiple regression models were used to determine the associations between healthy and unhealthy eating and mental health indicators while adjusting for sex, age, ethnicity, small area deprivation and household poverty as covariates. RESULTS: Approximately 30% of young people in the lowest quartile for healthy eating reported significant depressive symptoms. Greater healthy eating was significantly associated with fewer depressive symptoms, better well-being and fewer emotional difficulties (all P < 0.001 after adjusting for covariates). Greater unhealthy eating was significantly associated with greater depressive symptoms, poorer well-being and greater emotional difficulties (all P < 0.001 after adjusting for covariates). CONCLUSIONS: Findings from this study contribute to a growing body of literature that indicate that eating behaviours are associated with mental health indicators among adolescents. Findings from the current study suggest that efforts to enhance healthy eating may also have a positive impact on mental health.

Uneven reductions in high school students' alcohol use from 2007 to 2012 by age, sex, and socioeconomic strata.

BACKGROUND: Many Western countries have reported declines in adolescent alcohol use. This study examined changes in adolescent alcohol use in New Zealand between 2007 and 2012 and explored variations across sociodemographic strata. METHODS: Data from 2 nationally representative, cross-sectional high school surveys conducted in 2007 (n = 7709) and 2012 (n = 7266) were examined. Changes in the prevalence of drinking in the past 4 weeks were examined among the total sample, as well as the frequency of drinking in the past 4 weeks and typical drinking-occasion quantity among drinkers. Only students residing in urban areas were included. Variation in changes was investigated across 4 demographic groups characterized by age (<16 years, ≥16 years) and sex. Interactions with household- and neighborhood-level socioeconomic position (SEP) identified any differential changes between socioeconomic strata. RESULTS: From 2007 to 2012, significantly fewer students consumed alcohol in the past 4 weeks. Interaction analyses demonstrated that, among young females (<16 years), declines were significantly greater among those of high household SEP when compared with those of low household SEP. Among drinkers, reductions in the frequency of drinking were found among all demographic groups and SEP strata. Interaction analyses revealed that only young males (<16 years) showed significantly reduced typical drinking-occasion quantities. Among young females, significant interactions revealed a shift towards increasing typical drinking-occasion quantities among those of low household and neighborhood SEP, whereas their more advantaged counterparts showed no significant change over time. CONCLUSIONS: Fewer drinking occasions characterized the major declines in adolescent drinking between 2007 and 2012. Whereas young males showed reductions in the typical quantity consumed, young females of low household and neighborhood SEP progressed towards higher typical quantities. To address the uneven distribution of alcohol-related harm and improve the targeting of harm reduction initiatives, it remains imperative to examine changes in both the overall shift and shape of the distribution curve.

Risk and Protective Factors for Suicidal Behaviors Among Pacific Youth in New Zealand.

BACKGROUND: New Zealand has the second highest youth suicide rate in the OECD and particularly among Pacific New Zealanders, who have a threefold higher risk of suicide attempt compared with the general population. AIMS: Protective and risk factors for suicide attempts among New Zealand Pacific adolescents were assessed using data from Youth'12, an adolescent health and well-being survey. METHOD: This randomly selected nationally representative sample of New Zealand secondary school students included 1,445 Pacific high school students aged 12-17 years. RESULTS: One in 10 (11.6%) Pacific adolescents reported attempting suicide. Risk factors for suicide included: being female, household food insecurity, low levels of family connections and family monitoring, life dissatisfaction, having a religious affiliation, and previous suicide by a family member or friend. Of those who had made a suicide attempt, 71% also experienced both suicide ideation and self-harm. CONCLUSION: This study suggests that given the high rates of suicide ideation and attempts among Pacific young people, targeted trials for new ways of support should be prioritized for this high-risk group. The Pacific family environment, which continues to be the critical space for intervening, and the school environment, as a provider of health services, were both protective of suicide attempt.

Predictors of drinking patterns in adolescence: a latent class analysis.

