Youth’12 The Health and Wellbeing of Secondary School Students in New Zealand: Results for Young People Attracted to the Same Sex or Both Sexes

Almost four percent (3.8%) of young people reported being attracted to others of the same sex or both sexes in Youth’12. This proportion is comparable to that found in the previous surveys conducted in 2001 and 2007, suggesting that over the past 11 years there has been no change in relation to the number of New Zealand secondary school students who are same/both-sex attracted. Furthermore these young people are ethnically, geographically, and socially diverse, and attend schools from around the country. In 2012, the majority (53.1%) of same/both-sex attracted young people had ‘come out’ (i.e. told people close to them about their sexuality) whilst 31.3% of same/both-sex attracted students had come out in 2001. However, in Youth’12 only 14.4% of these young people said that they could easily talk to their family about their sexuality. Most same/both-sex attracted students reported feeling positive towards school and described caring relationships with their parents and friends. Same/both-sex attracted students were also generous with their time in that they were more likely (than their opposite-sex attracted counterparts) to work as volunteers in their communities. Although most same/both-sex attracted students are doing well, there are significant and harmful disparities when these students are compared to their opposite-sex attracted peers. Same/both-sex attracted young people are often exposed to environments that are challenging and discriminatory, and this in turn affects their wellbeing. For example, same/both-sex attracted youth are more likely to be bullied, be physically harmed, and to be afraid that someone would hurt or bother them at school. Furthermore, 59.4% of same/both-sex attracted students had deliberately self-harmed, 41.3% had significant depressive symptoms, 18.3% had attempted suicide in the last 12 months, and 35.7% had difficulty getting help for their emotional concerns. These mental health issues have not improved since 2001, and worryingly the proportion of same/both-sex attracted students experiencing significant depressive symptoms has increased from 27.0% in 2001 to 41.3% in 2012, while the proportion of opposite-sex attracted students with these symptoms has remained fairly constant (9.5% in 2007 and 11.4% in 2001 and 2012). This suggests that poor progress is being made in terms of addressing mental health concerns. Overall this report highlights that while many same/both-sex attracted students are doing well, in comparison to opposite-sex attracted students, same/both-sex attracted young people continue to experience compromised health and wellbeing. Evidence from international studies suggest that reducing these disparities must focus on creating safe and nurturing environments which build upon the young person’s strengths and assets, and refrains from problematising (or pathologising) same/both-sex attracted young people

Youth Gambling: The health and wellbeing of New Zealand secondary school students in 2012

