Alcohol consumption in New Zealand women before and during pregnancy: findings from the Growing Up in New Zealand study.

AIM: To examine alcohol consumption before and during pregnancy in the mothers of a contemporary sample of New Zealand children. METHOD: Analysis of data from the antenatal assessment of 6,822 women enrolled in the Growing Up in New Zealand study, using logistic regression models to examine associations between maternal alcohol use and maternal demographics, pregnancy planning and parity. RESULTS: Seventy-one percent of women drank alcohol before becoming pregnant, 23% during and 13% after the first trimester. The odds of drinking alcohol before pregnancy were significantly higher for younger women who were European or Maori with an unplanned pregnancy and in their first pregnancy; during the first trimester, higher for women who were European or Maori with no secondary school qualification, in their first pregnancy, with an unplanned pregnancy; and in the second and third trimesters, higher for European or Maori women aged 30 and over, in their first pregnancy. CONCLUSIONS: Drinking is common in New Zealand women before pregnancy, particularly among European and Maori women. Some women consume small amounts of alcohol and some engage in heavy drinking in pregnancy. Both are a risk for fetal harm. Population-wide and targeted measures are needed to reduce consumption overall and provide support to specific population groups.

Adolescent gambling behaviour, a single latent construct and indicators of risk: findings from a national survey of New Zealand high school students.

This study explores underlying latent construct/s of gambling behaviour, and identifies indicators of "unhealthy gambling". Data were collected from Youth'07 a nationally representative sample of New Zealand secondary school students (N = 9107). Exploratory factor analyses, item-response theory analyses, multiple indicators-multiple causes, and differential item functioning analyses were used to assess dimensionality of gambling behaviour, underlying factors, and indicators of unhealthy gambling. A single underlying continuum of gambling behaviour was identified. Gambling frequency and 'gambling because I can't stop' were most strongly associated with unhealthy gambling. Gambling to 'feel better about myself' and to 'forget about things' provided the most precise discriminants of unhealthy gambling. Multivariable analyses found that school connectedness was associated with lower levels of unhealthy gambling.

Parental smoking during pregnancy: findings from the Growing Up in New Zealand cohort.

AIMS: To investigate patterns of exposure to tobacco smoke in pregnancy among a representative sample of New Zealand women. METHODS: Analyses of smoking-related data from the first wave of the Growing Up in New Zealand cohort study, ie from the first data-collection point during the antenatal period in 2009-10. RESULTS: Twenty percent of mothers reporting smoking before pregnancy and 9.9% of mothers continued during pregnancy. These figures were higher in younger women (p<.0001), women with lower educational achievement (p<.001) and Maori women (p<.001). Similarly, being Maori (p<.0001) and having a lower education achievement (p<.0029) were associated with smoking during an unplanned compared to a planned pregnancy. Multiparous mothers were more likely to be smokers than primaparous mothers (11%: 95% Confidence Interval [CI] 10.0-12.1 vs 8.3%: 95% CI 7.2-9.4). Second-hand smoke exposure was more common for younger women (Odds Ratio [OR] 3.2: 95% CI 1.6-6.4), Maori women (OR 1.9: 95% CI 1.4-2.5), and women with unplanned pregnancies (OR 3.4 95% CI 12.0-14.8). CONCLUSIONS: There are differences in a range of contextual and behavioural factors related to smoking before and during pregnancy. Low educational achievement, being young, Maori and multiparous were all associated with smoking during pregnancy. A better understanding of why these differences exist is needed in order to find appropriate interventions to support women in becoming smoke-free.

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.

Unhealthy Gambling Amongst New Zealand Secondary School Students: An Exploration of Risk and Protective Factors.

