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Introduction: Improving the health of Indigenous adolescents is central to addressing the health inequities faced by Indigenous peoples. To achieve this, it is critical to understand what is needed from the perspectives of Indigenous adolescents themselves. There have been many qualitative studies that capture the perspectives of Indigenous young people, but synthesis of these has been limited to date. Methods and analysis: This scoping review seeks to understand the specific health needs and priorities of Indigenous adolescents aged 10-24 years captured via qualitative studies conducted across Australia, Aotearoa New Zealand, Canada, the USA, Greenland and Sami populations (Norway and Sweden). A team of Indigenous and non-Indigenous researchers from these nations will systematically search PubMed (including the MEDLINE, PubMed Central and Bookshelf databases), CINAHL, Embase, Scopus, the Informit Indigenous and Health Collections, Google Scholar, Arctic Health, the Circumpolar Health Bibliographic Database, Native Health Database, iPortal and NZresearch.org, as well as specific websites and clearinghouses within each nation for qualitative studies. We will limit our search to articles published in any language during the preceding 5 years given that needs may have changed significantly over time. Two independent reviewers will identify relevant articles using a two-step process, with disagreements resolved by a third reviewer and the wider research group. Data will then be extracted from included articles using a standardised form, with descriptive synthesis focussing on key needs and priorities. This scoping review will be conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Ethics and dissemination: Ethics approval was not required for this review. Findings will be disseminated via a peer-reviewed journal article and will inform a broader international collaboration fo

Introduction: Improving the health of Indigenous adolescents is central to addressing the health inequities faced by Indigenous peoples. To achieve this, it is critical to understand what is needed from the perspectives of Indigenous adolescents themselves. There have been many qualitative studies that capture the perspectives of Indigenous young people, but synthesis of these has been limited to date. Methods and analysis: This scoping review seeks to understand the specific health needs and priorities of Indigenous adolescents aged 10-24 years captured via qualitative studies conducted across Australia, Aotearoa New Zealand, Canada, the USA, Greenland and Sami populations (Norway and Sweden). A team of Indigenous and non-Indigenous researchers from these nations will systematically search PubMed (including the MEDLINE, PubMed Central and Bookshelf databases), CINAHL, Embase, Scopus, the Informit Indigenous and Health Collections, Google Scholar, Arctic Health, the Circumpolar Health Bibliographic Database, Native Health Database, iPortal and NZresearch.org, as well as specific websites and clearinghouses within each nation for qualitative studies. We will limit our search to articles published in any language during the preceding 5 years given that needs may have changed significantly over time. Two independent reviewers will identify relevant articles using a two-step process, with disagreements resolved by a third reviewer and the wider research group. Data will then be extracted from included articles using a standardised form, with descriptive synthesis focussing on key needs and priorities. This scoping review will be conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Ethics and dissemination: Ethics approval was not required for this review. Findings will be disseminated via a peer-reviewed journal article and will inform a broader international collaboration fo

Introduction: Improving the health of Indigenous adolescents is central to addressing the health inequities faced by Indigenous peoples. To achieve this, it is critical to understand what is needed from the perspectives of Indigenous adolescents themselves. There have been many qualitative studies that capture the perspectives of Indigenous young people, but synthesis of these has been limited to date. Methods and analysis: This scoping review seeks to understand the specific health needs and priorities of Indigenous adolescents aged 10-24 years captured via qualitative studies conducted across Australia, Aotearoa New Zealand, Canada, the USA, Greenland and Sami populations (Norway and Sweden). A team of Indigenous and non-Indigenous researchers from these nations will systematically search PubMed (including the MEDLINE, PubMed Central and Bookshelf databases), CINAHL, Embase, Scopus, the Informit Indigenous and Health Collections, Google Scholar, Arctic Health, the Circumpolar Health Bibliographic Database, Native Health Database, iPortal and NZresearch.org, as well as specific websites and clearinghouses within each nation for qualitative studies. We will limit our search to articles published in any language during the preceding 5 years given that needs may have changed significantly over time. Two independent reviewers will identify relevant articles using a two-step process, with disagreements resolved by a third reviewer and the wider research group. Data will then be extracted from included articles using a standardised form, with descriptive synthesis focussing on key needs and priorities. This scoping review will be conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Ethics and dissemination: Ethics approval was not required for this review. Findings will be disseminated via a peer-reviewed journal article and will inform a broader international collaboration fo