Gambling has become a widely available activity in today’s society (Hardoon & Derevensky, 2002; Turchi & Derevensky, 2006). In fact, many researchers “have noted that an entire generation has now grown up in an era when lottery and casino gambling is widely available and heavily advertised” (Volberg, Gupta, Griffiths, Ólason, & Delfabbro, 2010, p. 3). Evidence suggests that it has become a popular past-time not only for adults, but also for children and young people (Derevensky & Gupta, 2000; Gupta & Derevensky, 1998a; Hardoon & Derevensky, 2002; Jacobs, 2000; Splevins, Mireskandari, Clayton, & Blaszczynski, 2010; Turchi & Derevensky, 2006). Moreover, research indicates that gambling is one of the first risky activities that adolescents become involved with (i.e. they begin gambling prior to experimentation with alcohol, drugs, sexual behaviour) (Volberg, et al., 2010). Whilst for many youth involvement in gambling does not result in problematic behaviour, others go on to experience serious problems (Dickson, Derevensky, & Gupta, 2003). A vast range of adolescent gambling prevalence studies that have been undertaken over the past 25 years, across different countries, and incorporating general populations as well as youth specifically. Rates of youth problem gambling have often been found to be higher than the rates identified for adults (Huang & Boyer, 2007; Shaffer & Hall, 1996; Welte, Barnes, Tidwell, & Hoffman, 2008; Williams, Page, Parke, & Rigbye, 2008), with some estimating them to be more than double those of adults (Gupta & Derevensky, 1998a; Jackson, Dowling, Thomas, Bond, & Patton, 2008; Lesieur, et al., 1991), or up to three times as high (Rigbye, 2010). However, it has also been recognised that there is far less research in this field compared to that which has explored other youth risk behaviours such as substance use (Blinn-Pike, Worthy, & Jonkman, 2010). The gap in New Zealand-based information regarding prevalence of youth gambling has been identified previously (Bellringer, et al., 2003; Rossen, Tse, & Vaidya, 2009) and in 2003 it was recommended that research be undertaken to measure the involvement of New Zealand youth in gambling as well as associated factors and gambling-related problems (Bellringer, et al., 2003). A limited body of research has since employed various sources of data to consider youth gambling in New Zealand (e.g. Gray, 2010; Ministry of Health, 2008, 2009; Rossen, 2008; Rossen, Butler, & Denny, 2011). An extremely valuable source of information on New Zealand youth is the University of Auckland’s (UoA) National youth health and wellbeing surveys. To date, the UoA’s Adolescent Health Research Group (AHRG) has completed three National youth health and wellbeing surveys. The Youth2000 Survey Series aim to provide nationally representative information on the health and wellbeing of young people attending New Zealand secondary schools. The Survey Series includes a wide range of questions about issues that contribute to the health and wellbeing of young people (such as substance use, injuries and violence, home and family) and allow researchers to take an ecological approach to identifying overall risk and protective factors in young people’s lives. Youth’12, a survey of 8,500 secondary school students throughout New Zealand, is the most recent survey to be undertaken by the AHRG. The inclusion of gambling items in the Youth’12 survey provides a unique opportunity to examine the impacts of gambling and problem gambling on secondary school students throughout New Zealand within an ecological framework. This report was commissioned by the Ministry of Health and begins with a comprehensive review of the local and international youth gambling literature, followed by an overview of the Youth2000 Survey Series and methodology for Youth’12. A thorough analysis of Youth’12 gambling items was undertaken with results being reported under the following eight categories (detailed results for each set of analyses are also provided in the appendices): - Students and their own gambling (Section Five); - Unhealthy gambling amongst students (Section Six); - Attitudes and motivating factors towards gambling (Section Seven); - The impacts of others’ gambling on students (Section Eight); and, - Risk and protective factors for student gambling (Section Nine); - Gambling and Māori taitamariki in Aotearoa (Section 10); - Gambling and Pacific young people in New Zealand (Section 11); and, - Gambling and Asian young people in New Zealand (Section 12). Finally, a discussion chapter provides an overview of the findings and implications

European Code against Cancer 4th Edition:Breastfeeding and cancer

Breast cancer is the most frequent cancer in women, and incidence rates have been rising in European Union (EU) countries over recent decades due in part to a sharp decline in breastfeeding practices. Evidence for a protective association between breastfeeding and the risk of breast cancer at all ages is convincing, and modest protective relationships between breastfeeding and the risk of endometrial and ovarian cancers have been suggested. The reduction in breast cancer risk is estimated at 2% for an increase of 5 months of lifetime breastfeeding. The longer women breastfeed, the more they are protected against breast cancer. In addition, breastfeeding is associated with several health benefits for both the mother and the breastfed child. Taking all this evidence into account, the 4th edition of the European Code against Cancer recommends: ‘‘Breastfeeding reduces the mother’s cancer risk. If you can, breastfeed your baby’’

The utilisation of health research in policy-making: Concepts, examples and methods of assessment

The importance of health research utilisation in policy-making, and of understanding the mechanisms involved, is increasingly recognised. Recent reports calling for more resources to improve health in developing countries, and global pressures for accountability, draw greater attention to research-informed policy-making. Key utilisation issues have been described for at least twenty years, but the growing focus on health research systems creates additional dimensions. The utilisation of health research in policy-making should contribute to policies that may eventually lead to desired outcomes, including health gains. In this article, exploration of these issues is combined with a review of various forms of policy-making. When this is linked to analysis of different types of health research, it assists in building a comprehensive account of the diverse meanings of research utilisation. Previous studies report methods and conceptual frameworks that have been applied, if with varying degrees of success, to record utilisation in policy-making. These studies reveal various examples of research impact within a general picture of underutilisation. Factors potentially enhancing utilisation can be identified by exploration of: priority setting; activities of the health research system at the interface between research and policy-making; and the role of the recipients, or 'receptors', of health research. An interfaces and receptors model provides a framework for analysis. Recommendations about possible methods for assessing health research utilisation follow identification of the purposes of such assessments. Our conclusion is that research utilisation can be better understood, and enhanced, by developing assessment methods informed by conceptual analysis and review of previous studies

