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Local Policy Documents and Evidence-Based Reviews Relevant to thePrevention of Alcohol-Related HarmTable 48 below provides an overview of New Zealand alcohol and addiction policy documents andinternational evidence-based reviews and guidelines that address reducing alcohol use andalcohol-related harm in young people. In addition, Table 112 (Page 414) provides an overview ofpublications relevant to the prevention of drug use in young people, which frequently encompassalcohol and other drug use.Table 48. Local Policy Documents and Evidence-Based Reviews Relevant to the Reduction ofAlcohol-Related Harm in Young PeopleMinistry of Health Policy DocumentsMinistry of Health. 2010. Mental Health and Addiction Action Plan 2010. Wellington: Ministry of Health.http://www.health.govt.nz/publication/mental-health-and-addiction-action-plan-2010This document builds on Te Tāhuhu and Te Kōkiri, the national strategy and action plan for mental health and addictionsto 2015, identifying the key priorities for Ministry-led activities. Tackling alcohol and other drug-related harm is one of fourprioritised actions and includes increasing the number of community youth alcohol and other drug (AOD) treatmentplaces available to give young offenders access to court directed community AOD treatment programmes.Ministry of Health. 2007. Te Raukura. Mental health and alcohol and other drugs: Improving outcomes for childrenand youth. Wellington: Ministry of Health. http://www.health.govt.nz/publication/te-raukura-mental-health-and-alcoholand-other-drugs-improving-outcomes-children-and-youthThis report identifies continued improvement in child and adolescent mental health (CAMHS) and alcohol and other drug(AOD) specialist services as a priority for the mental health and addiction sector. The key issues are identified, includinginequalities, access to services, child and youth AOD services, intersectoral collaboration and primary mental healthcare. Priorities for action are defined, including improvement in understanding and recognition of AOD issues in CAMHS;improvement in these gaps availability of AOD service provision within CAMHS; and identification by DHBs of gaps inAOD service provision for children and youth, and development and implementation of plans to address improvement inunderstanding and recognition of AOD issues in CAMHS.Ministry of Health. 2005. Te Tāhuhu – Improving Mental Health 2005–2015: The Second New Zealand MentalHealth and Addiction Plan Wellington: Ministry of Health.Ministry of Health. 2006. Te Kōkiri: The Mental Health and Addiction Action Plan 2006–2015. Wellington: Ministry ofHealth.http://www.health.govt.nz/our-work/mental-health-and-addictions/mental-health/mental-health-strategic-directionTe Tāhuhu set out Government policy and priorities for mental health and addiction for 2005–2015. Te Kōkiri set out theaction plan and includes a mixture of high level initiatives and specific operational actions. Addiction is identified as oneof ten leading challenges and a number of actions to improving access to and quality of addiction services and broadenthe range of services available are included. Young people are identified as at increasing risk of substance abuse andspecific attention to services for this group is recommended.Cochrane Systematic ReviewsFoxcroft DR & Tsertsvadze A. 2011. Universal family-based prevention programs for alcohol misuse in youngpeople. Cochrane Database of Systematic Reviews doi:10.1002/14651858.CD009308http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD009308/frame.htmlThis reviewed assessed the effectiveness of universal family-based prevention programs in preventing alcohol misuse inchildren aged up to 18 years. Twelve heterogeneous RCTs, with 202 to 3,496 participants, were included in the review.The majority of trials assessed the effectiveness of interventions to promote the awareness and skills in parents andadolescents. Nine trials showed some evidence of effectiveness compared to a control or other intervention group, withpersistence of effects over the medium and longer-term (up to 36 months), four of which were gender-specific, focusingon young females. Two studies with large sample sizes found no effects.Foxcroft DR & Tsertsvadze A. 2011. Universal multi-component prevention programs for alcohol misuse in youngpeople. Cochrane Database of Systematic Reviews doi:10.1002/14651858.CD009307http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD009307/frame.htmlThis review assessed the effectiveness of universal multi-component prevention programs in preventing alcohol misusein children up to 18 years of age. Twenty RCTs, with 361 to 12,022 participants, assessing combinations of school,community, and/or family-based programmes, were included. The aims of the evaluated interventions in the majority oftrials were the promotion of awareness in parents and adolescents. It was unclear whether the majority of trials usedadequate randomisation of programme allocation concealment. Twelve of the trials showed some evidence ofeffectiveness compared to a control or other intervention group, with persistence of effects ranging from 3 months to 3years. Assessment of the additional benefit of multiple versus single component interventions was possible in 7 trials withmultiple arms, only one of which showed a clear benefit for components delivered in more than one setting. Althoughthere is some evidence to support the effectiveness of multi-component interventions there is little evidence to supportmultiple components being more effective than interventions with single components.Alcohol-Related Hospital Admissions - 234
Foxcroft DR & Tsertsvadze A. 2011. Universal school-based prevention programs for alcohol misuse in youngpeople. Cochrane Database of Systematic Reviews doi:10.1002/14651858.CD009113http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD009113/frame.htmlThis review assessed the effectiveness of school-based programmes aimed at preventing alcohol misuse in youngpeople aged up to 18 years. The review included 53, mostly cluster-randomised, controlled trials. Interventions includedalcohol awareness education, social and peer resistance skills, normative feedback, and development of behaviouralnorms and positive peer affiliations aimed at reducing alcohol consumption or problem drinking. Eleven trials focussedexclusively on alcohol, with the remainder focussing on multiple factors or alcohol and other drugs. The results weremixed, six of the 11 alcohol exclusive studies and 14 of the remaining interventions found significantly greater reductionsin alcohol use in the intervention groups compared