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

This study explores the association between neighbourhood opportunities for Positive Youth Development (PYD) and adolescent depressive symptoms, well-being and suicide risk. A 2-stage random sample of 8500 students(years 9-13) from 91 high schools from throughout New Zealand was collected in 2012. Analyses were restricted to neighbourhoods with more than 10 students resulting in a final sample of 5191 adolescents within 266 neighbourhoods. Multilevel models linked data from neighbourhoods to individual student data to explore the association between neighbourhood opportunities for PYD and student depressive symptoms, well-being and suicide risk. Neighbourhoods with a high proportion of students involved in activities that help others, attend church groups, or participate in sports teams were associated with significantly increased wellbeing among students living in these neighbourhoods. No neighbourhood-level measures were found to significantly alter rates of depressive symptoms or suicide risk. Findings suggest that providing neighbourhood opportunities for PYD may enhance adolescent well-being.

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

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

The aims of this study were to examine indicators of socioeconomic deprivation among secondary school students and to determine associations between household poverty, neighbourhood deprivation and health indicators.

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.

AimTo 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.MethodsNationally 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.ResultsSMY 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.ConclusionsHealth services, schools, communities and families must be more responsive to the needs of SMY to ensure that disparities are addressed.

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

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.

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

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

Aims: The aims of this study are to identify clinically meaningful groups of adolescents based on their engagement in high levels of risk behaviours or severe emotional health concerns and to describe the demographic characteristics of these groups in two populations of school students in New Zealand.Methods: A nationally representative sample of secondary school students was surveyed in 2007; alternative education (AE) students in Auckland and Northland were surveyed in 2009. A total of 9107 secondary school students and 335 AE students completed a youth health questionnaire using Internet tablets. Latent class analysis (LCA) was used to identify groups of students on the basis of distinct profiles of their risk behaviours and mental health concerns.Results: The majority (80%) of students in secondary schools are 'healthy' and report few health concerns, 16% are considered 'risky' or 'distressed', and 4% report 'multiple' risk behaviour profiles or emotional health concerns. In AE, only 21% of students were considered 'healthy' with most featuring in the 'risky' or 'multiple' groups. Females were more likely to be 'distressed', whereas males were more likely to feature in the 'risky' or 'multiple' groups.Conclusions: Clinically-concerning health risk behaviours and emotional health concerns 'cluster' in up to 20% of students in secondary schools and up to 79% of students in AE. Gender, ethnic and socio-economic disparities are also observed. This highlights the importance of comprehensive psychosocial assessment and appropriate service provision, particularly for at-risk groups.

Aim: To describe indicators of health and well-being for New Zealand secondary school students; explore changes between 2001, 2007 and 2012; and compare these findings to international estimates.Methods: Three national health and well-being surveys of randomly selected New Zealand secondary school students were conducted. Data are presented as prevalence and variation over time (adjusted odds ratio (aOR)). Comparisons with international estimates were made with subsets of the data.Results: Between 2001 and 2012, students reported reductions in cigarette use (aOR 0.27, 95% confidence interval (CI) 0.23-0.32), alcohol use (aOR 0.39, 95% CI 0.33-0.46), marijuana use (aOR 0.37, 95% CI 0.31-0.43), sexual abuse (aOR 0.52, 95% CI 0.46-0.58), fighting (aOR 0.63, 95% CI 0.55-0.73), seatbelt use (aOR 1.47, 95% CI 1.31-1.65) and risky driving behaviours (aOR 0.39, 95% CI 0.33-0.45). Positive connections to school (perception that the school cares, aOR 1.22, 95% CI 1.10-1.35; liking school, aOR 1.55, 95% CI 1.33-1.82) and family (good family relationship, aOR 1.83, 95% CI 1.70-1.97) also improved. Indicators that did not improve and compared poorly with international estimates were protected sex (condom use at last sexual intercourse, aOR 0.77, 95% CI 0.68-0.87) and healthy life-style (daily physical activity, aOR 0.88, 95% CI 0.78-0.99; overweight/obese, aOR 1.09, 95% CI 0.92-1.31). Exposure to family violence (aOR 1.37, 95% CI 1.11-1.68) and depressive symptoms (aOR 1.03, 95% CI 0.91-1.17) also did not improve.Conclusions: There have been important improvements in the health and well-being of New Zealand adolescents over a relatively short period. These findings demonstrate that population rates of adolescent risk behaviours are amenable to change. Current policy efforts should not lose momentum, while identified priority areas must be adequately resourced to ensure young people have opportunities to thrive now and in the future.

