The Associations Between Cultural Identity and Mental Health Outcomes for Indigenous Māori Youth in New Zealand

Objectives: To explore the relationships between Māori cultural identity, ethnic discrimination and mental health outcomes for Māori youth in New Zealand.Study Design: Nationally representative, anonymous cross-sectional study of New Zealand secondary school students in 2012.Methods: Secondary analysis of Māori students (n = 1699) from the national Youth'12 secondary school students survey was undertaken. Theoretical development and exploratory factor analysis were undertaken to develop a 14-item Māori Cultural Identity Scale (MCIS). Māori students reporting > 8 items were classified as having a strong MCIS. Prevalence of indicators were reported and logistic regression models were used to explore how wellbeing (WHO-5), depressive symptoms (Reynolds Adolescent Depression Scale-SF), and suicide attempts were associated with the MCIS.Results: After adjusting for age, sex, ethnic discrimination and NZ Deprivation Index (NZDep), a strong Māori cultural identity (MCIS) was associated with improved wellbeing scores (OR 1.53, 95% CI 1.18–2.01) and fewer depressive symptoms (OR 0.53, 95% CI 0.38–0.73). Experiencing discrimination was associated with poorer wellbeing scores (OR 0.50, 95% CI 0.39–0.65), greater depressive symptoms (OR 2.2, 95% CI 1.55–3.18), and a previous suicide attempt (OR 2.47, 95% CI 1.71–3.58). Females less frequently reported good (WHO-5) wellbeing (OR 0.33, 95% CI 0.26–0.42), increased (RADS-SF) depressive symptoms (2.61, 95% CI 1.86–3.64) and increased suicide attempts [OR 3.35 (2.07–5.41)] compared to males. Wellbeing, depressive symptoms and suicide attempts did not differ by age or neighborhood level socio-economic deprivation, except those living in neighborhoods characterized as having medium level incomes, were less likely to have made a suicide attempt (OR 0.49, 95% CI 0.27–0.91).Conclusions: Māori youth who have a strong cultural identity were more likely to experience good mental health outcomes. Discrimination has a serious negative impact on Māori youth mental health. Our findings suggest that programmes, policies and practice that promote strong cultural identities and eliminate ethnic discrimination are required to improve mental health equity for Māori youth

Urban green space and mental well-being of Aotearoa New Zealand adolescents : A path analysis

Background Growing evidence shows the positive influence of neighbourhood green space on mental well-being among adults through multiple health behaviours, but similar studies are lacking for adolescents. Methods Data were drawn from the 2019 wave of the Youth2000 survey series in Aotearoa, New Zealand with secondary school students (aged 10-19 years) from the city of Tamaki Makaurau, Auckland. Emotional well-being was measured with the World Health Organization-5 Well-being Index, and depressive symptoms were assessed using the Reynolds Adolescent Depression Scale-short form. Neighbourhood green space was assessed using three different measures: percentage of green space, Normalised Difference Vegetation Index (NDVI) and the distance to nearest green space from place of residence. Exposure areas of these measures were calculated using Euclidean buffers of 100m, 300m, 800m and 1600m around participants’ meshblock residential addresses. Three mediating (physical activity, social cohesion, sleep) and ten control variables (in adjusted models) were included in path analysis to test the direct and indirect relationships between green space and adolescent mental well-being. Results In unadjusted models, percentage of green space had a negative relationship with emotional well-being, and inconsistent effects of NDVI were detected in different buffers. Minor indirect effects of physical activity and sleep were also found. Depressive symptoms and emotional well-being were more strongly related to other individual and neighbourhood factors (e.g., neighbourhood deprivation). After adjusting for control variables, no significant associations of green space with adolescent depressive symptoms and emotional well-being were identified. Conclusions Urban neighbourhood green space does not appear to be a dominant factor contributing to adolescent mental well-being through physical activity, social cohesion and sleep. Appropriate individual and environmental control variables are needed to take into consideration in future studies that explore the green space-mental well-being relationships in adolescents

Wellbeing and healthcare access for sexuality and gender minority secondary school students with long-term health conditions

