Children and Young People: Indicators of Wellbeing in New Zealand 2008

Health

Low birth weight births
Infant mortality
Immunisation
Hearing test failure at school entry
Oral health
Obesity
Physical activity
Cigarette smoking at 14-15 years
Youth suicide

ISBN 978-0-478-33506-4 (Print) 
ISBN 978-0-478-33507-1 (Online)

The other sections and the appendices of the Children and Young People: Indicators of Wellbeing in New Zealand 2008 can be found at www.msd.govt.nz

Health
Desired outcomes
All children and young people enjoy good physical and mental health with access to good-quality health care.
Introduction
The World Health Organization (WHO) defines health broadly:

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

All societies recognise that good health is critical to wellbeing. Positive health and life outcomes for children, particularly in the first years of life, increase their likelihood of successful participation in society throughout their youth and adulthood.

A range of factors affect health outcomes. These include genetic predisposition, lifestyle, the physical and social environment and the availability of health and disability support services. There is a well-established link between socio-economic position and health outcomes: children from poor families have higher rates of illness, injury and death than other children. A clean and safe environment, adequate income, good housing, affordable nutritious food, education and social support within families and communities all contribute towards good health.

The desired outcome for health is consistent with Article 24 of the United Nations Convention on the Rights of the Child (UNCROC), which recognises “the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health”. Article 23 of UNCROC states that a mentally or physically disabled child ‘should enjoy a full and decent life’, in conditions that ensure dignity, promote self-reliance and facilitate the child’s active participation in the community’.

Definitions of health differ between cultures. For example, the Māori word ‘Hauora’ has a broader meaning than physical well-being, and includes wairua (spiritual), whanau (family) and hinengaro (mental) aspects, as well as important cultural elements such as land, environment, language and extended family. Many Pacific people also believe that spiritual wellbeing is essential to health.
Indicators
There are nine indicators in the Health domain. Five of these focus on the early years of childhood, where improvements in outcomes are likely to have the greatest impact on later health and wellbeing.

Low birth weight births and the infant mortality rate are well-established indicators of infant health outcomes. Children born with a low birth weight have a greater risk of poor health or death in infancy. The risk of death during the first year of life is higher than at any other point during childhood.  Both the proportion of low birth weight births and the infant mortality rate reflect the impact of economic and social conditions on the health of mothers and newborns as well as the effectiveness of health systems.

Immunisation is an indicator of access to, and use of, preventive health care. High levels of immunisation coverage of young children are needed to prevent the spread of diseases which can have a substantial and long-lasting impact on health.

Monitoring the proportion of children who fail the hearing test at school entry shows where remedial health care is needed at a crucial time in children’s lives. Hearing loss in early childhood can interfere with the development of speech and language, potentially affecting later social and economic outcomes. 

Oral health is not just about having good teeth: it is critical to good health and wellbeing for children and in adulthood and most dental disease is preventable. The indicator includes two measures of oral health. The first—caries free at age 5—is a good measure of the prevalence of dental disease at school entry. The second measure—the average number of decayed, missing and filled teeth at around age 12—gives an indication of disease severity at the end of the period covered by the school dental service.
 
Obesity in childhood is a biological risk factor for adult obesity, which is associated with a wide range of serious adult health conditions. Obesity is related to lifestyle factors such as low levels of physical activity and the ready availability of highly processed and energy-dense foods and drinks. This indicator focuses on children aged 5–14 years.

Physical activity is protective against a number of serious health conditions. It can also help lower blood pressure and minimise excessive weight gain that carries a risk of future health problems. This indicator shows the proportion of young people aged 15–24 years who met physical activity guidelines.

Cigarette smoking at 14–15 years is also a future-oriented indicator. Because of the addictive properties of tobacco, smoking in young people is a major influence on levels of smoking among adults. Tobacco smoking is by far the leading single cause of preventable deaths in New Zealand.

Suicide is a leading cause of death among young people in New Zealand and an indicator of mental health in the youth population. This indicator includes two measures: the proportion of young people aged 15–24 who died by suicide, and the proportion of young people of that age who were hospitalised for self-harm.

Low birth weight births
Definition
The number of children who weighed less than 2,500 grams at birth, per 100 live births.
Relevance
Babies are born with a low birth weight either because they have failed to grow adequately before birth (small for gestational age), or because they are delivered pre-term (less than 37 weeks’ gestation). Outcomes differ depending on the cause. Low birth weight infants have a greater risk of poor health or death, require a longer period of hospitalisation after birth, and are more likely to develop significant disabilities (UNICEF and WHO, 2004). Risk factors for low birth weight include low parental socio-economic status, increased maternal age and multiple fertility, harmful behaviours like smoking, excessive alcohol consumption and poor nutrition, as well as a poor level of pre-natal care. 
Current level and trends
In 2006, there were 3,505 births registered with a birth weight of less than 2,500 grams, accounting for 5.8 percent of all live births registered in that year. The proportion of low birth weight births increased between 1993 and 2002 (from 5.9 percent to 6.5 percent), but has since declined and in 2006 it was just under the level recorded in 1993.

Figure H1.1 Low birth weight births as a proportion of all live births, 1993–2006

Source: Ministry of Health, New Zealand Health Information Service

Ethnic differences
A relatively high proportion of Māori babies have a low birth weight. In 2006, 6.7 percent of Māori babies registered weighed less than 2,500 grams, compared with 4.4 percent of Pacific babies and 5.7 percent of babies of Other (mainly European) ethnic groups.  While all three ethnic groups recorded a slight decline in the proportion of low birth weight births between 2002 to 2006, only for Mäori was the level below what it had been in 1996.