to a standard curriculum. There were no easily discernible patterns inprogrammes associated with positive results compared to those with no effect. The authors concluded that there iscurrently evidence to support some generic psychosocial and developmental prevention programmes.Thomas RE, et al. 2011. Mentoring adolescents to prevent drug and alcohol use. Cochrane Database of SystematicReviews doi:10.1002/14651858.CD007381.pub2http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD007381/frame.htmlThis review assessed the effectiveness of structured mentoring programmes to prevent alcohol and drug use. The reviewincluded 4 RCTs with 1,994 participants (aged 12 years in two trials and 9–16 years in two trials), conducted amongdeprived populations in the US. Two RCTs found mentoring reduced the rate of initiation of alcohol (pooled RR formentoring compared to no intervention 0.71, 95% CI 0.57 to 0.90) A third trial found no significant difference and thefourth trial did not assess alcohol use. One RCT found significantly less “illegal” drug usage (RR 0.54, 95%CI 0.35 to0.83). No adverse effects were detected. There was limited scope for the interventions to be effective due to low rates ofcommencing alcohol and drug use during the intervention period, probably reflecting the relative youth of the samples.Stade BC, et al. 2009. Psychological and/or educational interventions for reducing alcohol consumption inpregnant women and women planning pregnancy. Cochrane Database of Systematic Reviewsdoi:10.1002/14651858.CD004228.pub2http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004228/frame.htmlThis review assessed the effectiveness of psychological and educational interventions (such as supportive counsellingand brief education) aimed at reducing alcohol consumption during pregnancy in pregnant women or women planningpregnancy. Four RCTs (715 pregnant women) met inclusion criteria for the review. For most outcomes there were nosignificant differences between groups; and results relating to abstaining or reducing consumption were mixed. Althoughindividual studies suggested that interventions may increase abstinence and reduce alcohol consumption in pregnancy,the paucity of good quality RCTs limited the ability of the review to determine which type of intervention would be mosteffective.Kaner EFS, et al. 2007. Effectiveness of brief alcohol interventions in primary care populations. CochraneDatabase of Systematic Reviews doi:10.1002/14651858.CD004148.pub3http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004148/frame.htmlThis review assessed the effectiveness of brief alcohol interventions of up to four sessions, in adult patients presenting toprimary care for reasons other than specific alcohol treatment. Twenty-two RCTs (7,619 participants) were included inthe meta-analysis. Participants receiving brief intervention had lower alcohol consumption than the control group afterfollow-up of one year or longer (average difference 38 grams/week, range 23 to 54 grams). Subgroup analysis confirmeda benefit in men but not in women. While brief interventions appear to be effective in men, the benefit in women isunclear and it is not known whether such interventions are useful for young people.Other Systematic ReviewsNewton AS, et al. 2011. Instruments to Detect Alcohol and Other Drug Misuse in the Emergency Department: ASystematic Review. Pediatrics, 128(1), e180-e92.This review assessed the effectiveness of screening instruments aimed at identifying alcohol and other drug (AOD)misuse in paediatric patients presenting to emergency departments (ED) for other reasons. Six prospective diagnosticstudies, with 100 to 200 participants aged 12 to 21 years, were included. Meta-analysis was not possible due toheterogeneity but instruments based on diagnostic criteria for AOD disorders appeared to be the most effective indetecting alcohol abuse and dependence (sensitivity: 0.88; specificity: 0.90; LR+: 8.80, LR-0.13) and cannabis usedisorder (sensitivity: 0.96; specificity: 0.86; LR+: 6.83, LR-:0.05), indicating that they approached usefulness in ruling inAOD disorders and were useful in ruling in them out. The authors recommend that ED clinicians use a 2-questioninstrument for detecting youth alcohol misuse and a 1-question instrument for detecting cannabis misuse. Theserecommendations are based on a small number of US studies and may not be transferrable and it is not yet knownwhether screening should be targeted or universal, or the effect of identification on outcomes.Alcohol-Related Hospital Admissions - 235
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Cover Artwork: Long-tailed Blue But
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LIST OF FIGURESFigure 1. Gross Dome
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Figure 41. Number of Students Invol
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Figure 85. Proportion of Babies Bor
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Figure 127. Relationship Between th
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Table 21. Policy Documents Relevant
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Table 108. Proportion of Young Peop
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INTRODUCTION AND OVERVIEWIntroducti
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three then reviews mental health is
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Table 1. Overview of the Determinan
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Stream Indicator New Zealand Distri
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47MACROECONOMICINDICATORS
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Expenditure-based Measure of GDPThe
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Gini Coefficient: The Lorenz curve
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CHILD POVERTY AND LIVING STANDARDSI
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After Housing Costs (AHC)Relative P
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Figure 8. Proportion of Dependent C
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14 Items (Enforced Lacks) are inclu
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Local Policy Documents and Evidence
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Other Relevant New Zealand Evidence
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UNEMPLOYMENT RATESIntroductionIn th
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Figure 12. Unemployment Rates by Ag
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Unemployment Rates by Qualification
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Figure 18. Quarterly Unemployment R
