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.

An integrative review of racism in nursing to inform anti-racist nursing praxis in Aotearoa New Zealand.

AIM: To synthesise international literature to identify mechanisms that maintain racism in nursing and understand the factors that contribute to designing and implementing anti-racist praxis to inform nursing in Aotearoa New Zealand. DESIGN: An integrative literature review was undertaken, integrating Indigenous Kaupapa Maori methodologies to ensure a cultural and philosophical lens. METHODS: Peer-reviewed literature published, between January 2011 and July 2023 were sourced. Of 1296 articles, 16 met the inclusion criteria and 4 were identified via citation chaining. In total, 20 articles were included. The Johns Hopkins Research Evidence Tool was applied, findings extracted, and thematic analysis completed utilising Indigenous Kaupapa Maori principles. DATA SOURCES: Databases, including CINAHL, Scopus, PubMed and Aus/NZ Reference Centre, were searched in July 2023. RESULTS: Two key themes were identified: (1) colonial active resistance to change; and (2) transformational, visionary, and proactive nursing. CONCLUSION: Nurses are well-positioned to confront the structures that maintain racism in health and education systems but are often actors in maintaining status quo. Anti-racist praxis can be a mechanism for nurses to reimagine, redefine and transform nursing care, leadership, and nursing education to begin to eradicate racism. REPORTING METHOD: This integrative review adhered to the 2020 Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) method. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. IMPLICATIONS FOR THE PROFESSION: Racism remains prevalent in nursing and the healthcare system. It is necessary to implement anti-racist praxis and policies that resist, deconstruct, and dismantle power and racism while validating Indigenous values, beliefs and practices. This is vital to deliver equitable health care. IMPACT: This integrative review presents lived realities and knowledge of Indigenous and racially minoritised nurses and scholars, alongside nursing allies to inform anti-racist praxis. This evidence signifies that it is time to walk the walk to challenge the colonising systems and processes that hold racism in place.

The glue that binds us: The positive relationships between whanaungatanga (belonging), the wellbeing, and identity pride for takatapui who are trans and non-binary.

ISSUE ADDRESSED: This article explores how belonging can enhance well-being for takatapui (a traditional Maori term that embraces all Maori with diverse genders, sexualities and sex characteristics) who are trans and non-binary across a range of contexts. METHODS: We drew data from the 2018 Counting Ourselves, a nationwide community-based survey of trans and non-binary people in Aotearoa (New Zealand) (N = 1178); of which 161 (13.7%) identified as Maori, the Indigenous people of Aotearoa. RESULTS: Based on generalised regression models, feelings of belonging with friends, takatapui communities, Maori communities, and work communities were correlated to higher feelings of life satisfaction, life worthwhileness, and identity pride for takatapui who are trans and non-binary. In Te Ao Maori (the Maori worldview), such concepts of belonging and relationships are collectively known as whanaungatanga. CONCLUSIONS: Our findings affirm whanaungatanga as foundational to well-being among trans Maori people, enabling them to locate themselves within nurturing and supportive networks. SO WHAT?: Whanaungatanga is a key policy agenda, alongside other system-level change, that is needed to buffer takatapui who are trans and non-binary from poverty, stigma, and racism they face. This will require changes to the current policy and practice context. We argue that whanaungatanga, while an important strategy of well-being for trans and non-binary people, must also occur alongside wider system transformations to address transphobia, racism, and cisheteronormativity.

Flexible resources and experiences of racism among a multi-ethnic adolescent population in Aotearoa, New Zealand: an intersectional analysis of health and socioeconomic inequities using survey data.