Figure H1.2 Low birth weight births as a proportion of all live births, by ethnic group, 1996–2006

Source: Ministry of Health, New Zealand Health Information Service

Socio-economic differences
Mothers living in the most deprived areas (deciles 9–10 of the New Zealand Deprivation Index) are more likely to have a low birth weight birth. Of births registered in 2002–2006, the proportion that were born small for gestational age varied from 7.7 percent in the most deprived areas to 4.9 percent in the least deprived areas. The proportion born pre-term varied from 6.2 percent in the most deprived areas to 5.3 percent in the least deprived areas.
Regional differences
In 2006, the West Coast district health board (DHB) area had the highest proportion of low birth weight births registered (7.3 percent), followed by Taranaki and Northland (each 7.0 percent), Southland (6.9 percent), Whanganui (6.5 percent), MidCentral (6.4 percent), Lakes and Wairarapa (each 6.3 percent). The DHBs recording the lowest proportions of low birth weight births were South Canterbury (3.1 percent), Nelson-Marlborough (4.4 percent) and Capital and Coast (4.8 percent).
International comparison
In a comparison of the prevalence of low birth weight births in 30 OECD countries in 2005, New Zealand ranked 10th lowest with a rate of 6.1 percent, lower than the OECD median of 6.8 percent.  The New Zealand rate was above that in Canada (5.9 percent) but lower than the rates in Australia (6.4 percent), the United Kingdom (7.5 percent) and the United States (8.1 percent). As average birth weight varies by ethnic group, comparisons between countries with different ethnic distributions may be difficult to interpret.

Infant mortality
Definition
The annual number of deaths of infants aged less than one year, per 1,000 live births in that year.  Infant deaths consist of early neonatal deaths (those occurring within seven days of birth), late neonatal deaths (after seven days and before 28 days) and post-neonatal deaths (after 28 days and before one year).
Relevance
The infant mortality rate reflects the effect of economic and social conditions on the health of mothers and newborns as well as the effectiveness of health systems. Around two-thirds of the deaths that occur during the first year of life are neonatal deaths (ie, during the first four weeks). Congenital malformations, prematurity and other conditions arising during pregnancy are the principal factors contributing to neonatal mortality in developed countries.  For deaths beyond a month (post-neonatal mortality), there tends to be a greater range of causes, the most common being SIDS (Sudden Infant Death Syndrome), birth defects, infections and accidents.
Current level and trends
Provisional data for 2006 indicates that there were 308 infant deaths in that year, a rate of 5.1 per 1,000 live births.

The total infant death rate more than halved in the decade to 1998, falling from 10.9 per 1,000 in 1988 to 5.4 per 1,000 in 1998. The rate fluctuated at around 6 per 1,000 between 1999 and 2004, falling to 5.0 per 1,000 in 2005. Over that period, the neonatal death rate remained stable while the post-neonatal death rate declined.

Figure H2.1 Infant mortality rate, 1987–2006

Source: Ministry of Health, New Zealand Health Information Service
Note: 2005 and 2006 data is provisional.
Sex and ethnic differences
Male infants are slightly more likely than female infants to die in their first year of life. This is partly because females have a biological survival advantage during the neonatal period. In the period 2001–2006, rates were higher for males than for females by an average of 1.2 per 1,000 live births.

Infant mortality rates among Māori and Pacific people are relatively high, at 6.7 and 6.9 deaths per 1,000 live births respectively in 2005, compared with 3.9 per 1,000 among Other (mainly European) infants. The Mäori infant mortality rate in 2005 was 42 percent  lower than the Mäori rate in 1996 (11.6 per 1,000). Over the same period, the infant mortality rate for Pacific peoples fluctuated between 6–10 per 1,000. 

Table H2.1 Infant mortality rate, by ethnic group, 1996–2005

Year	Rate per 1,000 live births	
	Mäori	Pacific	Other	Total	
1996	11.6	7.3	5.3	7.3	
1997	10.7	8.8	4.7	6.8	
1998	7.2	7.5	4.1	5.4	
1999	8.7	6.4	4.4	5.8	
2000	8.5	10.2	4.6	6.3	
2001	8.6	6.7	4.0	5.6	
2002	8.9	7.7	4.7	6.2	
2003	7.5	6.7	4.2	5.4	
2004	7.4	8.7	4.7	5.9	
2005	6.7	6.9	3.9	5.0	
Source: Ministry of Health, New Zealand Health Information Service
Note: Figures for 2005 are provisional. 
Socio-economic differences
Infant mortality rates generally increase with increasing levels of neighbourhood socio-economic deprivation. Between 1997 and 2004 there was a difference of around 5 infant deaths per 1,000 live births between those from areas in the most deprived and the least deprived quintiles in New Zealand.
Age of mother
There is an association between maternal age and infant death rates, with infant mortality being higher among children born to younger mothers. In 2004 there were 10.5 infant deaths per 1,000 live births to mothers under the age of 20 years, and 7.1 per 1,000 for mothers aged 20 to 24 years. For infants with mothers in older age groups the rates were about four or five deaths per 1,000 live births. 
Regional differences
District health board (DHB) areas with infant mortality rates considerably higher than the national average of 5.9 per 1,000 in 2000–2004 included Whanganui (8.8), Taranaki (7.9), Northland (7.8), Counties-Manukau and Lakes (both 7.6 per 1,000). The DHBs with the lowest rates over that period were Capital and Coast (4.3) and Canterbury (4.4).
International comparison
In 2006, New Zealand’s infant mortality rate (5.1 per 1,000) was higher than the OECD median of 3.8 per 1,000. New Zealand ranked 22nd out of 30 OECD countries.  Iceland had the lowest rate (1.4 per 1,000) and Turkey the highest (22.6 per 1,000).  New Zealand’s infant mortality rate was similar to those of the United Kingdom (5.0 per 1,000) and Canada (5.4 per 1,000 in 2005), a little higher than that of Australia (4.7 per 1,000), but lower than the rate in the United States (6.9 per 1,000 in 2005).