This paper outlines a project that investigated the impact of gambling and problem gambling on the health and wellbeing of Asian families and communities in New Zealand. This 2-year, multi-phase qualitative project included focus group discussions and individual face-to-face interviews with stakeholders and individuals who have experienced or been impacted by problem gambling across New Zealand’s five major Asian ethnic subgroups of Chinese, Indian, Korean, Southeast Asian and Asian with Refugee background. This paper provides details on two major themes that emerged from the data: the role of settlement, the environment and coping behaviours in problem gambling amongst Asians; and, the impacts and consequences of gambling for Asian people and their families. Problem gamblers were found to employ dysfunctional coping strategies to deal with settlement adversities with adverse effects on the mental health and social and financial wellbeing of individuals, families and communities. Based on the data provided by participants, potential strategies have been developed for enhancing resilience through other variables that protect against problem gambling, and moderating those variables that may increase risk for problem gambling. These include: utilising cultural strengths, building trust, normalising help-seeking, educating Asian communities about the dangers of gambling, and creating a supportive social and institutional environment for Asian immigrants.

Objective: This pragmatic randomized study was conducted to compare the effectiveness of telephone and face-to-face counseling in influencing problematic gambling beliefs and behaviors. Method: Ninety-two participants from diverse ethnic backgrounds who had been affected by problem gambling were provided with psychological interventions delivered either by telephone or conventional face-to-face counseling over a 3-month period. Results: A significant overall time effect between pre- and postintervention assessments was found for total hours, money and proportion of income spent, and the attitudes and beliefs scores. There was no significant difference in effect size between the two groups. Conclusion: This study provides preliminary evidence that both face-to-face and telephone counseling interventions might be equally effective in terms of short-term clinical outcomes measured postintervention.

PurposeThe purpose of this paper is to analyse attitudes, understanding of gambling and gambling related harm among Asians in New Zealand using secondary data from the New Zealand 2006/07 Gaming and Betting Attitudes Survey (GBAS).Design/methodology/approachThis survey interviewed 1,973 nationwide randomly selected youths and adults (≥18 years) using structured questionnaire. Chinese (N=113) and Indian (N=122) data were analysed separately to compare between them and with NZ Europeans (N=792). Descriptive analysis was carried out and was subsequently tested for significant correlations by weighted (p<0.01) and un‐weighted (p<0.05) variables.FindingsA higher proportion of Chinese males (66.8 percent) represented in the survey compared to Indian (43.0 percent) and NZ European (48.9 percent) where Chinese consisted of more youthful age structure. Chinese respondents were more likely to be in the lowest income bracket (NZ$10,000) compared to others. Among the ten gambling activities “casino table gambling” and “casino electronic machines” (slot‐style machine) were most popular among the Chinese where Indians preferred “gambling/casino evening”. A significant proportion of Chinese were unwilling to refer family or friends to gambling help services despite believing that gambling does more harm than good. Pre‐committed gambling sum was the most common harm minimising strategy suggested by participants. They believed education and consultation could deter youths from harmful gambling.Research limitations/implicationsThis survey highlighted gambling behaviours and thoughts of the ethnic minority population in New Zealand. Study outcomes would be valuable in formulating ethnic specific preventative programme and may have policy implication.Originality/valueThere has been limited research on gambling behaviour of ethnic minorities in New Zealand. This paper fills some of the gaps.

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

PurposeInjuries are influenced by individual attitudes and risk‐taking behaviours and the identification of these factors is vital for the development of effective injury prevention strategies. This paper aims to examine the injury risk behaviours and attitudes towards injury prevention among young Asians in Auckland, New Zealand and their willingness to modify behaviours and attitudes.Design/methodology/approachA total of four focus group discussions with Asian tertiary students were conducted to discuss injury‐related issues and their preventions. Analysis used statements drawn from the focus group discussions and were summarised to draw conclusions.FindingsInjuries related to sports were the most frequently occurring, followed by domestic, workplace and traffic injuries. Cultural identity and family values were thought to have an influence on students' risk behaviours. Family convictism and positive peer pressure protects students from participating in risky sports and using recreational drugs. International students were vulnerable to risky behaviours due to isolation and were less likely to engage in health promotion and prevention activities. Family hierarchy and cultural orientations prevented some Asian students from discussing personal issues with parents and impeded gathering injury prevention skills.Research limitations/implicationsPrioritisation of domestic injuries with suspected under‐reporting, marginalisation and social isolation discourages sections of Asian youths from reporting injuries or seeking help. There is a paucity of knowledge about the mental health and suicidal behaviours of Asian students, which requires further investigation. More social research is warranted to understand the injury risk behaviours of Asian youths in order to develop an effective prevention strategy.Originality/valueThis study demonstrates how family values generate protective attitudes against injury risk behaviours among young Asians.