The clinical effectiveness and cost-effectiveness of abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis: a systematic review and economic evaluation

Background: Juvenile idiopathic arthritis (JIA) is characterised by joint pain, swelling and limitation of movement caused by inflammation. Subsequent joint damage can lead to disability and growth restriction. Treatment commonly includes disease modifying anti-rheumatic drugs (DMARD) such as methotrexate. Clinical practice now favours newer drugs termed biologic DMARDs where indicated.Objective: To assess the clinical and cost-effectiveness of four biologic DMARDs (etanercept, abatacept, adalimumab and tocilizumab - with or without methotrexate where indicated) for the treatment of JIA (systemic or oligoarticular JIA excluded).Data sources: Electronic bibliographic databases including MEDLINE, EMBASE, The Cochrane Library and DARE were searched for published studies from inception to May 2015 for English language articles. Bibliographies of related papers, systematic reviews and company submissions were screened and experts were contacted to identify additional evidence.Review methods: Systematic reviews of clinical-effectiveness, health-related quality of life and cost-effectiveness were undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. A cost-utility decision analytic model was developed to compare estimated cost-effectiveness of biologic DMARDs versus methotrexate. The base case time horizon was 30 years and the model took a National Health Service (NHS) perspective, with costs and benefits discounted at 3.5%.Results: Four placebo-controlled RCTs met the inclusion criteria for the clinical-effectiveness review (one RCT evaluating each biologic DMARD). Only one RCT included UK participants. Participants had to achieve an American College of Rheumatology Pediatric (ACR Pedi) 30 response to open-label lead-in treatment in order to be randomised. An exploratory adjusted indirect comparison suggests that the four biologic DMARDs are similar with fewer disease flares and greater proportions with ACR Pedi 50 and 70 responses among participants randomised to continued biologic DMARD. However, confidence intervals were wide, the number of trials was low and there was clinical heterogeneity between trials. Open-label extensions of the trials showed that generally ACR responses remained constant or even increased after the double-blind phase. The proportions of adverse events and serious adverse events were generally similar between treatment and placebo groups. Four economic evaluations of biologic DMARDs for patients with JIA were identified but all had limitations. Two quality of life studies were included, one of which informed the cost-utility model. The incremental cost-effectiveness ratio (ICER) for adalimumab, etanercept and tocilizumab versus methotrexate was £38,127, £32,526 and £38,656 per QALY, respectively. The ICER for abatacept versus methotrexate as a second line biologic was £39,536 per QALY.Limitations: The model does not incorporate the natural history of JIA in terms of long-term disease progression, as the current evidence is limited. There are no head-to-head trials of biologic DMARDs and clinical evidence for specific JIA subtypes is limited.Conclusions: Biologic DMARDs are superior to placebo (with methotrexate where permitted) in children with (predominantly) polyarticular course JIA, and an insufficient response to previous treatment. Randomised comparisons of biologic DMARDs with long-term efficacy and safety follow- are needed to establish comparative effectiveness. RCTs for JIA subtypes where evidence is lacking are also required.Funding: The National Institute for Health Research Health Technology Assessment programme. <br/

A school-based resilience intervention to decrease tobacco, alcohol and marijuana use in high school students

<p>Abstract</p> <p>Background</p> <p>Despite schools theoretically being an ideal setting for accessing adolescents and preventing initiation of substance use, there is limited evidence of effective interventions in this setting. Resilience theory provides one approach to achieving such an outcome through improving adolescent mental well-being and resilience. A study was undertaken to examine the potential effectiveness of such an intervention approach in improving adolescent resilience and protective factor scores; and reducing the prevalence of adolescent tobacco, alcohol and marijuana use in three high schools.</p> <p>Methods</p> <p>A non-controlled before and after study was undertaken. Data regarding student resilience and protective factors, and measures of tobacco, alcohol and marijuana use were collected from grade 7 to 10 students at baseline (n = 1449) and one year following a three year intervention (n = 1205).</p> <p>Results</p> <p>Significantly higher resilience and protective factors scores, and significantly lower prevalence of substance use were evident at follow up.</p> <p>Conclusions</p> <p>The results suggest that the intervention has the potential to increase resilience and protective factors, and to decrease the use of tobacco, alcohol and marijuana by adolescents. Further more rigorous research is required to confirm this potential.</p