Immunisation
Definition
Immunisation coverage is the proportion of children who are fully immunised against vaccine-preventable diseases at the age of two years, as measured by the National Childhood Immunisation Register (NIR).
Relevance
Vaccine-preventable diseases such as measles, rubella, whooping cough and hepatitis B have a significant impact on the health of children. Achieving high immunisation coverage levels of children plays a crucial role in preventing the spread of such diseases. 

The National Immunisation Register (NIR) was rolled-out to DHBs throughout 2005, as a tool to help improve immunisation coverage.  The NIR now identifies the immunisation status of all New Zealand children aged 0–2 years and provides information on population level immunisation coverage.  The 2005 Childhood Immunisation Coverage survey provided information about immunisation coverage prior to NIR data becoming available. 
Current level and trends
In 2007, 71 percent of children were fully immunised at age two. This is lower than the 77 percent recorded by the National Childhood Immunisation Coverage Survey 2005 but considerably higher than the level recorded the last time a similar survey was carried out in 1991/92, when 60 percent of children were fully immunised at age two. However, it is below the target level of 95 percent required to prevent the outbreak of diseases such as measles. 

Figure H3.1 Proportion of children fully immunised at age two years, by ethnic group, 2007

Source: Ministry of Health (2008a) 
Note: Prioritised ethnic data is used in this graph.
Ethnic differences
Māori children are less likely than children of other major ethnic groups to be fully immunised by age two. In 2007, 63 percent of Māori children were fully immunised at age two, compared with 68 percent of Pacific children, 75 percent of Asian children and 78 percent of New Zealand European children. The coverage rate for children of Other ethnic groups was lowest at 62 percent.
Socio-economic differences
Children living in more socio-economically deprived areas are less likely than others to be fully immunised at age two. In 2007, 66 percent of children who lived in decile 9 and 10 areas (the most deprived areas) were fully immunised at age two, compared with 71 percent of those in deciles 7–8, 73 percent of those in deciles 5–6, 75 percent of those in deciles 3–4, and 77 percent of those in deciles 1–2 (the least deprived areas).   

Figure H3.2 Proportion of children fully immunised at age two years, by deprivation index, 2007

Source: Ministry of Health (2008a)
Note: Deprivation index based on 2001 census is used in this graph.

Regional differences
There was some difference in immunisation coverage between the district health board (DHB) areas. The Southland DHB area had the highest immunisation coverage in 2007, with 91 percent of children fully immunised at age two, while Otago, Canterbury, Whanganui and Hawkes Bay all had rates of 80 percent or higher. The lowest rate of immunisation was recorded in Bay of Plenty (62 percent), while Northland, Lakes and Counties-Manukau DHBs also had rates below 70 percent.
International comparison
New Zealand children have relatively low immunisation coverage compared to children in other OECD countries. Of the five main vaccinations completed by around age two, New Zealand’s rate was higher than the OECD average only for HepB3, the third dose of Hepatitis B vaccine.
Table H3.1 Immunisation coverage rate (%), by vaccine type, New Zealand compared to selected OECD countries, 2006
	DTP3
Diphtheria, tetanus, pertussis	HepB3
Hepatitis B	Hib3
Haemophilus influenzae type B	MCV
Measles-containing vaccine	Pol3
Polio	
New Zealand	89	87	80	82	89	
Australia	92	94	94	94	92	
Canada (1)	94	14	94	94	94	
United Kingdom	92	..	92	85	92	
United States	96	92	94	93	92	
						
OECD mean	95	84	91	93	95	
OECD median	97	92	94	95	97	
						
No. of OECD countries	30	19	27	30	30	
New Zealand rank	28th	12th	26th	29th	28th	
Source: WHO/UNICEF coverage estimates for 1980–2006, as of August 2007, update of January 2008.
Note: (1) Canada: Hepatitis B is offered at Grade 4 (some children may need this during infancy). 

Hearing test failure at school entry
Definition
The proportion of new entrant school children (aged five) who failed the new entrant hearing screening (audiometry) test.
Relevance
Hearing loss in early childhood can interfere with the development of speech and language, potentially affecting social and educational outcomes. Hearing loss in children is often caused by persistent “glue ear” (otitis media with effusion). Glue ear is associated with the common cold and other causes of nasal congestion, exposure to second-hand smoke, low rates of breastfeeding, overcrowding, and attendance at childcare centres.
Current level and trends
In 2005/2006, 6.6 percent of new entrant school children failed the new entrant hearing screening test. There has been an improvement since 1991/1992, when 10.5 percent of such children failed the hearing screening test. Over the last three years the failure rate has plateaued.

Figure H4.1 Proportion of new entrants who failed the hearing screening test, 1991/1992 to 2005/2006

Source: Greville Consulting (2006)

Ethnic differences
There are large ethnic differences in new entrant hearing screening test failure rates.  In 2005/2006, Pacific school entrants had the highest rate (11.2 percent), followed by Māori school entrants (10.3 percent). The rates for European and Asian children were much lower, at 4.4 percent and 3.8 percent, respectively. 

There have been improvements for Mäori and Pacific children over the last 15 years. For Pacific children, the hearing screening test failure rate fluctuated between 14–16 percent over the decade to June 2003, then fell sharply to 10–11 percent in the most recent two years. For Māori children the rate was around 14 percent between 1994 and 2001, falling to around 10–11 percent in the most recent three years.