BACKGROUND: As societies become increasingly diverse, understanding the complex nature of racism for multiple ethnic, social, and economic identities of minority youth is required. Here we explore the experience of racism between and among privileged majority adolescent groups and targeted minority (Indigenous and ethnic) adolescents in New Zealand. Using the concept of structural and embodiment flexible resources, which act as risk and protective factors, we examine the social and health effects on minority youth. METHODS: In this intersectional analysis, we use self-reported data from the Youth2000 survey series administered in 2001, 2007, 2012, and 2019 to large, representative samples of students from mainstream state and private schools in the Auckland, Tai Tokerau, and Waikato regions of New Zealand. Students were in school years 9-13 and mostly aged 13-17 years. Ethnic or migrant group, income level of country of origin, and migrant generation were used as measures of structural resources and perceived ethnicity as a measure of embodiment resource. Racism and its effects were measured as socioeconomic inequities (household, neighbourhood, and school-level deprivation); interpersonal discrimination (unfair treatment, bullying, and safety); and health inequities (forgone health care, symptoms of depression, and attempted suicide). We used generalised linear models to explore variations in economic, interpersonal, and health outcomes for Indigenous and migrant youth, adjusting for mediating effects of household deprivation and measures of flexible resources (migration generation, income level of country of origin, and perceived ethnicity). FINDINGS: We collected data from a total of 20 410 adolescents from the four survey waves between 2001 and 2019. Participants had a median age of 15 years (IQR 14-16). Socioeconomic, interpersonal, and health inequities varied with access to flexible resources among Maori and racialised migrant youth. Maori and racialised migrants from low-income and middle-income countries in particular experienced high levels of socioeconomic inequities. Racialised migrant youth experienced persistent socioeconomic inequities extending over three generations, especially Pasifika migrant adolescents. Minorities perceived as White experienced less discrimination and had more advantages than visibly racialised groups. Regression models showed that embodiment resources, and to a lesser extent structural resources, mediated, but did not eliminate ethnic disparities in socioeconomic status and interpersonal discrimination; these resources did not strongly mediate ethnic disparities in health. Trend analyses indicate consistency in these patterns with ethnicity-based inequities persisting or increasing over time. INTERPRETATION: Indigenous and ethnic minority experiences of racism are heterogeneous. Structural flexible resources (wealth) and, more substantially, embodiment flexible resources (perceived Whiteness) mitigate individual experiences of racism. In multi-ethnic western societies, anti-racist interventions and policies must address both structural deprivation and associated intergenerational mobility and colourism (ie, implicit and explicit bias against non-White youth). FUNDING: Health Research Council of New Zealand.

Determinants of ethnic differences in the uptake of child healthcare services in New Zealand: a decomposition analysis.

BACKGROUND: There are persistent ethnic gaps in uptake of child healthcare services in New Zealand (NZ), despite increasing policy to promote equitable access. We examined ethnic differences in the uptake of immunisation and primary healthcare services at different ages and quantified the contribution of relevant explanatory factors, in order to identify potential points of intervention. METHODS: We used data from the Growing Up in New Zealand birth cohort study, including children born between 2009 and 2010. Econometric approaches were used to explore underlying mechanisms behind ethnic differences in service uptake. Multivariable regression was used to adjust for mother, child, household, socioeconomic, mobility, and social factors. Decomposition analysis was used to assess the proportion of each ethnic gap that could be explained, as well as the main drivers behind the explained component. These analyses were repeated for four data time-points. RESULTS: Six thousand eight hundred twenty-two mothers were enrolled during the antenatal survey, and children were followed up at 9-months, 2-years and 4-years. In univariable models, there were ethnic gaps in uptake of immunisation and primary care services. After adjusting for covariates in multivariable models, compared to NZ Europeans, Asian and Pacific children had higher timeliness and completeness of immunisation at all time-points, while indigenous Maori had lower timeliness of first-year vaccines despite high intentions to immunise. Asian and Pacific mothers were less likely to have their first-choice lead maternity caregiver (LMC) than NZ Europeans mothers, and Maori and Asian mothers were less likely to be satisfied with their general practitioner (GP) at 2-years. Healthcare utilisation was strongly influenced by socio-economic, mobility and social factors including ethnic discrimination. In decomposition models comparing Maori to NZ Europeans, the strongest drivers for timely first-year immunisations and GP satisfaction (2-years) were household composition and household income. Gaps between Pacific and NZ Europeans in timely first-year immunisations and choice of maternity carer were largely unexplained by factors included in the models. CONCLUSIONS: Ethnic gaps in uptake of child healthcare services vary by ethnicity, service, and time-point, and are driven by different factors. Addressing healthcare disparities will require interventions tailored to specific ethnic groups, as well as addressing underlying social determinants and structural racism. Gaps that remain unexplained by our models require further investigation.

