Search

'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, Tamaki Makaurau, and Waikato (Youth19) to explore differences in mental health and wellbeing outcomes for young people from a selection of intersectional identities (Maori, 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. Pakeha, 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 systems-level policy recommendations, including strategies to improve inclusiveness and reduce discrimination. Keywords: Intersectionality, Inequity, Maori, Pacific, Rangatahi, Rainbow, Takatapui, Disability, Youth, Wellb eing, Mental health, Di scrimination, INTRODUCTION Aotearoa New Zealand has an ethno-culturally diverse population of young people, foregrounded by a foundation of biculturalism, in the context of Te Tiriti o Waitangi (Came et al., 2021). [...]

: Objective: To investigate smoking and vaping in secondary school students (aged 13–18 years) in New Zealand (NZ) following the introduction of ‘pod’ e‐cigarettes, which have been associated with the rapid escalation of youth vaping elsewhere. Methods: Data on smoking and vaping were collected in 2019 as part of a comprehensive youth health survey (N=7,721). Results: Vaping was 2–3 times more prevalent than smoking, with 10% of students vaping regularly (monthly or more often), and 6% weekly or more often, compared with 4% and 2%, respectively, for tobacco smoking. Nicotine‐containing e‐cigarettes were sometimes or always used by 80% of regular and 90% of weekly vapers. Regular and weekly smoking was rare in low deprivation (affluent) areas, whereas regular and weekly vaping prevalence was similar across the socioeconomic spectrum. More than 80% of ever‐vapers (N=2732) reported they were non‐smokers when they first vaped, and 49% of regular vapers (N=718) had never smoked. Conclusions: A significant proportion of New Zealand adolescents, many of whom have never smoked, use nicotine‐containing e‐cigarettes regularly. Implications for public health: Vaping is less harmful than smoking, but it is not harmless. Public health action is needed to support young non‐smokers to remain smokefree and vape‐free., The advent of e‐cigarettes has brought both public health opportunities and risks.[sup.1,2] Vaping offers an alternative nicotine delivery system with lower health risks than combustible tobacco,[sup.3] so, for nicotine‐dependent smokers, [...]

Substantial progress in adolescent health research has been made over recent decades, but important knowledge gaps remain. Informed by targeted reviews of the literature, expert consultation, and authors' collective experiences, we propose future directions in adolescent health research. We identified five key principles on how future research must be approached alongside what technical investments are required to act on them. Principles: 1. Research with adolescents must be decolonizing in practice , dismantling systems of oppression, exploitation, and cultural dominance; 2. Research must recognize socio-political, structural, and commercial determinants of adolescent health ; 3. Research must be developmentally and contextually appropriate, reflecting adolescents' evolving capacities and increasingly complex and intersecting determinants of health; 4. Research must be strengths-based – moving away from problematizing adolescents and/or their behaviours toward focusing on their strengths as levers for change; and 5. Research must be built on a foundation of respectful partnerships as a right , and because adolescents have unique knowledge and skills to contribute. Technical investments: 1. Sampling techniques and approaches that provide equity of opportunity for all to participate; 2. High-quality descriptive studies from all nations to understand adolescents' ever-evolving contexts, needs and assets; 3. Investment in what works within each context and for whom through trials and robust assessments/evaluations; and 4. Implementation science research strategies. Adolescent health research will require reorientation and innovation in both how we approach research and what technical investments are required to improve the health and wellbeing of adolescents now and into the future. [ABSTRACT FROM AUTHOR]