Figure H4.2 Proportion of new entrants who failed the hearing screening test, by ethnic group, 1992/1993 to 2005/2006
Source: Craig et al (2007), Table 53
Regional differences
In 2005/2006, school entry hearing screening test failure rates were highest in the district health board areas of Hawkes Bay (10.8 percent) and Waitemata (10.0 percent). South Canterbury (8.9 percent) and Northland (8.3 percent) were also well above the national rate of 6.6 percent. The lowest rates were recorded in Hutt/Capital and Coast (1.0 percent), Wairarapa (1.5 percent) and Lakes (1.8 percent).

Oral health
Definition 
The proportion of children who are free of dental caries (tooth decay) at age 5; and the sum of decayed, missing or filled teeth for individual children in Year 8 (around age 12), expressed as an average number per child (DMFT score). For both measures, the denominator is the child population at the respective ages who completed treatment with the school dental service in the year.
Relevance
Dental problems such as caries (tooth decay) and gum disease are common in developed countries and thus represent a major public health problem. Dental diseases are highly related to lifestyle factors, which include a high sugar diet. They also reflect whether or not protective measures such as exposure to fluoride and good oral hygiene are present.  People with poor oral hygiene may experience pain and discomfort, functional impairment, low self-esteem and dissatisfaction with their appearance.  Much of the burden of dental disease falls on disadvantaged and socially marginalised populations.
Current level and trends
In 2006, 53 percent of five year olds were caries free. This was similar to the level in previous years, with the proportion fluctuating between 51 percent and 57 percent since 1990.

The mean DMFT score for 12 year olds (the average number of decayed, missing and filled teeth among Year 8 students) was 1.6 in 2006. The mean DMFT score fell from 2.0 in 1990 to 1.3 in 1994. It then increased to 1.6 in 1997 and remained at around that level over the decade to 2006. The stability in the DMFT score for 12-year olds over the past 15 years contrasts with a significant fall in the previous decade, from 5.1 in 1980 to 2.0 in 1990.

Figure H5.1 Proportion of children caries free at age 5 and mean DMFT score at age 12, 1990–2006

Source: Ministry of Health

The proportion of children who are caries free is consistently higher among those who attend schools with fluoridated water supplies. In 2006, 57 percent of 5 year olds in schools with fluoridated water supplies were caries free, compared with 49 percent of those in schools without fluoridated water. Similarly, the likelihood of having decayed, missing or filled teeth is lower in fluoridated areas.  The DMFT score for 12 year olds was 1.3 for those in schools with fluoridated water and 1.8 for those in other schools. 
Ethnic differences
At 5 years, Māori and Pacific children are less likely to be caries free than children of other ethnic groups, regardless of whether they are in schools with fluoridated water supplies. In 2006, 31 percent of Māori children and 32 percent of Pacific children were caries free, compared with 62 percent of children belonging to other ethnic groups. For each ethnic group, the proportion of children who were caries free was higher for those in schools with fluoridated water.

Table H5.1 Proportion (%) of children caries free at age 5, by ethnic group and fluoridation status of school, 2006

Ethnic group	Fluoridation status of school	
	Fluoridated	Non-fluoridated	Total	
Māori 	38	24	31	
Pacific	32	28	32	
Other	68	57	62	
Total	57	49	53	
Source: Ministry of Health
Note: European and Asian ethnic groups are included in the Other category in this table

At 12 years, Māori and Pacific children are more likely than other children to have decayed, missing or filled teeth. In 2006, the mean DMFT score for 12 year olds was 2.4 for Māori children, 1.8 for Pacific children and 1.3 for children of all other ethnic groups. Children of all ethnic groups in schools with fluoridated water supplies had lower DMFT scores than those in schools without fluoridated water.

Table H5.2 Mean DMFT score at age 12, by ethnic group and fluoridation status of school, 2006

Ethnic group	Fluoridation status of school	
	Fluoridated	Non-fluoridated	Total	
Māori	1.9	2.8	2.4	
Pacific	1.7	2.3	1.8	
Other	1.1	1.6	1.3	
Total	1.3	1.8	1.6	
Source: Ministry of Health
Note: European and Asian ethnic groups are included in the Other category in this table.
Regional differences
Child oral health varies widely by district health board (DHB) area. In 2006, the DHBs with the highest proportions of caries free 5 year olds were Hutt Valley, Waitemata, Capital and Coast, Otago and Auckland (all at least 60 percent). Those with the lowest proportions were Northland, Lakes, Tairawhiti, and Bay of Plenty (all 40 percent or below). 

The DHBs with the highest scores for decayed, missing and filled teeth among Year 8 children in 2006 were Bay of Plenty, Northland and Waikato (each with a score of 2 or more).  Those with the lowest DMFT scores (of 1 or less) were Capital and Coast, Hutt Valley and Auckland. 
International comparison
A comparison of child dental health in OECD countries is available only for the DMFT Index. This is the sum of decayed, missing or filled permanent teeth for individual children, expressed as an average number per child. The data are for 12 year-old children.

Over the past 25 years, there has been a substantial improvement in child dental health in most OECD countries. Between 1980 and 2003, the average decline in DMFT per child was 67 percent in the 19 OECD countries for which data were available. Over this period, the decline in New Zealand was 69 percent (from 5.1 to 1.6 DMFT per child).  

In 2003, New Zealand ranked 17th out of 26 countries, with 1.6 DMFT per child. The New Zealand score was higher than the OECD median (1.2 DMFT per child) and higher than the scores of the United Kingdom (0.8 DMFT per child), Australia (1.0 per child), and the United States (1.3 per child).