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.

Prevalence, severity and impact of chronic pain among a representative cross-sectional study of New Zealand high school students.

AIM: To report the prevalence of self-reported chronic pain and severity among young people in New Zealand and explore the relationships between pain and mental health, substance use, socialisation and school engagement. METHODS: Prevalence of self-reported chronic pain frequency and severity are reported from an anonymous, representative cross-sectional self-administered health and well-being questionnaire by students aged 12-18 years in New Zealand. Multivariable models exploring chronic pain and mental health, substance use, socialisation and school engagement are reported controlling for age, sex, ethnicity, socio-economic status, disability and history of sexual abuse. RESULTS: Overall, 22.8% (95% confidence interval (CI) 21.2-24.5) of young people reported chronic pain for 6 months or more, with 3.2% (95% CI 3.1-4.5) reporting severe pain weekly or more often. Females and rural adolescents were more likely to report chronic and severe pain. Asian youth reported less pain than other ethnic groups. Increased severity of pain was associated more with poorer daily functioning and socialising than with frequency of pain. Severe pain occurring weekly or more often was more common among students who had a disability (2.3% 95% CI 1.8-2.7 vs. 9.8%, 95% CI 7.2-12.5) or a history of sexual abuse (2.4% 95% 1.9-2.9 vs. 8.5%, 95% CI 6.3-10.5). Those reporting chronic pain had higher proportions of self-reported significant depressive symptoms, lower well-being, lower school engagement and lower access to health care, particularly for those reporting higher levels of intensity and frequency of pain. CONCLUSIONS: Chronic pain is common in adolescent populations, and has a significant association with decreased daily functioning, socialising, school engagement and mental well-being. Adolescents with chronic pain report significant unmet health-care needs.

Conceptualising relational care from an Indigenous Maori perspective: A scoping review.

OBJECTIVE: To identify and describe the attributes of relational care from an Indigenous Maori healthcare consumer perspective. DATA SOURCES: CINAHL Plus, Ovid MEDLINE, ProQuest Nursing & Allied Health, Scopus, New Zealand Index, the Ministry of Health Library, New Zealand Research and Google Scholar were searched between 23 and 30 May 2022. METHODS: This scoping review used the Joanna Briggs Institute methodology for scoping reviews, thematic analysis and the Patterns, Advances, Gaps, Evidence for practice and Research recommendations framework for the synthesis of the findings. RESULTS: A total of 1449 records were identified, and 10 sources were selected for final review. We identified five relational attributes that were most important to Maori: (1) the expressive behaviours and characteristics of healthcare professionals (HCPs), (2) communication to facilitate the healthcare partnership, (3) appreciating differing worldviews, (4) the context in which healthcare is delivered and (5) whanaungatanga (meaningful relationships). CONCLUSION: The relational attributes identified are inextricably linked. Connecting with HCPs and developing a therapeutic relationship is fundamental to improving consumer experience and engagement with mainstream healthcare services. Whanaungatanga is fundamental to meaningful engagements with HCPs. Future research should explore how relational care is practiced in acute care settings when clinician-consumer interactions are time-limited, examine how the health system influences the capacity for relational care and how Indigenous and Western paradigms can co-exist in healthcare. IMPLICATIONS: This scoping review can inform future projects addressing health equity for Indigenous communities by creating environments that prioritise culturally safe relational care and value Indigenous knowledge systems. REPORTING METHOD: We used the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. NO PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Indigenous social exclusion to inclusion: Case studies on Indigenous nursing leadership in four high income countries.