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CHILDREN RELIANT ON BENEFIT RECIPIE
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Table 4. Number of Children Aged 0-
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Table 5. Number of Children Aged 0-
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YOUNG PEOPLE RELIANT ON BENEFITSInt
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Table 7. Number of Young People Age
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New Zealand Distribution by Ethnici
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Figure 25. Young People Aged 16-24
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Table 10. Number of Young People Ag
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HOUSEHOLD COMPOSITION91
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Data Source and MethodsDefinitionPr
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Figure 29. Proportion of Children A
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Robertson J, et al. 2006. Review of
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Canadian National Occupancy Standar
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Figure 33. Proportion of Children a
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Other Relevant EvidenceMarmot Revie
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Note 2: The number of new school en
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Figure 36. Proportion of New Entran
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Sylva K, et al. 2004 The Effective
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Table 15. Enrolments in Māori Medi
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Table 16. Number of Students (Māor
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Local Policy Documents which Consid
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HIGHEST EDUCATIONAL ATTAINMENT AT S
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Figure 43. Highest Educational Atta
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Figure 46. Highest Educational Atta
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SENIOR SECONDARY SCHOOL RETENTION A
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Participation in Tertiary Education
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Midland Region Distribution and Tre
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The following section uses informat
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Figure 54. Age-Standardised Rates o
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Figure 56. Age-Standardised School
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TRUANCY AND UNJUSTIFIED ABSENCESInt
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Figure 60. Total Unjustified Absenc
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Figure 63. Total Unjustified Absenc
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Table 22. The National Immunisation
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Figure 64. Immunisation Coverage by
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Figure 67. Immunisation Coverage by
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Figure 71. Immunisation Coverage at
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Soares-Weiser K, et al. 2012. Vacci
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Briss PA, et al. 2000. Reviews of e
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Data Sources and MethodsIndicatorPr
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Figure 75. Proportion of New Zealan
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Proportion Receiving Core Contacts
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Figure 81. Proportion of Babies who
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The B4 School CheckThe B4 School Ch
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Page 183 and 184: Other Relevant EvidenceThe Scottish
Page 185 and 186: 185SUBSTANCE USE
Page 188 and 189: Notes on InterpretationNote 1: The
Page 190 and 191: Maternal Smoking at First Registrat
Page 192 and 193: Figure 86. Proportion of Babies Bor
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Page 208 and 209: Figure 93. Proportion of Year 10 St
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Page 212 and 213: TOBACCO USE IN YOUNG PEOPLEIntroduc
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Page 216 and 217: 2009 New Zealand Tobacco Use Survey
Page 218 and 219: Source of Tobacco in the Last Month
Page 220 and 221: Carson KV, et al. 2011. Community i
Page 222 and 223: Other Relevant PublicationsMāori A
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Page 226 and 227: ALCOHOL-RELATED HOSPITAL ADMISSIONS
Page 228 and 229: Figure 100. Alcohol-Related Hospita
Page 230 and 231: Table 45. Listed External Causes of
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Page 236 and 237: Shults RA, et al. 2009. Effectivene
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Page 244 and 245: Mortality from conditions with a so
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Page 256 and 257: Midland Region Distribution by Caus
Page 258 and 259: Figure 107. Hospital Admissions for
Page 260 and 261: INFANT MORTALITY AND SUDDEN UNEXPEC
Page 262 and 263: New Zealand Distribution and Trends
Page 264 and 265: Figure 111. Total Infant Mortality,
Page 266 and 267: Table 62. Neonatal and Post Neonata
Page 268 and 269: Table 65. Neonatal and Post Neonata
Page 270 and 271: Distribution by Ethnicity, NZ Depri
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Page 278 and 279: with a review of interventions aime
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Family ViolenceDefinitions and New
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need for multidisciplinary interven
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6 days to determine gestational age
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In New Zealand, information on fact
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post intervention. Engagement in ed
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antenatal care, including two nutri
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throughout pregnancy, birth and the
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Alcohol and Other DrugsNational and
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Zealand had a number of specialist
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in one Cochrane review [274] (see p
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interventions to treat antenatal de
