A community survey of sun exposure, sunburn and sun protection

AIM

To describe outdoor activities, sun protection behaviours and the experience of sunburn in a sample of New Zealanders during summer weekends of 1994.

METHODS

1243 respondents to a telephone survey provided information regarding their outdoor activities for the 5 hour period around midday of the previous Saturday and Sunday. The sample was drawn from those aged 15 to 65 years in the five centres of Auckland, Hamilton, Wellington, Christchurch and Dunedin. Respondents provided information on sun exposure, sunburn, sun protection and beliefs about tanning, as well as background demographic information, skin type and previous experience of sunburn.

RESULTS

12% of the sample (or 17% of all those outdoors) reported being sunburned on the preceding weekend, and those sunburned tended to be men, and to be under age 35 years. The face, neck and limbs were the areas most frequently reported as burned. Sporting activities and beach or water activities were associated with the highest number of episodes of burning. Overall 38% of those outside reported wearing a hat and 32% reported the use of a sunscreen. Positive attitudes to tanning were quite common and probably present the main target for change in the community.

CONCLUSION

On any sunny weekend in summer about three-quarters of adult New Zealanders will be out in the sun for relatively long periods of time, and many will get sunburned. The reduction of such harmful sun exposures remains an important public health goal.

Obsessive-compulsive disorder in a birth cohort of 18-year-olds: prevalence and predictors

OBJECTIVE

To report descriptive epidemiological information on obsessive-compulsive disorder (OCD) in an unselected birth cohort of 930 males and females, aged 18 years.

METHOD

An epidermiological study of the prevalence of self-reported OCD at age 18, and a longitudinal analysis of the prospective predictors of OCD.

RESULTS

Using the Diagnostic Interview Schedule, the authors found a 1-year prevalence rate of 4%, with a male-female ratio of 0.7:1. The majority of OCD cases met criteria for a comorbid disorder, most commonly depression (62%), social phobia (38%), and substance dependence (alcohol 24%, marijuana 19%).

CONCLUSIONS

Data collected on the sample from birth to age 18 years indicated that many childhood risk factors theorized in the literature did not predict OCD in this sample. However, a history of depression and substance use were prospective risk factors for OCD.

A community study of preschool behaviour disorder in New Zealand

A two stage epidemiological study of 320 children aged between 2.5 and 5 years of age, from eight randomly selected preschool centres, was performed in order (1) to test the psychometrics of the Behaviour Check List (BCL), a parent report instrument for preschool children, (2) to estimate the prevalence, and (3) to describe the correlates of preschool behaviour disorder. After the initial screening using the BCL, the Hyperactivity Scale (HAS) and the Internalising Disorder Scale (IDS), parents were interviewed using the Behaviour Screening Questionnaire (BSQ); the children were examined using the Rutter and Graham's interview. Data was also collected on family functioning, maternal mental health, social adversity, development, physical health and perinatal history. The BCL was found to be a reliable and valid screening measure. A cut off point of 8+ was established for New Zealand preschoolers; this is lower than that in the UK sample, illustrating the importance of retesting the instruments in a different culture. The prevalence rate of behaviour problems based on clinical diagnosis was 22.5%. Results of logistic regression analysis showed that poor family functioning, poor maternal mental health and parental separation were associated significantly with behaviour disorder. This study emphasises the need to identify preschool behaviour disorder and associated risk factors to enable an early intervention.

Models of adolescent psychopathology: childhood risk and the transition to adulthood

OBJECTIVE

To examine the relationship between DSM-III disorder in adolescence (age 15 years) and DSM-III-R disorder in early adulthood (age 18 years), in relation to a history of behavior problems or disorder, other family and individual characteristics, and events commonly associated with the transition to adulthood.

METHOD

The sample came from a New Zealand birth cohort selected from the general population. Data were obtained from ages 3 to 18 years for 890 of those enrolled.