Modular Approach to Therapy for Anxiety, Depression, Trauma, or Conduct Problems in outpatient child and adolescent mental health services in New Zealand: study protocol for a randomized controlled trial

Background: Mental health disorders are common and disabling for young people because of the potential to disrupt key developmental tasks. Implementation of evidence-based psychosocial therapies in New Zealand is limited, owing to the inaccessibility, length, and cost of training in these therapies. Furthermore, most therapies address one problem area at a time, although comorbidity and changing clinical needs commonly occur in practice. A more flexible approach is needed. The Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems (MATCH-ADTC) is designed to overcome these challenges; it provides a range of treatment modules addressing different problems, within a single training program. A clinical trial of MATCH-ADTC in the USA showed that MATCH-ADTC outperformed usual care and standard evidence-based treatment on several clinical measures. We aim to replicate these findings and evaluate the impact of providing training and supervision in MATCH-ADTC to: (1) improve clinical outcomes for youth attending mental health services; (2) increase the amount of evidence-based therapy content; (3) increase the efficiency of service delivery. Methods: This is an assessor-blinded multi-site effectiveness randomized controlled trial. Randomization occurs at two levels: (1) clinicians (≥60) are randomized to intervention or usual care; (2) youth participants (7–14 years old) accepted for treatment in child and adolescent mental health services (with a primary disorder that includes anxiety, depression, trauma-related symptoms, or disruptive behavior) are randomly allocated to receive MATCH-ADTC or usual care. Youth participants are recruited from ‘mainstream’, Māori-specific, and Pacific-specific child and adolescent mental health services. We originally planned to recruit 400 youth participants, but this has been revised to 200 participants. Centralized computer randomization ensures allocation concealment. The primary outcome measures are: (i) the difference in trajectory of change of clinical severity between groups (using the parent-rated Brief Problem Monitor); (ii) clinicians’ use of evidence-based treatment procedures during therapy sessions; (iii) total time spent by clinicians delivering therapy. Discussion: If MATCH-ADTC demonstrates effectiveness it could offer a practical efficient method to increase access to evidence-based therapies, and improve outcomes for youth attending secondary care services

Cancer incidence and mortality trends in Australian adolescents and young adults, 1982-2007

Background: Increasing incidence and lack of survival improvement in adolescents and young adults (AYAs) with cancer have led to increased awareness of the cancer burden in this population. The objective of this study was to describe overall and type-specific cancer incidence and mortality trends among AYAs in Western Australia from 1982-2007.Methods: Age-adjusted incidence and mortality rates were calculated for all malignancies combined and for each of the most common diagnostic groups, using five-year age-specific rates. Joinpoint regression analysis was used to derive annual percentage changes (APC) for incidence and mortality rates.Results: The annual incidence rate for all cancers combined increased in males from 1982 until 2000 (APC = 1.5%, 95%CI: 0.9%; 2.1%) and then plateaued, whilst rates for females remained stable across the study period (APC = -0.1%; 95%CI: -0.2%; 0.4%) across the study period. For males, significant incidence rate increases were observed for germ cell tumors, lymphoblastic leukemia and thyroid cancer. In females, the incidence of Hodgkin's lymphoma, colorectal and breast cancers increased. Significant incidence rate reductions were noted for cervical, central nervous system and lung cancers. Mortality rates for all cancers combined decreased from 1982 to 2005 for both males (APC = -2.6%, 95%CI:-3.3%;-2.0%) and females (APC = -4.6%, 95%CI:-5.1%;-4.1%). With the exception of bone sarcoma and lung cancer in females, mortality rates for specific cancer types decreased significantly for both sexes during the study period.Conclusions: Incidence of certain AYA cancers increased, whilst it decreased for others. Mortality rates decreased for most cancers, with the largest improvement observed for breast carcinomas. Further research is needed to identify the reasons for the increasing incidence of certain cancers. © 2012 Haggar et al.; licensee BioMed Central Ltd