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In ConclusionWhile it is hoped that
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308
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Data Source and MethodsDefinition1.
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Figure 119. Hospital Admissions for
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Other Systematic ReviewsLouwers ECF
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INJURIES ARISING FROM ASSAULT IN YO
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New Zealand Distribution by Age and
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Flood M & Fergus L. 2008. An Assaul
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Note 2: The numbers in this section
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Table 78. Number of Notifications t
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Table 80. Outcome of Assessment for
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Table 82. Number of Notifications R
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Table 84. Outcome of Assessment for
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Data Source and MethodsDefinition1.
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Family Violence Investigations Wher
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Table 90. Local Policy Documents an
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Stover CS, et al. 2009. Interventio
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348
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350
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oader contextual influences on the
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In addition, Table 112 on Page 414
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Williams SB, et al. 2009. Screening
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Ministries of Education, Health, Ju
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Figure 129. Children and Young Peop
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Table 92. Children Aged 0-14 Years
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IN-DEPTH TOPIC: MENTAL HEALTH ISSUE
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this [350]. The review stated that
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psychotic disorders including first
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Social Workers in SchoolsIn 2011 th
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Children or young people with sever
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EpidemiologyThe 2009 review by Meri
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A diagnosis of conduct disorder acc
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programme using a questionnaire. Si
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developmentally appropriate diagnos
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playthings or the environment, appe
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state more than it cost) provided t
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ACCESS TO MENTAL HEALTH SERVICES: L
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Table 97. Children and Young People
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Midland Region DistributionChildren
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ACCESS TO MENTAL HEALTH SERVICES: L
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Table 101. Hospital Admissions for
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Numbers Accessing Services by Diagn
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Table 103. Young People Aged 15-24
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Table 108. Proportion of Young Peop
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Midland Region DistributionAmongst
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Fletcher A, et al. 2008. School Eff
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New Zealand Distribution and Trends
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Figure 138. Mortality from Suicide
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Figure 139. Mortality from Suicide
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Ougrin D & Latif S. 2011. Specific
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426
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428
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Guide to Community Preventive Servi
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information on all of the events oc
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3. In addition, some providers admi
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as in the majority of the analyses
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APPENDIX 5: THE NATIONAL MORTALITYC
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As a result of these changes, there
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2. Research also suggests that ethn
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APPENDIX 8: POLICE AREA BOUNDARIESF
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Figure 142. Police Area Boundaries
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3. The condition exhibits a socioec
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REFERENCES1. Children's Commissione
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33. Mackay R. 2005. The Impact of F
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71. Ministry of Health. 2011. Immun
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107. ASH New Zealand. 2011. Nationa
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141. Child and Youth Mortality Revi
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175. Pihama L. 2011. Overview of M
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208. King-Hele S, Webb RT, Mortense
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244. Nelson Marlborough District He
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274. Ramsay J, Carter Y, Davidson L
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306. Jewkes R. 2002. Intimate partn
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347. Heflinger CA, Hinshaw SP. 2010
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376. Ministry of Education. 2012. W
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410. Ministry of Health. 2001. New
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443. Zeanah PD, Bailey LO, Berry S.
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480. Weinberg MK, Olson KL, Beeghly
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