The application of both Indigenous and Western knowledge systems in research may provide a well-rounded understanding of health, illness, and wellbeing for Indigenous communities in colonised societies. While many researchers have used a dual approach to researching Indigenous communities in colonised societies, tensions continue to exist around the use of Indigenous and Western ways of knowing together. There are also ongoing tensions between Indigenous methodologies and ethics processes rooted in Western understandings of research. Kaupapa Māori research is an Indigenous Māori approach to research that is about being Māori, is connected to Māori philosophy, culture and knowledge, and centres priorities for Māori. Grounded theory is a Western scientific approach to produce a theory grounded in qualitative data. This paper presents a novice researcher's reflections on using kaupapa Māori research and grounded theory to explore the relational aspects of acute health care in Aotearoa, New Zealand. The research design attempts to utilise the ethics of kaupapa Māori research and the essential methods of grounded theory to develop a research approach that is robust and culturally appropriate. Conforming to conventional Western science-based research methods while endeavouring to privilege Indigenous realities is challenging and, at times, impossible. However, grounded theory can be flexible enough to adapt to the ethics of kaupapa Māori research. Research at the interface between Indigenous and Western knowledge systems presents opportunities for innovation in research design and can provide an ethical foundation for conducting research with Indigenous communities. [ABSTRACT FROM AUTHOR]

Objective: The objective was to identify clinically meaningful groups of adolescents based on self-reported mental health and wellbeing data in a population sample of New Zealand secondary school students. Methods: We conducted a cluster analysis of six variables from the Youth19 Rangatahi Smart Survey (n = 7721, ages 13–18 years, 2019): wellbeing (World Health Organization Well-Being Index), possible anxiety symptoms (Generalized Anxiety Disorder 2-item, adapted), depression symptoms (short form of the Reynolds Adolescent Depression Scale) and past-year self-harm, suicide ideation and suicide attempt. Demographic, contextual and behavioural predictors of cluster membership were determined through multiple discriminant function analysis. We performed cross-validation analyses using holdout samples. Results: We identified five clusters (n = 7083). The healthy cluster (n = 2855, 40.31%) reported positive mental health across indicators; the anxious cluster (n = 1994, 28.15%) reported high possible anxiety symptoms and otherwise generally positive results; the stressed and hurting cluster (n = 667, 9.42%) reported sub-clinical depression and possible anxiety symptoms and some self-harm; the distressed and ideating cluster (n = 1116, 15.76%) reported above-cutoff depression and possible anxiety symptoms and high suicide ideation; and the severe cluster (n = 451; 6.37%) reported the least positive mental health across indicators. Female, rainbow, Māori and Pacific students and those in higher deprivation areas were overrepresented in higher severity clusters. Factors including exposure to sexual harm and discrimination were associated with increasing cluster severity. Conclusion: We identified high prevalence of mental health challenges among adolescents, with distinct clusters of need. Youth mental health is not 'one size fits all'. Future research should explore youth behaviour and preferences in accessing support and consider how to best support the mental health of each cluster. [ABSTRACT FROM AUTHOR]

The use of frequency-based criteria to detect harmful substance use in adolescents is rare despite its potential to identify young people at risk. We compared high school students who use high amounts of substances to students with lower levels (or nil) of use across health and well-being indicators to explore the feasibility of this kind of categorization. Based on survey questions from Youth'12, a cross-sectional adolescent health survey involving 3% (8,500) of New Zealand high school students, we selected criteria indicative of substance use that would warrant specialist alcohol and other drugs (AOD) treatment. Two sets of "high-use" criteria (e.g., drinking "alcohol most days a week or more") for both older and younger adolescents were selected. Eleven percent of students met criteria for "high use," with higher rates in males and older students. Rates of high use were similar across high-, medium- and low-deprivation neighborhoods. Binge alcohol use (9.2%) was the predominant form of "high use." Students with "high use" reported poorer health outcomes across numerous areas including mental health, physical health, risk behaviors, and access to health care. Only 5% of "high-use" students had accessed an AOD service. The wide range of negative health outcomes associated with a high level of substance use suggests that brief screening focusing on the level of substance use may help in identifying young people at risk. Simple and brief processes may improve the uptake and implementation of screening in primary care and other settings, and further research in this area is recommended.

