Lecture 35. Youth Flashcards
what is considered youth and adolescent population?
youth- 10-24 yo
adolescents- 10-19 yo
NZ stats
- highest proportion of 10-24 yo
- highest aldolescent mortality rate compared to other OECD countries
Current situation
-1/6 th of the world’s population- adolescents
highest ever young population historically
-most ~ 86 % live in LMIC
triple dividend
- Benefits for adolescents now
- Benefits for their future adult lives
- Benefits for their children
What is the leading cause of DALYS among 10-24 yo?
Mental health & substance use has been the highest ranked from 1990-2016
DALYs causes trends in 10-24 yo
- communicable diseases going down apart from HIV
- injuries are going up
What is the leading cause of death in 10-24 yo?
Injuries:
- Transport injuries
- Self-harm and violence
Death causes trend
- injuries going up
- communicable diseases going down apart from HIV
What is the leading cause of DALYs in NZ?
Mental health and substance use
What is the leading cause of death in NZ?
self harm and violence( injury)
transport injuries
estimated 5 causes of adolescent DALYs across countries:
high income: mental health, road traffic injuries, 1 nutritional cause
African LMIC: predominantly communicable diseases, HIV/AIDS + nutritional
South-East Asia: mental health, nutritional, road injury
The top 5 causes vary!
youth2000
NZ national youth health surveys
2001, 2007, 2012, 2019
cross-sectional study: a random sample of secondary students
anonymous, self-reported, online
questions in English and Maori
Across all surveys:
92% prevalence of good to excellent health
each student had an equal chance of being invited to complete the survey if they were at school
-represents students in 2ndary school
who are not represented in the Youth2000 survey?
- students not at school on the day
- students who do not go to school regularly
- students who do not go to school at all
- they are the ones most likely to have more health issues!
- could miss the proportion of students who have greater health needs
These youth, compared with survey participants, are likely to be:
- at higher risk of
• adverse health outcomes
• unmet health needs
• socio-economical disadvantage
- fewer positive connections with
supportive networks (e.g., school)
poverty trends based on Youth2000 survey:
-the proportion of students whose parents worry often about not having enough money to buy food is increasing
- big % of students whose parents worry about not having money to pay the bills
- increasing socio-economic hardships
Substance use trends based on Youth2000 survey
-smoking, marijuana use, and alcohol use are decreasing amongst school children
Vaping has emerged as a new issue
• 12% reported vaping monthly
• 8% vaping weekly (more common among higher-income communities)
the issue with prevalence of substance use in more deprived children
-even though the trends emerge in high income first( eg vaping)
children from low-income families have fewer resources to quit-> prolonged use
Experiences in difficulties accessing healthcare from Youth2000:
- Māori, Pasifika and Asian students
- Students from more deprived neighborhoods
- Students living with a disability or chronic health conditions
- Students who were worried about drinking or had tried to cut down
(concerned about drinking)
inverse care law
The availability of good medical
[or social] care tends to vary
inversely with the need for it in
the population served.
due to the political interests to serve the majority needs
Emotional wellbeing trends from Youth2000
- overall most students show good emotional wellbeing
- declines in wellbeing, especially among females
Symptoms of depression Youth2000
• Most students do not have significant symptoms of depression
• Sharp increases in proportions of students with depressive
symptoms since 2012
-clinically significant symptoms
Symptoms of depression using inequity lens
- Significant ethnic disparity for Maori
- Gap is widening particularly for females
Symptoms of depression: rainbow youth
- Decline in wellbeing for Rainbow Young People
- High and increasing symptoms of depression since 2012
who shows the worse wellbeing?
Rainbow young people with disability/ chronic health conditions:
• High symptoms of depression
• Low wellbeing
trend with depressive symptoms, factors
having 2 or more minorities, marginalised ethnicities, or identities increases the risk of depressive symptoms
trend with depressive symptoms, factors
having 2 or more minorities, marginalised ethnicities, or identities increases the risk of depressive symptoms
self-reported suicide attempts trends Youth2000
- Increase in suicide attempts - especially for males
- Highest in communities exposed to socioeconomic deprivation
Snowflake hypothesis
Aspects affecting early development (2000-2005)
parents experienced economic and social instabilities
• Experience of young people when they younger
– Increased parental monitoring, parental stress/financial, geopolitical polarisation
→ overprotection and low resilience ‘
Igen hypothesis
Contemporary 2012- current aspects
Social media, internet access, smartphones
• Increase use → poor mental health mediated by other factors
– Decline in exercise (NZ health survey data, 15-17 yr olds), ‘risk taking’, not talking to parents, reduced sleep, online bullying
• Increasing perfectionism, emphasis on exceptionalism, individual achievement
Doomer hypothesis
Impact of job insecurities, housing affordability, climate crisis, political polarisation
What are the top reported problems in youth?
- mental health and pressure
- social media and tech
- bleak futures, climate change
- risky choices
What are the top reported problems in youth?
- mental health and pressure
- social media and tech
- bleak futures, climate change
- risky choices
Limitations of national youth surveys
Who is not represented?
Problem: Recruitment bias
eg. the older the students get the more they get along with teachers. Or is it that the ones that don’t get along drop out?
Examining ‘causal relationships’
- Cross-sectional studies (like Youth2000 surveys) can collect data on many exposures & outcomes of interest at the same time
- We don’t know which comes first -reverse causality
It is difficult to know which came first (exposure or outcome of interest) in cross-sectional surveys when questions refer to similar recall periods
• This means the Bradford Hill aspect of ‘temporality’ is unlikely to be fulfilled (Module 2)
How reliable might this information be? (Measurement bias)
- We can never be entirely certain!
- But, the survey was Anonymous and confidential which would increase the likelihood of honesty and
- Self-reported information (directly entered into an internet tablet rather than responding to an interviewer). This reduces but does not eliminate the likelihood that respondents are providing socially desirable rather than completely honest answers.
Use of technology for collecting data
Better response rates BUT
- Students with some disabilities or language difficulties may not complete the survey - Recruitment bias
- Can’t get back to youth whose responses may indicate they are vulnerable or at risk (because the survey is anonymous).
Reflecting on the health outcomes, but did not get the opportunity to get help
→ Youth19: Opportunity for students to opt-in to receive digital health and wellbeing resources
‘strengths based’ approaches
-not the answer→ needs to address the upstream determinants BUT can be implemented in the meantime
→ act to increase resilience
→ improve connection
resilience
‘Resilience’ refers to the ability to spring back despite adversity
- People with various protective (or resiliency) factors may be less vulnerable to harm despite exposure to risk
- The presence of resiliency factors is associated with a reduction in health risk behaviors
The relationship between neighbourhood characteristics and student wellbeing
-higher social cohesion→ better wellbeing
Strength-based approaches examples
- Promote bonding and positive connections to family school, community
- Promote social, emotional, cognitive, behavioural, and moral competence
- Foster spirituality
- Foster self-efficacy (belief in ability to perform & achieve goals)
- Foster clear and positive identity
- Foster belief in the future
- Provide recognition for positive behaviour
- Foster healthy standards for behavior