Introduction: Improving the health of Indigenous adolescents is central to addressing the health inequities faced by Indigenous peoples. To achieve this, it is critical to understand what is needed from the perspectives of Indigenous adolescents themselves. There have been many qualitative studies that capture the perspectives of Indigenous young people, but synthesis of these has been limited to date. Methods and analysis: This scoping review seeks to understand the specific health needs and priorities of Indigenous adolescents aged 10-24 years captured via qualitative studies conducted across Australia, Aotearoa New Zealand, Canada, the USA, Greenland and Sami populations (Norway and Sweden). A team of Indigenous and non-Indigenous researchers from these nations will systematically search PubMed (including the MEDLINE, PubMed Central and Bookshelf databases), CINAHL, Embase, Scopus, the Informit Indigenous and Health Collections, Google Scholar, Arctic Health, the Circumpolar Health Bibliographic Database, Native Health Database, iPortal and NZresearch.org, as well as specific websites and clearinghouses within each nation for qualitative studies. We will limit our search to articles published in any language during the preceding 5 years given that needs may have changed significantly over time. Two independent reviewers will identify relevant articles using a two-step process, with disagreements resolved by a third reviewer and the wider research group. Data will then be extracted from included articles using a standardised form, with descriptive synthesis focussing on key needs and priorities. This scoping review will be conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Ethics and dissemination: Ethics approval was not required for this review. Findings will be disseminated via a peer-reviewed journal article and will inform a broader international collaboration fo

OBJECTIVE: The aim of the present study was to investigate the relationship between area-level socio-economic status and healthy and less healthy eating behaviours among adolescents and to determine whether the relationship between area-level socio-economic status and dietary behaviours was related to the relevant attitudes and environments. DESIGN: Data were collected as part of Youth'07, a nationally representative survey of the health and well-being of New Zealand youth. SETTING: New Zealand secondary schools, 2007. SUBJECTS: A total of 9107 secondary-school students in New Zealand. RESULTS: Students from more deprived areas perceived more supportive school environments and cared as much about healthy eating as students in more affluent areas. However, these students were significantly more likely to report consuming fast food, soft drinks and chocolates. CONCLUSIONS: Addressing area-level socio-economic disparities in healthy eating requires addressing the availability, affordability and marketing of unhealthy snack foods, particularly in economically deprived areas.

Natural environments – green spaces, blue spaces (such as lakes, rivers and beaches), and biodiversity –have potential health benefits. However, there is lack of knowledge about the relationships between these environments and adolescent emotional health. Our study assessed the relationship between the natural environments of residential neighbourhoods and the emotional health of adolescents living in urban New Zealand. Data from 4575 adolescents were drawn from the 2012 wave of the Youth2000 survey series. Emotional health was assessed using the World Health Organization-5 Well-being Index and depressive symptoms were measured using the Reynolds Adolescent Depression Scale-short form. Measures of greenness, vegetation diversity, blue spaces, and a composite available nature index were calculated for participant residential neighbourhoods (within 400 meters, 800 meters, and 1600 meters of the residential address). Cross-classified multilevel linear models were used to assess relationships between each natural environment exposure and each emotional health outcome, and adjusted for sex, age, ethnicity, household deprivation, and neighbourhood deprivation. Results showed significant relationships between reduced depressive symptoms and increased mean greenness, presence of native vegetation, and having a higher nature availability index. Unexpectedly, greater variability in greenness was associated with reduced wellbeing. Our study provides novel evidence of the importance of natural environments for the emotional health of adolescents, adding to mounting evidence that it is important to protect, rehabilitate and plan for natural spaces in urban areas.

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 = 7,064) 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.

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.

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

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.

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.

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 p

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.