The Statistics New Zealand Integrated Data Infrastructure (IDI) is a collection of de-identified whole-population administrative datasets. Researchers are increasingly utilising the IDI to answer pressing social and policy research questions. Our work provides an overview of the IDI, associated issues for Māori (the Indigenous peoples of New Zealand), and steps to realise Māori data aspirations. We first introduce the IDI including what it is and how it was developed. We then move to an overview of Māori Data Sovereignty. We consider the main issues with the IDI for Māori including technical issues and problems with ethnic identifiers, deficit-framed work, community involvement, consent, social licence, further data linkage, offshore access, and barriers to access for Māori. We finish with a set of recommendations around how to improve the IDI for Māori, making sure that Māori can get the most out of administrative data for our communities. These include the need to build data researcher capacity and capability for Māori; work with hapori Māori to increase utilisation; change accountability mechanisms, including greater co-governance of data; adequately fund alternatives; or potentially even abolishing the IDI and starting again. [ABSTRACT FROM AUTHOR]

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

This population-based study of 2931 respondents to Youth07 (a cross-sectional survey of New Zealand secondary students' health) examines associations between weight-related variables and sexual risk-taking. It is hypothesized that girls who report poorer body satisfaction or previous weight-loss attempts will be: more likely to be currently sexually active; less likely to negotiate contraceptive use; and less likely to discuss preventing sexually transmitted infections with her partner. It is hypothesized that these relationships will not exist among boys. Multiple logistic regression models were used to measure associations between weight-related variables and sexual risk-taking. Among girls, weight satisfaction was found to be associated with regular contraception use and discussion of sexually transmitted infection prevention with their partners. Weight-loss attempts were found to be positively associated with female sexual activity. Weight-loss attempts were associated with irregular contraceptive use among boys. No significant relationships were found to predict condom use at last intercourse. Health professionals and sexuality educators should consider that poor body satisfaction may affect sexual decision-making. Anticipatory guidance and education that seeks to enhance body satisfaction and encourage responsible sexual decision-making should be part of any risk-reduction strategy. (Contains 3 tables.)

Whanaungatanga (nurturing of relationships) is at the heart of wellbeing for rangatahi (Māori youth), yet little research has considered how rangatahi understand and experience whanaungatanga. Furthermore, policy makers, organisations and practitioners have had limited guidance to reflect on whanaungatanga with young Māori in ways that support rangatahi wellbeing and aspirations. As part of a broader photo-elicitation project on whanaungatanga with young Māori, we describe Te Tapatoru, a model of whanaungatanga based on the experiences and insights of 51 rangatahi. Using a Māori critical realist approach, we demarcated rangatahi descriptions of whanaungatanga into three interconnected areas. The first component, ko wai, a reciprocal connection, emphasised the importance of a reciprocal connection with people (or more than people). The second component, he wā pai, a genuine time/place, spoke to how contexts, time and places provided the space for meaningful connections to take root and flourish. The final component, he kaupapa pai, a genuine kaupapa (activity, process) considered how rangatahi desired connection which responded to their desires and aspirations. This approach harnesses rangatahi potential by creating reciprocal and invigorating supportive environments based on rangatahi aspirations and insights. Policy and practice recommendations are made which centre this rangatahi informed approach to whanaungatanga. [ABSTRACT FROM AUTHOR]