Peer reviewedPublisher PD

Mental Health and Wellbeing for Young People from Intersectional Identity Groups: Inequity for Māori, Pacific, Rainbow Young People, and Those with a Disabling Condition

‘Intersectionality’ describes the converging effects of ethnicity, gender, sexuality, disability, and other social group characteristics that influence life experiences. We draw on a representative study of year 9-13 students in Tai Tokerau, Tāmaki Makaurau, and Waikato (Youth19) to explore differences in mental health and wellbeing outcomes for young people from a selection of intersectional identities (Māori, Pasifika, Rainbow, and young people with a Disabling Condition). We found a pervasive pattern of inequity for young people who have intersectional identities compared to those from the majority groups (i.e. Pākehā, non-disabled, cis-heterosexual youth). Intersectional youth had higher levels of inequity and faced a greater array of inequities. There was evidence of an additive effect for some indicators. Thematic analysis of open-text survey responses found the need for positive inclusive environments, and support for all young people, including those at the intersections of identity. Drawing on the findings, we offered several systemslevel policy recommendations, including strategies to improve inclusiveness and reduce discrimination

Body size and weight, and the nutrition and activity behaviors 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 behaviors 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. Subjects: A total of 7,769 students, 9% were SGM individuals. Results: Overall, weight control behaviors, poor nutrition and inactivity were common and, in many cases, more so for SGM students. Specifically, male SGM students were significantly more likely to have tried to lose weight (aOR=1.95; 95% CI 1.47, 2.59), engage in unhealthy weight control (aOR=2.17; 95% CI 1.48, 3.19), consume fast food and takeaways (aOR=2.89; 95% CI 2.01, 4.15), and be physically inactive (aOR=2.54; 95% CI 1.65, 3.92), and were less likely to participate in a school sports team (aOR=0.57; 95% CI 0.44, 0.75), compared with other males. Female SGM students were significantly more likely to engage in unhealthy weight control (aOR=1.58; 95% CI 1.20, 2.08), be overweight or obese (aOR=1.24; 95% CI 1.01, 1.53), and consume fast food and takeaways (aOR=2.19; 95% CI 1.59, 3.03), and were less likely to participate in a school sports team (aOR=0.62; 95% CI 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 and takeaways frequently (aOR 0.62; 95% CI 0.40, 0.96). Conclusions: SGM students reported increased weight control behaviors, poor nutrition and inactivity. Professionals, including public health nutritionists, must recognize and help to address the challenges facing sexual and gender minorities

Classifying multiple ethnic identifications: Methodological effects on child, adolescent, and adult ethnic distributions

Background: The burgeoning global multi-ethnic population, in conjunction with the importance of accurate ethnic group counts for research and policy purposes, make classification of multiple ethnic responses a complex but important issue. There are numerous possible classification approaches, differing in ethical implications and ease of statistical application. Objective: This study empirically examines the validity and consistency of three comparatively accessible ethnic classification methods (total response, administrative-prioritisation, and self-prioritisation) in increasingly ethnically diverse age cohorts (adults, adolescents, and children). Methods: We utilised secondary data from two large-scale studies in Aotearoa/New Zealand which asked children (N = 6,149; responded via mother proxy), adolescents (N = 8,464), and adults (N = 11,210) to select (1) all the ethnicities they identified with, and (2) their main ethnicity. The data were coded, then analysed using descriptive statistics and z-tests for proportional differences. Results: The majority of multi-ethnic participants were able to select a main ethnic group when required, but around 20Š could not or refused to do so, and there was over 60Š discrepancy between self-prioritised ethnicity and administrative-prioritised ethnicity. Differences by age group and ethnic combination were apparent. Comparison of overall ethnic group proportions outputted by the three classification methods revealed within-group variation, particularly where there were higher rates of multi-ethnic identification. Contribution: This study empirically demonstrates that researchers' choice of ethnic classification method can have a strong influence on ethnic group proportions. Researchers should therefore select the classification method most appropriate for their research question and clearly report the method employed

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

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 nontransgender 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

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 (pp = 0.0061); being worried about and/or trying to cut down on gambling (p 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

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