Temporal, seasonal and weather effects on cycle volume: an ecological study

<p>Abstract</p> <p>Background</p> <p>Cycling has the potential to provide health, environmental and economic benefits but the level of cycling is very low in New Zealand and many other countries. Adverse weather is often cited as a reason why people do not cycle. This study investigated temporal and seasonal variability in cycle volume and its association with weather in Auckland, New Zealand's largest city.</p> <p>Methods</p> <p>Two datasets were used: automated cycle count data collected on Tamaki Drive in Auckland by using ZELT Inductive Loop Eco-counters and weather data (gust speed, rain, temperature, sunshine duration) available online from the National Climate Database. Analyses were undertaken using data collected over one year (1 January to 31 December 2009). Normalised cycle volumes were used in correlation and regression analyses to accommodate differences by hour of the day and day of the week and holiday.</p> <p>Results</p> <p>In 2009, 220,043 bicycles were recorded at the site. There were significant differences in mean hourly cycle volumes by hour of the day, day type and month of the year (<it>p </it>< 0.0001). All weather variables significantly influenced hourly and daily cycle volumes (<it>p </it>< 0.0001). The cycle volume increased by 3.2% (hourly) and 2.6% (daily) for 1°C increase in temperature but decreased by 10.6% (hourly) and 1.5% (daily) for 1 mm increase in rainfall and by 1.4% (hourly) and 0.9% (daily) for 1 km/h increase in gust speed. The volume was 26.2% higher in an hour with sunshine compared with no sunshine, and increased by 2.5% for one hour increase in sunshine each day.</p> <p>Conclusions</p> <p>There are temporal and seasonal variations in cycle volume in Auckland and weather significantly influences hour-to-hour and day-to-day variations in cycle volume. Our findings will help inform future cycling promotion activities in Auckland.</p

Ethnic discrimination prevalence and associations with health outcomes: data from a nationally representative cross-sectional survey of secondary school students in New Zealand

<p>Abstract</p> <p>Background</p> <p>Reported ethnic discrimination is higher among indigenous and minority adult populations. There is a paucity of nationally representative prevalence studies of ethnic discrimination among adolescents. Experiencing ethnic discrimination has been associated with a range of adverse health outcomes. NZ has a diverse ethnic population. There are health inequalities among young people from Māori and Pacific ethnic groups.</p> <p>Methods</p> <p>9107 randomly selected secondary school students participated in a nationally representative cross-sectional health and wellbeing survey conducted in 2007. The prevalence of ethnic discrimination by health professionals, by police, and ethnicity-related bullying were analysed. Logistic regression was used to examine the associations between ethnic discrimination and six health/wellbeing outcomes: self-rated health status, depressive symptoms in the last 12 months, cigarette smoking, binge alcohol use, feeling safe in ones neighbourhood, and self-rated school achievement.</p> <p>Results</p> <p>There were significant ethnic differences in the prevalences of ethnic discrimination. Students who experienced ethnic discrimination were less likely to report excellent/very good/good self-rated general health (OR 0.51; 95% CI 0.39, 0.65), feel safe in their neighbourhood (OR 0.48; 95% CI 0.40, 0.58), and more likely to report an episode of binge drinking in the previous 4 weeks (OR 1.77; 95% CI 1.45, 2.17). For all these outcomes the odds ratios for the group who were 'unsure' if they had experienced ethnic discrimination were similar to those of the 'yes' group.</p> <p>Ethnicity stratified associations between ethnic discrimination and the depression, cigarette smoking, and self-rated school achievement are reported. Within each ethnic group participants reporting ethnic discrimination were more likely to have adverse outcomes for these three variables. For all three outcomes the direction and size of the association between experience of ethnic discrimination and the outcome were similar across all ethnic groups.</p> <p>Conclusions</p> <p>Ethnic discrimination is more commonly reported by Indigenous and minority group students. Both experiencing and being 'unsure' about experiencing ethnic discrimination are associated with a range of adverse health/wellbeing outcomes. Our findings highlight the progress yet to be made to ensure that rights to be free from ethnic discrimination are met for young people living in New Zealand.</p