Objective: To describe trends in self-reported sexual and reproductive health behaviours among New Zealand secondary school students. Methods: Nationally representative health and wellbeing surveys conducted in 2001 (n=9,699), 2007 (n=9,107) and 2012 (n=8,500) were analysed. Logistic regressions were used to explore variations in sexual health outcomes between 2001 and 2012. Results: 'Ever had sex' (-6.9%, p<0.001); 'currently sexually active' (- 2.3%, p<0.001); 'always use condoms' (-3.3%, p=0.006); 'condoms at last sex' (-7.0, p=0.002); 'contraception at last sex' (-5.8%, p<0.001) and sexually transmitted infections (-0.3%, p=0.001) have reduced over time. 'Always use contraception' did not change significantly (-1.4%, p=0.514) over time. Māori (OR 0.7), Pacific (OR 0.5) and socioeconomically deprived students (OR 0.7) less frequently used condoms. Māori (OR 0.6), Pacific (OR 0.4), Asian (OR 0.5), younger (OR 0.6), and socioeconomically deprived (OR 0.6) students less frequently used contraception. Conclusions: Students in 2012 were more likely to delay sexual activity, but were less likely to use condoms and contraception consistently, compared to students in 2001. Declining contraceptive use over an 11-year period suggests that current strategies are inadequate, particularly for Māori, Pacific and socioeconomically deprived students. Appropriate and accessible sexual and reproductive health services are urgently required.

Little population-based work has been published about the mental health of adolescents with both sexual/gender (SG) and ethnic minority (i.e. double minority) status. This study aimed to provide an overview on their mental health. Analysis of data from a total of 17,607 high school students from New Zealand’s 2007 and 2012 cross-sectional nationally representative Adolescent Health Surveys, including a total of 1306 (7.4%) SG minority participants, of whom 581 (3.3%) were also an ethnic minority. SG minority status, minority ethnicity, and female sex were associated with higher mental distress and poorer well-being. Generally speaking, double minority students reported poorer mental health than SG majority students of the same ethnicity, but reported better mental health than SG minority New Zealand European students. Explanations and future directions for research were suggested to further explore how double minority students negotiate mental health in the context of their communities/cultures in New Zealand.

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.

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.

Objective: To explore the prevalence of long-term health conditions (which includes disorders such as asthma and diabetes, lasting six months or more) among sexuality and gender minority youth (SGMY) within Aotearoa New Zealand, and report on SGMY access to health care services. Method: We used data from a population-based survey (Youth’19) of 7,059 secondary school students in Aotearoa New Zealand. Multivariable logistic regression models were used to investigate the associations of five sex, gender and sexuality groups: heterosexual cisgender females (n=3,127, 44.30%); heterosexual cisgender males (n=2,934, 41.64%); sexuality minority cisgender females (n=659, 9.34%); sexuality minority cisgender males (n=216, 3.06%); and gender minority adolescents (n=123, 1.74%), and the selected outcome variables (i.e., general health, long-term health conditions, difficulties accessing healthcare and talked to a health provider privately). Results: Gender minority adolescents reported the highest odds of having a long-term health condition (adjusted Odds Ratio/aOR=6.69, 95% Confidence Intervals/CI 3.89-11.42) compared to heterosexual cisgender males. Sexuality minority cisgender females and males also had significantly higher odds of having a long-term health condition compared to heterosexual cisgender males. Gender minority youth also reported the highest odds of experiencing difficulties accessing health care (aOR=3.99, 95% CI 2.50-6.36) compared to heterosexual cisgender males. Sexuality minority cisgender females and males were also significantly more likely to experience difficulties accessing healthcare than heterosexual cisgender males. Conclusion: SGMY are more likely to report a long-term health condition compared to their peers and access to health care for SGMY is constrained. Health and social care service providers need to ensure their provisions are safe, accessible, inclusive, and appropriate for SGMY.

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.

Little population-based work has been published about the mental health of adolescents with both sexual/gender (SG) and ethnic minority (i.e. double minority) status. This study aimed to provide an overview on their mental health. Analysis of data from a total of 17,607 high school students from New Zealand’s 2007 and 2012 cross-sectional nationally representative Adolescent Health Surveys, including a total of 1306 (7.4%) SG minority participants, of whom 581 (3.3%) were also an ethnic minority. SG minority status, minority ethnicity, and female sex were associated with higher mental distress and poorer well-being. Generally speaking, double minority students reported poorer mental health than SG majority students of the same ethnicity, but reported better mental health than SG minority New Zealand European students. Explanations and future directions for research were suggested to further explore how double minority students negotiate mental health in the context of their communities/cultures in New Zealand.

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

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.