Obesity
Definition
The proportion of children aged 5–14 years who were obese in the 2002 National Children’s Nutrition Survey and the 2006/07 New Zealand Health Survey.
For children, obesity is defined as having a body mass index (BMI - a measure of weight adjusted for height) greater than or equal to sex and age specific BMI cut-off points developed by the International Taskforce on Obesity (IOTF).
Relevance
Overweight and obese children are likely to be obese into adulthood, and to have abnormal lipid profiles and high blood pressure at a younger age. Obese children may also suffer stigmatisation due to their weight. Obesity is associated with a long list of adult health conditions including heart disease, diabetes, stroke, high blood pressure and some cancers. 

Over the past two decades, increasing levels of obesity internationally are thought to be related to societal and environmental factors such as increasingly sedentary lifestyles and the ready availability of highly processed and energy-dense foods and drinks. 
Current level and trend
The 2006/07 New Zealand Health Survey found that 8.4 percent of children aged 5–14 years were obese, according to international cut-off levels.

There was no significant change in the prevalence of child obesity between 2002 and 2006/07. Figures from the 2002 National Children’s Nutrition Survey of children aged 5–14 years, adjusted for comparability with the 2006/07 New Zealand Health Survey data, showed that 9.0 percent were obese.
Age and sex differences
In 2006/07, there was no significant difference by sex or age in the prevalence of obesity among children aged 5–14 years.  This was also the case in 2002.

Table H6.1 Age-specific obesity prevalence rate, children aged 2–14 years, 2002, 2006/07
	2–4 years	5–9 years	10–14 years	Total 2–14 years	Total 5–14 years	
2002						
Male	..	7.0	9.2	..	8.1	
Female	..	9.0	11.0	..	10.0	
Total 	..	7.9	10.1	..	9.0	
2006/07						
Male	7.6	8.4	7.7	8.0	8.1	
Female	9.1	8.0	9.2	8.7	8.7	
Total 	8.3	8.2	8.5	8.3	8.4	
Source: Ministry of Health, Public Health Intelligence
Note: The 2002 National Children’s Nutrition Survey collected data on 5–14 year olds only.
Ethnic differences
Using the IOTF BMI cut-offs, the age-standardised obesity prevalence rate for children aged 5–14 years was highest for Pacific children (26.2 percent in 2006/07). Māori children also had a higher rate compared to the total population (12.7 percent). Between 2002 and 2006/07, the prevalence of obesity fell by around half for children of European and Other ethnic groups. For Māori and Pacific children, there was no significant change.

Table H6.2 Age-standardised obesity prevalence rate (%), children aged 5–14 years, by sex and ethnic group, 2002, 2006/07

	European/
Other	Māori	Pacific	
Asian	Total	
2002						
Male	9.2	14.3	27.5	..	8.1	
Female	11.0	15.7	27.2	..	10.0	
Total	10.1	15.0	27.3	..	9.0	
2006/07						
Male	5.2	12.0	23.7	5.6	8.1	
Female	4.6	13.4	28.9	7.1	8.7	
Total 	4.9	12.7	26.2	6.3	8.4	
Source: Ministry of Health, Public Health Intelligence
Notes: (1) Total response standard output for ethnic groups has been used. (2)The 2002 National Children’s Nutrition Survey was not designed to provide reliable estimates for Asian children.

Figure H6.1 Age-standardised obesity prevalence rate, children aged 5–14 years, by ethnic group, 2002, 2006/07

Source: Ministry of Health, Public Health Intelligence
Notes: (1) Total response standard output for ethnic groups has been used. (2) The 2002 National Children’s Nutrition Survey was not designed to provide reliable estimates for Asian children.

Socio-economic differences
The prevalence of child obesity is much higher in the most deprived neighbourhoods. In 2006/07, children aged 5–14 years who were living in the most deprived fifth of areas (NZDep2006 quintile 5) were nearly four times as likely as those in the least deprived area (NZDep2006 quintile 1) to be obese (16.4 percent, compared with 4.3 percent).

Figure H6.2 Age-standardised obesity prevalence rate, children aged 5–14 years, by NZDep2006 quintile, 2006/07

Source: Ministry of Health, Public Health Intelligence

Physical activity
Definition
The proportion of young people aged 15–24 years who met physical activity guidelines (ie, were physically active for at least 30 minutes a day on five or more days over the last week), as measured by the 2002/03 and 2006/07 New Zealand Health Surveys.
Relevance
Physical activity is protective against health conditions such as heart disease, type 2 diabetes and certain cancers (colon, post-menopausal breast and endometrial). Physical activity also helps to lower blood pressure, as well as minimising weight gain, overweight and obesity, which are risk factors for heart disease and type 2 diabetes. 
Current level
In 2006/07, 55 percent of young people aged 15–24 years met physical activity guidelines, reporting that they had been physically active for at least 30 minutes a day on five or more days over the last week. In 2002/03 the proportion was also 55 percent. 
Age and sex differences
Males aged 15–24 years were significantly more likely than females of that age to meet physical activity guidelines.  In 2006/07, 63 percent of males reported being physically active for at least 30 minutes a day on five or more days in the last week, compared to 47 percent of females. The sex difference was significant for both 15–19 year olds and 20–24 year olds.