This study sought to determine the prevalence of gambling and unhealthy gambling behaviour and describe risk and protective factors associated with these behaviours amongst a nationally representative sample of New Zealand secondary school students (n = 8,500). Factor analysis and item response theory were used to develop a model to provide a measure of 'unhealthy gambling'. Logistic regressions and multiple logistic regression models were used to investigate associations between unhealthy gambling behaviour and selected outcomes. Approximately one-quarter (24.2 %) of students had gambled in the last year, and 4.8 % had two or more indicators of unhealthy gambling. Multivariate analyses found that unhealthy gambling was associated with four main factors: more accepting attitudes towards gambling (p < 0.0001); gambling via gambling machines/casinos/track betting (p = 0.0061); being worried about and/or trying to cut down on gambling (p < 0.0001); and, having attempted suicide (p = 0.0009). Unhealthy gambling is a significant health issue for young people in New Zealand. Ethnic and social inequalities were apparent and these disparities need to be addressed.

The Association Between Supportive High School Environments and Depressive Symptoms and Suicidality Among Sexual Minority Students.

The purpose of this study was to determine if sexual minority students in supportive school environments experienced fewer depressive symptoms and lower rates of suicide ideation, plans and attempts ("suicidality") than sexual minority students in less supportive school environments. In 2007, a nationally representative sample (N = 9,056) of students from 96 high schools in New Zealand used Internet tablets to complete a health and well-being survey that included questions on sexual attractions, depressive symptoms, and suicidality. Students reported their experience of supportive environments at school and gay, lesbian, bisexual, and transgender (GLBT) bullying, and these items were aggregated to the school level. Teachers (n = 2,901) from participating schools completed questionnaires on aspects of school climate, which included how supportive their schools were toward sexual minority students. Multilevel models were used to estimate school effects on depressive symptoms and suicidality controlling for background characteristics of students. Sexual minority students were more likely to report higher levels of depressive symptoms and suicidality than their opposite-sex attracted peers (p < .001). Teacher reports of more supportive school environments for GLBT students were associated with fewer depressive symptoms among male sexual minority students (p = .006) but not for female sexual minority students (p = .09). Likewise in schools where students reported a more supportive school environment, male sexual minority students reported fewer depressive symptoms (p = .006) and less suicidality (p < .001) than in schools where students reported less favorable school climates. These results suggest that schools play an important role in providing safe and supportive environments for male sexual minority students.

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.

The health and well-being of transgender high school students: results from the New Zealand adolescent health survey (Youth'12).

PURPOSE: To report the prevalence of students according to four gender groups (i.e., those who reported being non-transgender, transgender, or not sure about their gender, and those who did not understand the transgender question), and to describe their health and well-being. METHODS: Logistic regressions were used to examine the associations between gender groups and selected outcomes in a nationally representative high school health and well-being survey, undertaken in 2012. RESULTS: Of the students (n = 8,166), 94.7% reported being non-transgender, 1.2% reported being transgender, 2.5% reported being not sure about their gender, and 1.7% did not understand the question. Students who reported being transgender or not sure about their gender or did not understand the question had compromised health and well-being relative to their non-transgender peers; in particular, for transgender students perceiving that a parent cared about them (odds ratio [OR], .3; 95% confidence interval [CI], .2-.4), depressive symptoms (OR, 5.7; 95% CI, 3.6-9.2), suicide attempts (OR, 5.0; 95% CI, 2.9-8.8), and school bullying (OR, 4.5; 95% CI, 2.4-8.2). CONCLUSIONS: This is the first nationally representative survey to report the health and well-being of students who report being transgender. We found that transgender students and those reporting not being sure are a numerically small but important group. Transgender students are diverse and are represented across demographic variables, including their sexual attractions. Transgender youth face considerable health and well-being disparities. It is important to address the challenging environments these students face and to increase access to responsive services for transgender youth.

Stability and change in the mental health of New Zealand secondary school students 2007-2012: results from the national adolescent health surveys.