RESULTS

For both males and females, disorder at age 15 was strongly predicted by histories of early mental health problems. However, neither those histories, background characteristics, nor the experience of adolescent transition events modified the strength of association between disorder at ages 15 and 18 years. In childhood, after adjusting for histories of behavior problems, parental separations and (for boys) poor social competence remained independent predictors of disorder at age 15. Overall, boys appeared more vulnerable and those from socially disadvantaged backgrounds in early childhood had an elevated risk of disorder at age 18. After adjusting for disorder at age 15, adolescent unemployment remained an independent predictor of disorder at age 18 for both males and females.

CONCLUSIONS

This study modeled the continuity of disorder across the adolescent transition period and, after taking earlier disorder into account, identified clear predictors of later disorder. This is the first step in the process of developing more effective interventions to reduce the risk of mental health disorders.

Smoking among New Zealand adolescents 1960-93

AIM

To examine the prevalence of smoking among New Zealand youth from the 1960's to the 1990's to determine whether smoking among the young is increasing or decreasing.

METHOD

Major surveys of smoking among adolescents were reviewed and analysed to identify trends in smoking over time. Using data from the Dunedin and Christchurch longitudinal studies of child development, it was also possible to examine recent cohort changes in uptake of smoking.

RESULTS

Evidence suggests that by the 1990's about one in every five 15 year-olds had smoked in the last month, while about one in every ten smoked daily. This represents a significant decline from very high levels of smoking in the 1970's, and appears to have occurred among boys and girls, European and Maori, although perhaps less so among adolescent girls.

CONCLUSION

Despite some community perceptions to the contrary, there have been significant declines in smoking among adolescents over the last three decades. Overall, the data present a somewhat encouraging view of smoking among New Zealand youth. However, further inroads into smoking in this age group may well depend upon greater restrictions of access to cigarettes and overcoming barriers to the implementation of school based educational programmes.

Disability in late adolescence. II: Follow-up of perceived limitation

The disabilities experienced by a large cohort of 18-year-olds have been reported in the previous paper of this series. In this paper, we present the results of a detailed examination of the extent to which the disabilities caused limitation in the everyday activities of this group of young people. The results showed that nearly three-quarters of the members of the sample reported having one or more difficulties in performing activities in their daily lives, though the extent of limitation on their activities was low for most adolescents. Of this group who reported any type of disablement, 23% indicated it imposed very little general limitation on their lives (on a five point scale) and 6% rated it at the highest degree of limitation. Approximately half those with a disability felt the condition was improving, but 28% required an aid or help from another person. From 8% to 11% of those with a disability rated it as serious in relation to aspects of their daily living (education, leisure, social and work) and about half of those with a serious degree of limitation had sought help. The most common disabilities related to behaviour, communication and situations, for example environmental factors. As part of an ongoing study, the results provide a base from which to examine the extent and severity of disability among young people and change in disability as a result of the ageing process.

Health beliefs among New Zealand adolescents

A modified version of the Multidimensional Health Locus of Control (MHLC) scale was administered to 837 adolescents, aged 15 years, to assess their beliefs about health. There were significant sex differences on the total scores of the internal and powerful others dimensions of the scale. MHLC beliefs were not significantly associated with self-reported ratings of general health or mental health. Significantly more distress due to the experience of negative life events was reported by females with a strong internal locus of control. Maternal health beliefs showed stronger associations with daughters' health beliefs than sons'. For males, strong beliefs in an internal locus of control and weak beliefs in chance were significantly associated with aspects of attachment, social support and self-perceived strengths. There were weak correlations for the majority of associations between health beliefs and health measures and most of the adolescents reported either good or very good health. The findings suggest that adolescents' health beliefs may be quite different from those of adults.

Delivery of health care to the underserved: potential contributions of telecommunications technology. Consensus conference entitled "Telemedicine and Access to Care."

OBJECTIVE

To evaluate the potential uses of telecommunications in medicine (telemedicine), determine the most important principles in designing telemedicine applications, decide what research questions to address, and identify potential barriers to full use of telemedicine.

DESIGN

A consensus conference on telemedicine was convened in October 1993 to assemble a wide variety of participants with the assigned task of addressing the objective.