Table H7.1 Proportion (%) of 15–24 year olds who met physical activity guidelines in the last week, by age and sex, 2002/03, 2006/07
Age group	Males	Females	Total	
	2002/03	2006/07	2002/03	2006/07	2002/03	2006/07	
15–19	63.9	61.6	50.0	50.0	57.5	55.9	
20–24	63.3	65.4	44.9	43.8	53.5	54.5	
15–24	63.6	63.4	47.0	47.0	55.3	55.2	
							
Source: Ministry of Health, Public Health Intelligence

Ethnic differences
Asian young people were significantly less likely than young people in general to have met physical activity guidelines in the previous week. In 2006/07, the age-standardised rate for Asian 15–24 year olds was 38 percent while the rate for all young people of that age was 55 percent. In each ethnic group, males were more likely than females to have met physical activity guidelines, but this sex difference was significant only for European/Other and Mäori young people. These patterns were similar in 2002/03.
 
Figure H7.1 Proportion of 15–24 year olds who met physical activity guidelines in the last week, by ethnic group and sex, 2006/07

Source: Ministry of Health, Public Health Intelligence
Note: Total response standard output for ethnic groups has been used.
Age-standardised using WHO world population.

Between 2002/03 and 2006/07, European/Other males recorded a significant increase in the rate at which they met physical activity guidelines (from 57 percent to 68 percent). None of the changes for males of other ethnic groups, or for females, were statistically significant. 

Table H7.2 Proportion (%) of 15–24 year olds who met physical activity guidelines in the last week, by ethnic group and sex, 2002/03 and 2006/07

Ethnic group	Age-standardised rate (%)	
	Males	Females	Total	
	2002/03	2006/07	2002/03	2006/07	2002/03	2006/07	
European/Other	57.4	67.7	49.9	50.0	53.5	58.5	
Mäori 	59.7	65.6	51.2	47.9	55.2	56.1	
Pacific	53.2	58.2	44.2	41.8	48.5	49.6	
Asian	45.3	43.8	33.8	33.4	39.1	38.3	
Total	56.7	63.2	48.6	47.0	52.5	54.8	
							
Source: Ministry of Health, Public Health Intelligence
Note: Total response standard output for ethnic groups has been used.
Age-standardised using WHO world population.
Socio-economic differences
In 2006/07 there was no clear association between physical activity and the level of neighbourhood deprivation (as measured by NZDep2006 scores) among 15–24 year olds as a whole. However, there was some association among females, with the proportion who met physical activity guidelines increasing with levels of neighbourhood deprivation for those who lived in NZDep2006 quintiles 2–5.

Figure H7.2 Proportion of 15–24 year olds who met physical activity guidelines in the last week, by NZDep2006 quintile and sex, 2006/07
Source: Ministry of Health, Public Health Intelligence. Age-standardised using WHO world population.

Cigarette smoking at 14–15 years
Definition
The proportion of Year 10 (14–15 year old) secondary school students who smoke cigarettes regularly (daily, weekly or monthly).
Relevance
Tobacco smoking is by far the leading single cause of preventable deaths in New Zealand. Because of the addictive properties of tobacco, smoking in young people is a major influence on levels of smoking among adults. Smoking among young women is of particular concern, not only because of the impact on their own health but also potentially the impact on the health of their children. Maternal smoking, especially in pregnancy, is a preventable risk factor for sudden infant death syndrome (SIDS).
Current level and trends
A national survey of 14–15 year old (Year 10) students in 2007 found that 13 percent of student smoked cigarettes regularly (at least monthly). This was a decline from 14 percent in 2006.

Smoking prevalence among 14–15 year olds has declined considerably since the survey began in 1999. Between 1999 and 2007, the proportion of students who were regular smokers declined from 29 percent to 13 percent (a 55 percent reduction in relative terms).

Figure H8.1 Prevalence of regular cigarette smoking (at least monthly) at 14–15 years, by sex, 1999–2007

Source: Paynter (2008) Table 2a
Sex differences
Females aged 14–15 years are more likely to smoke cigarettes than males of that age. In 2007, 15 percent of female Year 10 students were regular smokers, compared with 11 percent of males. Between 2006 and 2007, the proportion of female students who were regular smokers fell from 18 percent to 15 percent, but smoking prevalence remained steady for males. As a result, the sex difference in Year 10 smoking prevalence narrowed to 4 percentage points in 2007, the smallest difference recorded since 1999. 

Between 1999 and 2007, the prevalence of smoking for females declined from 32 percent to 15 percent (a reduction of 54 percent) and for males, from 25 percent to 11 percent (a reduction of 57 percent). 
Ethnic differences
Among Year 10 students, Māori females have by far the highest smoking prevalence. In 2007, 34 percent of 14–15 year old Māori females reported smoking regularly, almost twice the rate of Māori males (19 percent). Pacific students had the second highest smoking rate (18 percent of Pacific females, 14 percent of Pacific males). Asian youth were the only ethnic group with a higher smoking rate for males than for females (8 percent, compared to 4 percent). 

While smoking prevalence among 14–15 year olds has fallen substantially for both sexes in all ethnic groups since 1999, the fall was larger for European/Other students than for Māori and Pacific students over the entire period. The decline in smoking among Māori students has accelerated since 2003.