OBJECTIVE: To describe the self-reported mental health of New Zealand secondary school students in 2012 and to investigate changes between 2007 and 2012. METHODS: Nationally representative health and wellbeing surveys of students were completed in 2007 (n=9107) and 2012 (n=8500). Logistic regressions were used to examine the associations between mental health and changes over time. Prevalence data and adjusted odds ratios are presented. RESULTS: In 2012, approximately three-quarters (76.2%, 95% CI 74.8-77.5) of students reported good overall wellbeing. By contrast (also in 2012), some students reported self-harming (24.0%, 95% CI 22.7-25.4), depressive symptoms (12.8%, 95% CI 11.6-13.9), 2 weeks of low mood (31%, 95% CI 29.7-32.5), suicidal ideation (15.7%, 95% 14.5-17.0), and suicide attempts (4.5%, 95% CI 3.8-5.2). Between 2007 and 2012, there appeared to be slight increases in the proportions of students reporting an episode of low mood (OR 1.14, 95% CI 1.06-1.23, p=0.0009), depressive symptoms (OR 1.16, 95% CI 1.03-1.30, p=0.011), and using the Strengths and Difficulties Questionnaire - emotional symptoms (OR 1.38, 95% CI 1.23-1.54, p<0.0001), hyperactivity (OR 1.16, 95% CI 1.05-1.29, p=0.0051), and peer problems (OR 1.27, 95% CI 1.09-1.49, p=0.0022). The proportion of students aged 16 years or older reporting self-harm increased slightly between surveys, but there was little change for students aged 15 years or less (OR 1.29, 95% CI 1.15-1.44 and OR 1.10, 95% 0.98-1.23, respectively, p=0.0078). There were no changes in reported suicidal ideation and suicide attempts between 2007 and 2012. However, there has been an improvement in self-reported conduct problems since 2007 (OR 0.78, 95% CI 0.70-0.87, p<0.0001). CONCLUSIONS: The findings suggest a slight decline in aspects of self-reported mental health amongst New Zealand secondary school students between 2007 and 2012. There is a need for ongoing monitoring and for evidence-based, accessible interventions that prevent mental ill health and promote psychological wellbeing.

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.

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.

A tale of missed opportunities: pursuit of a public health approach to gambling in New Zealand.

AIM: This paper provides a critical overview a decade after the New Zealand Government announced its intention to formally incorporate a public health approach into its comprehensive revision of gambling legislation. METHOD: The initial enthusiasm and the subsequent disillusionment with this approach are tracked. Four reasons for its lack of success are examined. FINDINGS: The New Zealand experiment with a public health approach to gambling is seen to have floundered in a network of vested interests. The pathways for influence included inappropriate industry input as well as community and government sector reliance on gambling profits. The new legislation neglected to set up systems for strong independent accountability, and this weakened the potential of public health initiatives. CONCLUSION: As with tobacco control, the policy integrity of a public health approach to gambling requires close attention to ways of reducing vested interests in both government and community sectors and to establishing strong points of independent accountability.

Sexual attraction, depression, self-harm, suicidality and help-seeking behaviour in New Zealand secondary school students.

OBJECTIVE: To describe the sexual attractions of New Zealand secondary school students and investigate the associations between sexual attraction and self-reported depression, self-harm, suicidality and help-seeking behaviour. METHOD: Multiple logistic regression was used to examine the associations between sexual attraction and depressive symptoms, suicidality, self-harming and help-seeking behaviours in a nationally representative secondary school health and well-being survey, undertaken in 2007. RESULTS: Of the students surveyed, 92% were attracted to the opposite sex, 1% to the same sex, 3% to both sexes, 2% were not sure and 2% were attracted to neither sex. Students who were attracted to the same or to both sexes consistently had higher prevalence estimates of depression (p = < 0.0001), suicidality (p = < 0.0001) and self-harming (p = < 0.0001). Odds ratios were highest for students who reported they were attracted to both sexes for depressive symptoms (OR 3.7, 95%CI 2.8-4.7), self-harm (OR 5.8, 95%CI 4.4-7.6) and attempted suicide (OR 7.0, 95%CI 5.2-9.4). Students not exclusively attracted to the opposite sex were more likely to report having seen a health professional for an emotional worry and were more likely to have difficulty accessing help for emotional concerns. CONCLUSIONS: The study findings highlight significant mental health disparities faced by students attracted to the same or both sexes, with those attracted to both sexes appearing particularly vulnerable. There is a vital need to ensure primary care and mental health services have the capacity and capability to screen and provide appropriate responsive care for youth who are attracted to the same or both sexes.