AIMS AND OBJECTIVES: This discursive paper provides a call to action from an international collective of Indigenous nurse academics from Australia, Canada, Aotearoa New Zealand and the USA, for nurses to be allies in supporting policies and resources necessary to equitably promote Indigenous health outcomes. BACKGROUND: Indigenous Peoples with experiences of colonisation have poorer health compared to other groups, as health systems have failed to address their needs and preferences. Achieving health equity will require leadership from Indigenous nurses to develop and implement new systems of care delivery. However, little is known about how Indigenous nurses influence health systems as levers for change. DESIGN: A Kaupapa Maori case study design. METHODS: Using a Kaupapa Maori case study methodology, coupled with expert Indigenous nursing knowledge, we developed a consensus on key themes. Themes were derived from three questions posed across the four countries. Themes were collated to illustrate how Indigenous nurses have provided nursing leadership to redress colonial injustices, contribute to models of care and enhance the Indigenous workforce. RESULTS: These case studies highlight Indigenous nurses provide strong leadership to influence outcomes for Indigenous Peoples. Five strategies were noted across the four countries: (1) Indigenous nationhood and reconciliation as levers for change, (2) Indigenous nursing leadership, (3) Indigenous workforce strategies, (4) Development of culturally safe practice and Indigenous models of care and (5) Indigenous nurse activism. CONCLUSIONS: In light of 2020 declared International Year of the Nurse and Midwife, we assert Indigenous nurses' work must be visible to support development of strategic approaches for improving health outcomes, including resources for workforce expansion and for implementing new care models. RELEVANCE TO CLINICAL PRACTICE: Curating strategies to promote Indigenous nurse leaders around the world is essential for improving models of healthcare delivery and health outcomes for Indigenous Peoples.

Effects of Ethnic Classification on Substantive Findings in Adolescent Mental Health Outcomes.

Although most adolescents are healthy, epidemiological studies show that a significant number experience mental health challenges, and that Indigenous and ethnic minority youth tend to have poorer mental health outcomes. However, ethnic classification in adolescence is complex due to increasing multi-ethnic identification, and little is known about how different classification methods affect research conclusions. This study used a nationally representative adolescent sample from Aotearoa New Zealand (N = 8275; ages 12-18; 55% female; 32% multi-ethnic) to investigate the effects that five ethnic classification methods have on substantive findings in three mental health outcomes: overall psychosocial difficulties, deliberate self-harm, and suicide attempts. The results showed that, depending on the classification method used, reported outcomes within the same nominal ethnic group varied by an effect size (d) of up to 0.12, and the reported magnitude of difference between nominal ethnic groups varied by an effect size (d) of up to 0.25. These effects are substantial given that they are solely due to a change in method. The impact that ethnic classification method has on substantive findings highlights the importance of criticality and transparency in research involving ethnicity data.

Demographic discrepancies between administrative-prioritisation and self-prioritisation of multiple ethnic identifications.

Ethnic classification is an inherently subjective process, especially when multiple ethnic identifications are involved. There are two methods commonly used to classify multiple ethnicities into single categories: administrative-prioritisation (assignment via a predetermined hierarchy) and self-prioritisation (where individuals select their "main" ethnicity). Currently, little is known about whether the demographic composition of outputted ethnic groups differs by prioritisation method. This study utilised large-scale data of multi-ethnic children (N = 1,860), adolescents (N = 2,413), and adults (N = 1,056) from Aotearoa New Zealand to examine individual and contextual demographic characteristics associated with discrepancies between administratively-prioritised and self-prioritised ethnicity. Results showed that discrepancy rates, which exceeded 50%, were systematically associated with neighbourhood ethnic composition and socioeconomic deprivation, but largely not associated with gender, age, and birthplace. The contextual nature of self-prioritisation highlights the importance of researchers' choice of ethnic classification method. Implications are discussed in the context of increasing multi-ethnic prevalence.

Ethnicity classification systems for public health surveys: experiences from HIV behavioural surveillance among men who have sex with men.