Objective: To describe trends in self-reported sexual and reproductive health behaviours among New Zealand secondary school students. Methods: Nationally representative health and wellbeing surveys conducted in 2001 (n=9,699), 2007 (n=9,107) and 2012 (n=8,500) were analysed. Logistic regressions were used to explore variations in sexual health outcomes between 2001 and 2012. Results: 'Ever had sex' (-6.9%, p<0.001); 'currently sexually active' (- 2.3%, p<0.001); 'always use condoms' (-3.3%, p=0.006); 'condoms at last sex' (-7.0, p=0.002); 'contraception at last sex' (-5.8%, p<0.001) and sexually transmitted infections (-0.3%, p=0.001) have reduced over time. 'Always use contraception' did not change significantly (-1.4%, p=0.514) over time. Māori (OR 0.7), Pacific (OR 0.5) and socioeconomically deprived students (OR 0.7) less frequently used condoms. Māori (OR 0.6), Pacific (OR 0.4), Asian (OR 0.5), younger (OR 0.6), and socioeconomically deprived (OR 0.6) students less frequently used contraception. Conclusions: Students in 2012 were more likely to delay sexual activity, but were less likely to use condoms and contraception consistently, compared to students in 2001. Declining contraceptive use over an 11-year period suggests that current strategies are inadequate, particularly for Māori, Pacific and socioeconomically deprived students. Appropriate and accessible sexual and reproductive health services are urgently required.

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.

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.

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 p

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.

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.

Background Rangatahi Maori, the Indigenous adolescents of Aotearoa New Zealand (NZ), have poorer health outcomes than Pakeha (NZ European/other European/“White”) adolescents. We explored the influence of policies for Indigenous youth by presenting health trends, inequities and contrasting policy case examples: tobacco control and healthcare access. Methods Cross-sectional representative surveys of NZ secondary school students were undertaken in 2001, 2007, 2012 and 2019. Health indicators are presented for Maori and Pakeha adolescents (relative risks with 95% CI, calculated using modified Poisson regression) between 2001−2019 and 2012−2019. Policy examples were examined utilising Critical Te Tiriti Analysis (CTA). Findings Rangatahi Maori reported significant health gains between 2001 and 2019, but an increase in depressive symptoms (13.8% in 2012 to 27.9% in 2019, RR 2.01 [1.65−2.46]). Compared to Pakeha youth there was a pattern of persistent Maori disadvantage, particularly for racism (RR 2.27 [2.08−2.47]), depressive symptoms (RR 1.42 [1.27−1.59]) and forgone healthcare (RR 1.63 [1.45−1.84]). Tobacco use inequities narrowed (RR 2.53 [2.12−3.02] in 2007 to RR 1.55 [1.25−1.93] in 2019). CTA reveals rangatahi Maori-specific policies, Maori leadership, and political support aligned with improved outcomes and narrowing inequities. Interpretation Age-appropriate Indigenous strategies are required to improve health outcomes and reduce inequities for rangatahi Maori. Characteristics of effective strategies include: (1) evidence-based, sustained, and comprehensive approaches including both universal levers and Indigenous youth-specific policies; (2) Indigenous and rangatahi leadership; (3) the political will to address Indigenous youth rights, preferences, priorities; and (4) a commitment to an anti-racist praxis and healthcare Indigenisation.

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 = 7,064) 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.

Natural environments – green spaces, blue spaces (such as lakes, rivers and beaches), and biodiversity –have potential health benefits. However, there is lack of knowledge about the relationships between these environments and adolescent emotional health. Our study assessed the relationship between the natural environments of residential neighbourhoods and the emotional health of adolescents living in urban New Zealand. Data from 4575 adolescents were drawn from the 2012 wave of the Youth2000 survey series. Emotional health was assessed using the World Health Organization-5 Well-being Index and depressive symptoms were measured using the Reynolds Adolescent Depression Scale-short form. Measures of greenness, vegetation diversity, blue spaces, and a composite available nature index were calculated for participant residential neighbourhoods (within 400 meters, 800 meters, and 1600 meters of the residential address). Cross-classified multilevel linear models were used to assess relationships between each natural environment exposure and each emotional health outcome, and adjusted for sex, age, ethnicity, household deprivation, and neighbourhood deprivation. Results showed significant relationships between reduced depressive symptoms and increased mean greenness, presence of native vegetation, and having a higher nature availability index. Unexpectedly, greater variability in greenness was associated with reduced wellbeing. Our study provides novel evidence of the importance of natural environments for the emotional health of adolescents, adding to mounting evidence that it is important to protect, rehabilitate and plan for natural spaces in urban areas.