This annual report - Taranaki District Health Board

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deprivation in some parts of the world, this relationship was not identified in a New Zealandstudy, although in this study it was not possible to differentiate between spontaneous andinduced preterm births [158].Understanding the link between deprivation and adverse pregnancy outcomesThe link between socioeconomic deprivation and adverse pregnancy and subsequent childhealth outcomes is likely to represent the cumulative effect of individual, familial,community and societal forces [149]. Risk factors such as smoking, poor dietary habits,higher fertility, teenage pregnancy and alcohol use are associated with bothsocioeconomic status and adverse birth outcomes, acting as steps in the causal pathwaylinking deprivation and adverse pregnancy outcomes [152]. Lower socioeconomic statushas also been linked to reduced access to antenatal care [143]. Barriers to accessing orengaging with care (identified as substance abuse, family violence, lack of recognition orcomplexity or seriousness of condition, maternal mental illness, cultural barriers, languagebarriers, ineligibility to access free care and ‘other’, which included late booking and nonattendance)were identified as the most common contributory factors to perinatal relateddeaths in New Zealand in 2010 [138].Young Maternal AgeDefinitions and New Zealand DistributionNew Zealand has a high teenage birth rate by OECD standards: in 2008 the number ofbirths per 1,000 women aged 15 to 19 years was 22.05, compared to the OECD averageof 16.34 per 1,000 [159,160]. Teenage pregnancy is strongly linked to social disadvantage,which acts as both a contributing factor and consequence of teenage pregnancy andparenthood [161,162,163]. Nationally, there is a clear social gradient in rates of teenagechildbirth [164]. From 2006 to 2010 the teenage childbirth rate was 51 per 1000 live birthsamong those living in the most deprived areas and 10 per 1000 live births among those inthe least deprived areas (RR 5.31, 95% CI 5.03 to 5.61). The teenage birth rate also variesby ethnicity. The average <strong>annual</strong> rate of live births for women aged 15 to 19 years during2005 to 2007 was higher for Māori (63 per 1,000 women) and Pacific (43 live births per1,000 women) women than for European/Other (22 per 1000 women) and Asian (7 per1,000 women) women [165]. However, these differences should be viewed in the contextof the higher birth rates for Māori and Pacific women at all ages up to 30 years. It has alsobeen suggested that young Māori women who become pregnant are less likely to have atermination of pregnancy than European women [166].Internationally, research indicates that a combination of access to skills and services andthe chance to gain the education and employment needed to succeed in society isassociated with lower rates of teenage pregnancy [162]. Factors related to teenagepregnancy operate at a number of levels and include: individual factors such as selfesteemand age at first intercourse; family factors such as a mother who was pregnant asa teenager, or being in care; education factors such as truancy and lack of qualifications;community factors such as social norms related to sexual activity; and social factors suchas childhood poverty, employment prospects and housing and social conditions [162].However, the relationship between these factors is complex.Associations between young maternal age and pregnancy outcomesTeenage pregnancy and parenthood are linked to a variety of adverse social and healthoutcomes, including low birthweight, higher infant and child mortality, postnatal depression,a higher rate of childhood accidents, lower levels of education, reduced employmentopportunities, longer-term welfare dependency and the intergenerational transfer ofpoverty [162,167,168]. In New Zealand between 2007 and 2010, teenage mothers were athigher risk of stillbirth and neonatal mortality due to preterm birth, fetal growth restrictionand perinatal infection, compared to mothers aged 20 to 39 years (perinatal relatedmortality 14 per 1000, compared to 10.4 per 1000) [138]. A similar pattern was also seenfor rates of SUDI, which were highest among mothers aged under 20 years, followed bythose aged 20 to 24 years between 2004 and 2008 (RR 4.96, 95% CI 3.43 to 7.17 forwomen under 20 years, and RR 3.29, 95% CI 2.35 to 4.62 for women aged 20 to 24 yearscompared to women aged 30 to 34 years). Teenage pregnancy has also been associatedIn-Depth Topic: Adversity in Pregnancy - 280
with an increase in the risk of both preterm birth and small for gestational age, however,after controlling for socioeconomic status, this association disappears for Māori women[153,168,169]. Young maternal age has also been linked to lower rates of breastfeeding[162,170]. Breastfeeding has many benefits for babies, including improved resistance toinfections, lower mortality in the first year of life and reduced risk of developing type 1 andtype 2 diabetes and childhood obesity, and has been linked to improved bonding and lowerrates of breast and ovarian cancer in mothers [170]. Research has identified a number ofcommon barriers to breastfeeding among teenage parents include lack of supportive socialnetworks, pain and embarrassment about feeding in public [171].Pregnant young people may be at increased risk of a variety of other adversities linked topoorer pregnancy outcomes, including alcohol use, smoking (see page 187) and interpartnerviolence [172,173]. The Christchurch <strong>Health</strong> and Development Study, which hasfollowed a cohort of 515 women born in 1977 to age 25 years, found that early motherhood(having a baby
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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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106
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108
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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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152
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154
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156
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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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Other Relevant EvidenceThe Scottish
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185SUBSTANCE USE
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Notes on InterpretationNote 1: The
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Maternal Smoking at First Registrat
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Table 32. Number of Cigarettes Smok
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National Institute for Health and C
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2. Proportion of babies born to mot
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Table 37. Number of Cigarettes Smok
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Figure 93. Proportion of Year 10 St
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Figure 95. Proportion of Year 10 St
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TOBACCO USE IN YOUNG PEOPLEIntroduc
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Figure 96. Daily Smoking Rates in Y
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2009 New Zealand Tobacco Use Survey
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Source of Tobacco in the Last Month
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Carson KV, et al. 2011. Community i
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Other Relevant PublicationsMāori A
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Other Cochrane Systematic Reviews o
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ALCOHOL-RELATED HOSPITAL ADMISSIONS
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Figure 100. Alcohol-Related Hospita
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Page 232 and 233: Midland Region Distribution and Tre
Page 234 and 235: Local Policy Documents and Evidence
Page 236 and 237: Shults RA, et al. 2009. Effectivene
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Page 244 and 245: Mortality from conditions with a so
Page 246 and 247: Table 50. Mortality from Conditions
Page 248 and 249: Figure 105. Hospital Admissions for
Page 252 and 253: Table 55. Hospital Admissions for C
Page 254 and 255: Table 57. Hospital Admissions for C
Page 256 and 257: Midland Region Distribution by Caus
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
Page 272 and 273: Figure 116. Sudden Unexpected Death
Page 274 and 275: Vennemann M, et al. 2007. Do immuni
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Page 278 and 279: with a review of interventions aime
Page 282 and 283: who delay a second pregnancy by two
Page 284 and 285: Family ViolenceDefinitions and New
Page 286 and 287: need for multidisciplinary interven
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Page 290 and 291: In New Zealand, information on fact
Page 292 and 293: post intervention. Engagement in ed
Page 294 and 295: antenatal care, including two nutri
Page 296 and 297: throughout pregnancy, birth and the
Page 298 and 299: Alcohol and Other DrugsNational and
Page 300 and 301: Zealand had a number of specialist
Page 302 and 303: in one Cochrane review [274] (see p
Page 304 and 305: interventions to treat antenatal de
Page 306 and 307: In ConclusionWhile it is hoped that
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Page 310 and 311: Data Source and MethodsDefinition1.
Page 318 and 319: Other Systematic ReviewsLouwers ECF
Page 320 and 321: INJURIES ARISING FROM ASSAULT IN YO
Page 322 and 323: New Zealand Distribution by Age and
Page 328 and 329: 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
Page 458 and 459:
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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