BACKGROUND: Race and ethnicity classification systems have considerable implications for public health, including the potential to reveal or mask inequities. Given increasing "super-diversity" and multiple racial/ethnic identities in many global settings, especially among younger generations, different ethnicity classification systems can underrepresent population heterogeneity and can misallocate and render invisible Indigenous people and ethnic minorities. We investigated three ethnicity classification methods and their relationship to sample size, socio-demographics and sexual health indicators. METHODS: We examined data from New Zealand's HIV behavioural surveillance programme for men who have sex with men (MSM) in 2006, 2008, 2011, and 2014. Participation was voluntary, anonymous and self-completed; recruitment was via community venues and online. Ethnicity allowed for multiple responses; we investigated three methods of dealing with these: Prioritisation, Single/Combination, and Total Response. Major ethnic groups included Asian, European, indigenous Maori, and Pacific. For each classification method, statistically significant associations with ethnicity for demographic and eight sexual health indicators were assessed using multivariable logistic regression. RESULTS: Overall, 10,525 MSM provided ethnicity data. Classification methods produced different sample sizes, and there were ethnic disparities for every sexual health indicator. In multivariable analysis, when compared with European MSM, ethnic differences were inconsistent across classification systems for two of the eight sexual health outcomes: Maori MSM were less likely to report regular partner condomless anal intercourse using Prioritisation or Total Response but not Single/Combination, and Pacific MSM were more likely to report an STI diagnosis when using Total Response but not Prioritisation or Single/Combination. CONCLUSIONS: Different classification approaches alter sample sizes and identification of health inequities. Future research should strive for equal explanatory power of Indigenous and ethnic minority groups and examine additional measures such as socially-assigned ethnicity and experiences of discrimination and racism. These findings have broad implications for surveillance and research that is used to inform public health responses.

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.

Factors Associated with Academic Achievement for Sexual and Gender Minority and Heterosexual Cisgender Students: Implications from a Nationally Representative Study.

Research on sexual and gender minority student achievement indicates that such students report lowered achievement relative to other students. Increased victimization and less school belonging, amongst other factors, have been identified as contributing to these inequalities. However, supportive schooling structures and caregiver support may support their achievement. A nationally representative survey of secondary school students was used to identify specific factors that support achievement for sexual minority (n = 485), gender minority (n = 298), and heterosexual cisgender (where one's sex assigned at birth "matches" a binary gender identity, i.e., a male assigned at birth identifies as a boy/man, n = 7064) students in New Zealand. While reported victimization did not affect achievement for sexual and gender minority students, school belonging, and teacher expectations of success, emerged as significant factors. Differences emerged between sexual minority and gender minority achievement factors, suggesting a range of detailed policy implications and recommendations.

New Zealand adolescents' concerns about their alcohol use and access to services: Associations with ethnicity and other factors.

Using a national survey of 8,500 New Zealand high school students, we investigated adolescents' concerns about their drinking, associated factors including help-seeking preferences and access to health care services, and how these varied by ethnicity and level of socioeconomic deprivation. Approximately 23.9% of the 3,704 current drinkers reported concerns (i.e., being worried about their drinking and/or having tried to cut down). Regression analyses revealed that Maori and Pacific youth were more likely than their New Zealand European peers to be concerned about their drinking. Concerned drinkers were more likely than nonconcerned drinkers to report hazardous drinking behaviors and alcohol-related problems, but these associations varied by age, ethnicity, and socioeconomic deprivation. Help-seeking preferences differed strongly by ethnicity. Concerned drinkers, and Maori and Pacific drinkers, were more likely to report difficulties accessing health care and alcohol and drug services. The factors associated with adolescents' drinking concerns and paradoxical difficulties accessing health care highlight the importance of engaging adolescents in developing responsive and equitable services.

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.

Home Gardening and the Health and Well-Being of Adolescents.