BACKGROUND: Uni-dimensional measures of alcohol consumption may be unable to fully capture the complexity of adolescent drinking and experience of alcohol-related harms. Latent class analysis provides an empirical method to understand different adolescent drinking patterns. METHODS: Latent class analysis was used to create typologies of drinking among the 5018 current drinkers in the national Youth '07 survey. Determinants of drinking patterns were identified using multinomial logistic regression. RESULTS: Four latent classes were identified, demonstrating an overall increase in risk of alcohol-related outcomes from increasing consumption. One class strongly deviated from this pattern, having moderate consumption patterns but disproportionately high levels of alcohol-related problems. Multinomial logistic regression found that the strongest predictors of belonging to high-risk drinking typologies were having a positive attitude to regular alcohol use, buying own alcohol, peers using alcohol, and obtaining alcohol from friends and/or other adults. Other significant predictors included being male, having a strong connection to friends, having parents with a low level of knowledge of their daily activities and poor connection to school. Class membership also varied by ethnicity. CONCLUSION: The latent class approach demonstrated variability in alcohol-related harms across groups of students with different drinking patterns. Longitudinal studies are necessary to determine the causes of this variability in order to inform the development of targeted policy and preventative interventions. Legislative controls, such as increasing the legal purchase age and reducing the commercial availability of alcohol, will continue to be important strategies for reducing harm in young people.

Clustering of adolescent health concerns: a latent class analysis of school students in New Zealand.

AIMS: The aims of this study are to identify clinically meaningful groups of adolescents based on their engagement in high levels of risk behaviours or severe emotional health concerns and to describe the demographic characteristics of these groups in two populations of school students in New Zealand. METHODS: A nationally representative sample of secondary school students was surveyed in 2007; alternative education (AE) students in Auckland and Northland were surveyed in 2009. A total of 9107 secondary school students and 335 AE students completed a youth health questionnaire using Internet tablets. Latent class analysis (LCA) was used to identify groups of students on the basis of distinct profiles of their risk behaviours and mental health concerns. RESULTS: The majority (80%) of students in secondary schools are 'healthy' and report few health concerns, 16% are considered 'risky' or 'distressed', and 4% report 'multiple' risk behaviour profiles or emotional health concerns. In AE, only 21% of students were considered 'healthy' with most featuring in the 'risky' or 'multiple' groups. Females were more likely to be 'distressed', whereas males were more likely to feature in the 'risky' or 'multiple' groups. CONCLUSIONS: Clinically-concerning health risk behaviours and emotional health concerns 'cluster' in up to 20% of students in secondary schools and up to 79% of students in AE. Gender, ethnic and socio-economic disparities are also observed. This highlights the importance of comprehensive psychosocial assessment and appropriate service provision, particularly for at-risk groups.

Family meals among New Zealand young people: relationships with eating behaviors and body mass index.

OBJECTIVE: To examine the relationship between family meals and nutrition behaviors of adolescents. DESIGN: Secondary analysis of Youth'07, a nationally representative survey. SETTING: Secondary schools in New Zealand. PARTICIPANTS: Randomly selected adolescents (aged 13-17 years, n = 9,107) completed a multimedia and anonymous survey about their health. VARIABLES MEASURED: Body mass index and eating behaviors. ANALYSIS: Multiple logistic regression equations were used to determine the associations between family meals and body size and dietary behaviors, controlling for demographic variables. RESULTS: Nearly 60% of young people shared a meal with their families 5 or more times in the previous week. Frequent family meals were associated with greater consumption of fruits and vegetables (P < .001), and breakfast (P < .001). Adolescents who frequently shared family meals were also more likely to report that what they ate in the past week was healthy than adolescents who did not (P < .001). There was no relationship between frequency of family meals and body mass index (P = .60). CONCLUSIONS AND IMPLICATIONS: Data from the current study suggest that family meals cannot be used as a single strategy for obesity prevention, but they may provide an important opportunity for young people to consume healthy food.

Emotional resilience: risk and protective factors for depression among alternative education students in New Zealand.

A total of 268 alternative education students from New Zealand were surveyed to examine risk and protective factors for depression within the social environment. Twenty-eight (35.4%) of the girls and 31 (21.1%) of the boys had cut-off scores that indicated a high likelihood of significant psychopathology from depression. Multivariate analysis demonstrated that family and peer connections were protective against depression. High levels of poverty, witnessing violence at home, and experiencing bullying at school were significant risk factors for depression.