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

Objective: To investigate prevalence and trends in key mental health and well-being indicators among New Zealand secondary school students. Methods: Representative cross-sectional youth health surveys with 2–4% of the New Zealand secondary school population were conducted in 2001, 2007, 2012 and 2019 (total n = 34,548). Results: In 2019, 69.1% reported good well-being (95% confidence interval = [67.6, 70.6]; World Health Organization 5-item), 22.8% reported clinically significant depression symptoms (95% confidence interval = [21.4, 24.1]; Reynolds Adolescent Depression Scale–Short Form) and 41.8% reported possible anxiety symptoms (95% confidence interval = [40.5, 43.2]; Generalized Anxiety Disorder 2, adapted). Past-year prevalence of periods of low mood (38.3%, 95% confidence interval = [36.6, 40.1]), deliberate self-harm (24.1%, 95% confidence interval = [22.8, 25.4]), suicide thoughts (20.8%, 95% confidence interval = [19.2, 22.4]) and suicide attempts (6.3%, 95% confidence interval = [5.5, 7.0]) were observed. After relative stability from 2001 to 2012, there were large declines in mental health to 2019. The proportion reporting good well-being decreased (odds ratio 0.71, 95% confidence interval = [0.65, 0.78], p < 0.001), depression symptoms increased (odds ratio 1.96, 95% confidence interval = [1.75, 2.20], p < 0.001) and past-year suicide thoughts and suicide attempts increased (odds ratio 1.41, 95% confidence interval = [1.25, 1.59], p < 0.001; odds ratio 1.60, 95% confidence interval = [1.32, 1.92], p < 0.001). Past-year deliberate self-harm was largely stable. Declines in mental health were unevenly spread and were generally greater among those with higher need in 2012 (females, Māori and Pacific students and those from higher deprivation neighbourhoods), increasing inequity, and among Asian students. Conclusion: Adolescent mental health needs are high in New Zealand and have increased sharply from 2012 among all demographic groups, especially females, Māori, Pacific and Asian students and those from high-deprivation neighbourhoods. Ethnic and socioeconomic disparities have widened. [ABSTRACT FROM AUTHOR]

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

Persistent health inequities between rangatahi Māori (Indigenous young people) and other young people within Aotearoa New Zealand are incurred by a colonial machinery of institutions, service systems and sociocultural contexts that facilitates the marginalisation of Māori. Despite a skilled and dedicated Māori workforce, current service contexts severely limit the innovation of Māori practitioners working from a basis of mātauranga Māori (Māori ways of knowing and being), and curtail their ability to support rangatahi Māori and their whānau (community of related families). We report on an interview study with 13 Māori practitioners in youth development, exploring their struggles, strengths and strategies, as part of a larger project exploring rangatahi wellbeing and whanaungatanga (connectedness and relationality). Utilising reflexive thematic analysis, we describe three conceptual domains that participant accounts spoke into: mitigating system failures to embrace rangatahi and their whānau, sustainability and longevity of services for rangatahi Māori, and fostering rangatahi tino rangatiratanga. Participant accounts illustrate the need for bold reform within youth services, towards sustainable models premised upon tino rangatiratanga – services led by Māori, designed by Māori, and intended to cater for the unique needs and aspirations of rangatahi Māori. [ABSTRACT FROM AUTHOR]

A total of 268 alternative education students from New Zealand were surveyed to examine risk and protective factors for depression within the social environment. Twenty-eight (35.4%) of the girls and 31 (21.1%) of the boys had cut-off scores that indicated a high likelihood of significant psychopathology from depression. Multivariate analysis demonstrated that family and peer connections were protective against depression. High levels of poverty, witnessing violence at home, and experiencing bullying at school were significant risk factors for depression.

Objective: To ascertain young people's perceptions of an adolescent health survey when administered by multimedia computer assisted self-administered Interview (M-CASI) through analysis of (1) questionnaire item responses and (2) focus group interviews. Methodology: Setting: Auckland, New Zealand, 1999. Study type: Pilot testing of a 488-item branching questionnaire delivered using a youth-oriented and user-friendly M-CASI interface in a variety of settings using both desktop and laptop computers. Post pilot focus groups of participants identifying their perceptions and experiences of the survey. Sample: 110 school students aged 12 to 18 years. Results: The mean number of questions answered by participants was 316 with the median time to completion being 48 minutes. On average 65% of the total number of questions were seen and of these 1.5% were deliberately not answered. A high level of acceptability and enjoyment of M-CASI was found in the analysis of focus group responses and agreed with the item responses relating to M-CASI within the questionnaire itself. Participants identified privacy and confidentiality as being particularly important for the honesty of their responses. The passive matrix screens of the computers were popular as they could only be viewed from in front. Conclusions: M-CASI is an acceptable instrument for the administration of a youth health survey. Laptop computers with passive matrix screens are able to enhance perceptions of privacy and confidentiality, which may improve honesty of responses. Implications: M-CASI is now feasible and offers advantages in health surveying.