Table 8.1 Prevalence of regular smoking (at least monthly) at 14–15 years, by ethnic group and sex, 1999–2007 

Year	Māori	Pacific	Asian	European/Other	
	Male	Female	Male	Female	Male	Female	Male	Female	
1999	33.6	50.9	23.7	33.3	13.4	10.4	24.2	30.0	
2000	33.7	51.1	25.8	31.3	14.6	9.0	23.3	28.8	
2001	28.7	47.5	23.0	29.4	11.4	7.7	20.0	25.9	
2002	24.9	47.8	16.5	28.5	11.2	7.3	16.6	23.2	
2003	27.0	47.4	19.7	26.9	10.2	7.3	14.2	21.1	
2004	24.4	42.2	17.7	26.3	6.9	5.9	11.2	16.7	
2005	21.3	41.2	16.3	25.5	8.3	5.3	11.0	16.6	
2006	20.7	37.0	13.9	21.4	5.4	4.1	8.1	12.9	
2007	19.0	33.7	14.1	18.4	8.0	4.0	8.2	10.6	
Source: Paynter, J. (2008) Tables 4a, 4d

Socio-economic differences
There were significant declines in smoking rates among students in all five socio-economic quintiles (the lowest fifth of schools by socio-economic status) between 1999 and 2007.  However, there was a greater decline in regular smoking prevalence during that period for males and females in the highest quintile (of 67 percent and 68 percent respectively), than for males and females in the lowest quintile (31 percent and 23 percent).  In 2007, male and female students at schools in the lowest socio-economic quintile (the lowest fifth of schools by socio-economic status) had regular smoking rates that were 2.5 and 3.2 times those of students at schools in the highest quintile. 
Parental smoking and smoking in the home
There is a clear association between parental smoking and the prevalence of smoking among Year 10 students. In 2007, students with no parent who smoked were less than half as likely to be regular smokers (7 percent) as those with one parent who smoked (17 percent), who in turn were about half as likely to smoke as students with two parents who both smoke (30 percent).

Table 8.3 Prevalence of regular smoking (at least monthly) at 14–15 years, by parental smoking status, 2001–2007
Parental smoking	2001	2002	2003	2004	2005	2006	2007	
Both	44.1	42.1	40.9	36.2	36.4	33.0	30.2	
One	31.2	28.2	25.9	22.2	20.7	19.0	16.9	
None	17.5	15.1	13.4	10.7	10.4	7.6	7.1	
Source: Paynter (2008) Table 7a

Smoking prevalence is much higher for students who live in homes where smoking is allowed inside than for those in homes where there is no smoking.

Table 8.4 Prevalence of regular smoking (at least monthly) at 14–15 years, by smoking in the home, 2001–2007
	2001	2002	2003	2004	2005	2006	2007	
Smoking allowed inside	37.5	35.7	36.1	28.9	29.1	27.3	25.8	
No smoking inside home	19.3	16.6	14.0	13.3	12.4	9.8	9.1	
Source: Paynter (2008) Table 8a
Regional differences
Over the period 1999–2007 the prevalence of regular smoking declined significantly in all 21 district health board (DHB) areas.  In 2007, DHB areas with relatively high regular smoking prevalence among 14–15 year olds included Tairawhiti, Whanganui, Hawke’s Bay, Wairarapa, Northland, Hutt Valley Lakes District and Waikato (14–19 percent). Smoking prevalence was below the national average in the Auckland, Waitemata and Taranaki DHB areas (10–11 percent).

Youth suicide
Definition
The number of suicide deaths per 100,000 population, expressed as a three-year moving average rate, for the population aged 15–24 years.
Relevance 
Suicide is a leading cause of death among young people and an indicator of mental health in the youth population. Risk factors for suicide and attempted suicide among youth include childhood adversity and trauma, socio-economic and educational disadvantage, mental health disorders and exposure to recent stress or life difficulty. Factors that have been suggested as playing a potentially protective role against suicidal behaviour include good coping skills and problem-solving behaviours, positive beliefs and values, feelings of self-esteem and belonging, connections to family or school, secure cultural identity, supportive family/whānau, hapū and iwi, responsibility for children, social support and holding attitudes against suicide.
Current level and trends
Provisional data for 2005 show there were 108 deaths from suicide among young people aged 15–24 years in that year. This was 4.4 percent fewer than the 113 young people who died in 2004 but still 11.3 percent more than the 97 who died in 2003. The three-year moving average youth suicide death rate was 18.1 per 100,000 in 2003–2005, compared with 18.6 per 100,000 in 2000–2002. The youth suicide rate has declined by a third from the peak in 1995–1997 of 27.2 deaths per 100,000 to 18.1 per 100,000 in 2003–2005. However, it is still higher than the rate in 1984–1986 (13.4 per 100,000).

Youth aged 15–24 years had the highest hospitalisation rate for intentional self-harm of any age group in 2006 (299.9 cases per 100,000, or 1,710 cases).

Figure H9.1 Three-year moving average youth suicide death rate (15–24 years), by sex, 1983–1985 to 2003–2005
Source:  Ministry of Health, New Zealand Health Information Service
Sex differences
Males have a much higher rate of death by suicide than females, with 26.0 deaths per 100,000 males aged 15–24 in 2003–2005 compared with the female rate of 9.9 per 100,000. Research suggests that the difference is associated with choice of methods. Females, however, make more non-fatal suicide attempts. In 2006, there were 1,205 hospitalisations of young females (an age-specific rate of 424.9 per 100,000) and 505 hospitalisations of young males for intentional self-harm (an age-specific rate of 176.2 per 100,000).

Most of the change in the youth suicide rate since 1983–1985 was due to a rise and fall in the male youth suicide rate. The male rate rose to a peak of 41.4 per 100,000 in 1995–1997 and declined to 24.5 per 100,000 by 2002–2004, increasing slightly to 26.0 per 100,000 in 2003–2005. The female suicide rate doubled from 1991–1993 to 1997–1999 (from 6.0 per 100,000 to 12.8 per 100,000), and then fell markedly to 8.6 per 100,000 in 2000–2002. Between 2000–2002 and 2003–2005, the youth suicide death rate decreased slightly for males and increased slightly for females.