BACKGROUND: The current article explores the associations between home gardening and dietary behaviors, physical activity, mental health, and social relationships among secondary school students in New Zealand. METHOD: Data were drawn from a national youth health and well-being survey, conducted in 2012. In total, 8,500 randomly selected students from 91 randomly selected secondary schools completed the survey. RESULTS: Two thirds of students had a vegetable garden at home and one quarter of all students participated in home gardening. Students participating in gardening were most likely to be male, of a Pacific Island ethnicity, of younger age, and living in a rural area. Gardening was positively associated with healthy dietary habits among students, such as greater fruit and vegetable consumption. Gardening was also positively associated with physical activity and improved mental health and well-being. Students who participate in gardening report slightly lower levels of depressive symptoms and enhanced emotional well-being and experience higher family connection than students who do not participate in gardening. CONCLUSIONS: Gardening may make a difference for health and nutrition behaviors and may contribute to adolescents' health and well-being in a positive manner. Health promoters should be encouraged to include gardening in future interventions for 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.

Adolescents with disability report higher rates of injury but lower rates of receiving care: findings from a national school-based survey in New Zealand.

OBJECTIVE: This study investigates the associations between living with a disabling condition and experiencing clinically attended injuries, risk behaviours and difficulties accessing healthcare for injury among adolescents attending secondary (high) schools in New Zealand. METHODS: A nationally representative cross-sectional self-report survey conducted in 2012 captured health and well-being data from 8500 secondary school students using a multimedia computer-assisted interview. Respondents reporting a disability or a long-term condition with functional limitations were defined as adolescents with a disabling condition (index group of interest). The association between experience of disability (or not) and injuries, related risk factors and access to healthcare was investigated using logistic regression models. RESULTS: One in six students (n=1268, 14.9%) reported a disabling condition. Compared with their peers, these students had significantly increased odds of needing treatment in the previous 12 months for an injury related to an RTC (OR 1.53; 95% CI 1.11 to 2.10), fall (OR 1.30; 95% CI 1.08 to 1.57), near drowning (OR 2.50; 95% CI 1.40 to 4.48), assault (OR 2.13; 95% CI 1.50 to 3.02) and self-harm (OR 4.25; 95% CI 3.03 to 5.96). Students with disabilities were also at increased odds of reporting they had problems accessing healthcare for injury (OR 1.51; 95% CI 1.27 to 1.81). Adolescents with disability were more likely than their peers to have been a passenger in a vehicle where the driver was under the influence of drugs (OR 1.29; 95% CI 1.03 to 1.62) or was driving dangerously (OR 1.40; 95% CI 1.21 to 1.62). CONCLUSIONS: Acknowledging the likely underestimation of effects in a mainstream school survey, adolescents with disability face elevated odds of injury and yet have poorer access to healthcare. Environmental and systemic causes of these disparities require greater attention with implementation of effective interventions.

What has changed from 2001 to 2012 for sexual minority youth in New Zealand?

AIM: To provide an overview of the health and well-being of sexual minority high school students in New Zealand, investigate differences between sexual minority youth (SMY) and exclusively opposite-sex-attracted youth (EOSAY), and examine changes across survey waves. METHODS: Nationally representative cross-sectional surveys were completed in 2001 (n = 9011), 2007 (n = 8002) and 2012 (n = 8167). Logistic regressions were used to examine the associations between selected outcomes and sexual attraction across survey waves. RESULTS: SMY accounted for 6% of participants in all three waves, with a greater proportion being 'out' in 2012 (P < 0.0001). SMY were more likely to work as volunteers (OR = 1.37) than EOSAY, and the majority of SMY reported good general health, liking school and having caring friends. With the exceptions of binge drinking and being driven dangerously by someone, SMY reported comparatively diminished health and well-being relative to EOSAY. Increasing proportions of SMY had depressive symptoms from 2001 (OR = 2.38) to 2012 (OR = 3.73) compared with EOSAY. There were some differences between the sexes; female SMY were less likely to report positive family relationships (OR = 0.59) and liking school (OR = 0.55), and they were more likely to have been hit (2012 OR = 1.95) than female EOSAY. Male SMY reported especially high rates of suicide attempts (2012 OR = 5.64) compared with male EOSAY. CONCLUSIONS: Health services, schools, communities and families must be more responsive to the needs of SMY to ensure that disparities are addressed.