Examination of Chinese gambling problems through a socio-historical-cultural perspective.

The aim of this review is to highlight emerging trends about Chinese people and gambling addiction over the last 15 years, and to provide a discourse on the potential link between gambling and Chinese culture and history. The authors reported on the phenomenon of gambling among Chinese people using relevant research studies and reports and traditional Chinese literature. Chinese people have elevated levels of gambling addiction compared to their Western counterparts. These elevated rates are coupled with the rapid expansion of gambling venues within the Pan-Pacific region. While there is an accumulated body of research on Chinese and gambling, a systematic cultural analysis of Chinese gambling is still under development. We undertook a brief comparison between two ancient civilizations, China and Rome, in order to gain better understanding about gambling among Chinese people. To effectively deal with gambling addictions among Chinese people, it is imperative to develop culturally responsive interventions.

Vested interests in addiction research and policy poisonous partnerships: health sector buy-in to arrangements with government and addictive consumption industries.

AIM: This paper critically appraises relationship arrangements among three broadly conceived sectors: the government sector, the health sector (including researchers) and addictive consumption industries (particularly tobacco, alcohol and gambling). METHOD: Three models for involvement are examined. In the 'tripartite partnership model' health sector agencies engage as co-equals with the government and industry sectors in order to implement public health initiatives such as host responsibility and public education. In the 'non- association model' the health sector engages with government agencies but not with the industry sector. In the 'managed association model' the health sector engages for specific purposes with the industry sector but contact is monitored and managed by government agencies. FINDINGS: Government and industry sectors commonly favour tripartite partnership arrangements. Health sector agencies that opt to engage in these partnership arrangements can encounter conflicts of interest and find their voice subsumed by dominant influences. Furthermore, their partnership compliance generates divisions within the health sector, with partnership dissenters often silenced and excluded from policy processes and funding. The non-association model is the least hazardous to the health sector because it protects against compromise and dominance. The managed association model is an option only when the government sector as a whole is committed strongly and clearly to the public health objectives. CONCLUSION: In contexts where key parts of the government sector are conflicted over their public health responsibilities, health sector engagement in partnership arrangements entails too many risks.

Primary care patients reporting concerns about their gambling frequently have other co-occurring lifestyle and mental health issues.

BACKGROUND: Problem gambling often goes undetected by family physicians but may be associated with stress-related medical problems as well as mental disorders and substance abuse. Family physicians are often first in line to identify these problems and to provide a proper referral. The aim of this study was to compare a group of primary care patients who identified concerns with their gambling behavior with the total population of screened patients in relation to co-morbidity of other lifestyle risk factors or mental health issues. METHODS: This is a cross sectional study comparing patients identified as worrying about their gambling behavior with the total screened patient population for co morbidity. The setting was 51 urban and rural New Zealand practices. Participants were consecutive adult patients per practice (N = 2,536) who completed a brief multi-item tool screening primary care patients for lifestyle risk factors and mental health problems (smoking, alcohol and drug misuse, problem gambling, depression, anxiety, abuse, anger). Data analysis used descriptive statistics and non-parametric binomial tests with adjusting for clustering by practitioner using STATA survey analysis. RESULTS: Approximately 3/100 (3%) answered yes to the gambling question. Those worried about gambling more likely to be male OR 1.85 (95% CI 1.1 to 3.1). Increasing age reduced likelihood of gambling concerns - logistic regression for complex survey data OR = 0.99 (CI 95% 0.97 to 0.99) p = 0.04 for each year older. Patients concerned about gambling were significantly more likely (all p < 0.0001) to have concerns about their smoking, use of recreational drugs, and alcohol. Similarly there were more likely to indicate problems with depression, anxiety and anger control. No significant relationship with gambling worries was found for abuse, physical inactivity or weight concerns. Patients expressing concerns about gambling were significantly more likely to want help with smoking, other drug use, depression and anxiety. CONCLUSION: Our questionnaire identifies patients who express a need for help with gambling and other lifestyle and mental health issues. Screening for gambling in primary care has the potential to identify individuals with multiple co-occurring disorders.