Table H9.1 Three-year moving average suicide death rate per 100,000 aged 15–24 years, by sex, selected years 1985–2005

Period	Male	Female	Total	
1985–1987	24.5	6.7	15.8	
1988–1990	37.2	7.5	22.5	
1991–1993	39.3	6.0	22.9	
1994–1996	41.1	12.2	26.8	
1997–1999	36.8	12.8	25.0	
2000–2002	28.3	8.6	18.6	
2003–2005	26.0	9.9	18.1	
Source:  Ministry of Health, New Zealand Health Information Service
Age differences
Since 1985–1987, males and females aged 20–24 have experienced higher suicide rates than those aged 15–19 years.

Table H9.2 Three-year moving average suicide death rate per 100,000 aged 15–19 and 
20–24 years, by sex, selected years 1985–2005

Period	15–19 years	20–24 years	
	Male	Female	Total	Male	Female	Total	
1985–1987	17.8	4.7	11.4	31.7	8.8	20.5	
1988–1990	29.1	4.9	17.2	45.9	10.2	28.3	
1991–1993	26.9	3.7	15.5	51.9	8.3	30.3	
1994–1996	31.5	12.1	22.0	50.3	12.4	31.5	
1997–1999	29.2	16.2	22.9	44.6	9.3	27.1	
2000–2002	20.0	9.5	14.9	37.4	7.5	22.6	
2003–2005	22.7	9.3	16.2	29.4	10.5	20.1	
Source:  Ministry of Health, New Zealand Health Information Service
Ethnic differences
Youth suicide rates for Māori are subject to considerable fluctuation because of small numbers, so trends over time are difficult to interpret. However, the rate of suicide among young Māori appears to be consistently higher than that for non-Māori. The three-year moving average youth suicide death rate for Māori  in 2003–2005 was 33.2 per 100,000 compared with 14.6 for non-Māori.  While the rates for non-Māori youth have declined (by 38 percent since 1996–1998), Māori rates, after an initial drop, have increased since 2000–2002, resulting in a decline of just 12 percent since 1996–1998.
Table H9.3 Three-year moving average suicide death rate per 100,000 aged 15–24 years, Māori , non-Māori , by sex 1996–1998 to 2003–2005
 	Males	Females	Total	
	Māori 	Non-Māori 	Māori 	Non-Māori 	Māori 	Non-Māori 	
1996–1998	55.5	35.8	19.8	11.1	37.5	23.6	
1997–1999	49.9	33.6	20.0	10.9	35.0	22.5	
1998–2000	47.3	29.5	16.8	9.6	32.2	19.8	
1999–2001	40.5	28.5	14.2	8.4	27.5	18.6	
2000–2002	40.9	25.2	14.2	7.1	27.6	16.3	
2001–2003	38.7	22.8	18.5	8.2	28.6	15.6	
2002–2004	43.8	20.1	20.8	8.4	32.3	14.4	
2003–2005	46.1	21.4	20.3	7.4	33.2	14.6	
Source:  Ministry of Health, New Zealand Health Information Service

From a statistical point of view, small numbers are even more of an issue for Asian and Pacific youth suicide rates, even when the data is aggregated over several years. For the period 2000–2005, the Asian ethnic group was the only ethnic group with a significantly lower youth suicide rate than the national average. Māori had a significantly higher youth suicide rate than the national average for both the 15–19 and 20–24 age groups. Pacific youth aged 20–24 had a higher suicide rate than the national average, while Pacific youth aged 15–19 had a lower rate than the national average. However, neither of these results was statistically significant.

Table H9.4 Age-specific youth suicide death rates by ethnic group, 2000–2005
 Age	Pacific	Asian	Māori 	Euro/Other	Total	
15–19 	11.0 
(6.0, 18.5)	6.3 
(3.1, 11.2)	28.8 
(23.4, 35.2)	13.2 
(11.2, 15.6)	15.4 
(13.6, 17.3)	
20–24	28.1 
(19.1, 39.9)	10.7 
(6.6, 16.3)	38.6 
(31.5, 46.7)	18.4 
(15.9, 21.2)	21.5 
(19.3, 23.9)	
Source: Ministry of Health
Note: If the respective confidence intervals (in brackets) do not overlap, the difference between rates is likely to be statistically significant.

Table H9.5 Number of youth suicide deaths by age and ethnic group, 2000–2005
 Age	Pacific	Asian	Māori 	Euro/Other	Total	
15–19	14	11	97	147	269	
20–24	31	21	104	189	345	
15–24	45	32	201	336	614	
Source: Ministry of Health
Socio-economic differences
In 2006, the intentional self-harm hospitalisation rate for youth (15–24) living in the most deprived areas of New Zealand was 1.5 times greater than for youth living in the least deprived areas. Hospitalisation events for intentional self-harm increase with deprivation, particularly for the 15–19 age group.
Figure H9.2 Intentional self-harm hospitalisation rate for youth aged 15–24 years, by NZDep2001 quintile and age, 2006

Source:  Ministry of Health, New Zealand Health Information Service
International comparison
In the most recent comparison of 13 OECD countries, the 2005 New Zealand male youth suicide rate of 27.6 per 100,000 was second highest after Finland (33.1 per 100,000 in 2004). Countries with lower youth suicide rates than New Zealand included Canada (17.5 in 2002), Australia (17.4 in 2003), the United States (16.5 in 2002), and the United Kingdom (8.0 per 100,000 in 2004). 

The 2005 New Zealand female youth suicide rate of 8.2 per 100,000 was third highest after Finland (9.7 in 2004) and Japan (8.4 in 2004).  Lower rates than New Zealand’s were recorded for Canada (5.2 in 2002), Australia (3.6 in 2003), the United States (2.9 in 2002) and the United Kingdom (2.3 in 2004).