RESULTS

Consensus was achieved on several key principles for implementation of successful telemedicine. Two of the most important principles will be (1) to focus on the needs of the underserved people more than on the capabilities of the available technologies and the regional centers and (2) to use the least expensive but appropriate telecommunications technology for any specific application. Greater professional connectivity between providers of health care in underserved areas and colleagues in tertiary medical centers is expected to minimize professional isolation in underserved areas.

CONCLUSION

Telecommunications technologies have considerable potential for improving health care to the rural and underserved populations, but a systematic approach to implementation, which takes into account the identified key principles, is needed.

The recognition and management of melanoma and other skin lesions by general practitioners in New Zealand

AIM

To assess current levels of knowledge and management practices with respect to melanoma and other skin cancers, in a representative sample of New Zealand general practitioners.

METHODS

A self-administered questionnaire was sent to a random sample of 900 general practitioners. The questionnaire included 12 cases with coloured photographs of skin lesions and a brief presenting history. Responders were asked to assess probable diagnosis, need for biopsy and management of the lesion. Other attitudinal and relevant background information was also gathered. The questionnaire was sent to a comparison sample of 35 dermatologists.

RESULTS

The overall response rate was 66% among the general practitioners and 68% among the dermatologists. The sample responding was representative of the larger population of doctors practising in New Zealand. Correct decisions whether or not to biopsy lesions (mean score of 10.1 out of 12) were significantly higher than the number of correct diagnoses (mean 8.4). Correct identification and recognition of the need to biopsy melanomas was high. Diagnostic skills and recognition of the need for biopsy were somewhat lower among general practitioners aged 50 years and over than among younger doctors. Doctors who had experience of a patient with melanoma had higher diagnostic skills and made more correct biopsy decisions. The general practitioners' scores for correct biopsy decisions were similar to those of the dermatologists sampled, although their diagnostic skills were somewhat lower, particularly with respect to nonmelanoma skin cancers.

CONCLUSION

The findings indicate a high level of expertise in terms of diagnosis of skin lesions and identification of need to biopsy suspicious lesions among general practitioners in this country.

Multidimensional health locus of control beliefs and psychological health for a sample of mothers

Five multidimensional health locus of control (MHLC) types for 772 women whose children are enrolled in a longitudinal study of their health and development were identified. The MHLC is composed of an internal and two external dimensions (chance and powerful others). The five independent MHLC clusters were: pure internal; believer in control; pure chance; yea-sayer; and nay-sayer. Women with high scores on the three dimensions of the MHLC (yea-sayer) compared with the rest of the sample were significantly more likely to be from a lower socio-economic status, score lower on a general verbal intelligence test and higher on the Neuroticism and Lie Scales of the Eysenck Personality Inventory. They rated their overall health as significantly poorer, and reported more symptoms of depression compared with the other groups. A pure internal locus of control was strongly associated with the report of good health. Women with a strong belief in internal and powerful other loci of control were significantly more likely to have received treatment for their depression compared with other groups. Help-seeking for children's problem behaviour did not vary significantly with MHLC groups. The present study replicated five out of six MHLC types identified in an earlier study, and established the external validity of the MHLC types on measures of health status. The findings support the use of MHLC types in future research on health locus of control.

Smoking in pregnancy and child development to age 9 years

This study examined the association between women's retrospective reports of smoking during pregnancy and subsequent language, cognitive, behavioural and physical development in their children up to age 9 years. While there was a strong association between maternal smoking and an index of disadvantageous child rearing, maternal smoking was not associated with more general family disadvantage. After controlling for levels of background disadvantage, no relationship was found between reports of smoking and language, cognitive or physical development. However, smoking was related to maternal reports of behaviour problems at age of school entry. Possible explanations for this relationship are discussed.

A longitudinal study of birth order, help seeking and psychopathology

Recent studies have suggested an association between birth order and psychopathology. However, the association remains unclear due to a lack of consideration of the confounding effects of family size. At age seven years the family size and birth order of children from a large cohort of New Zealand children were examined in relation to parental help seeking for behavioural and emotional problems, and the development of DSM-III (American Psychiatric Association, 1980) disorder in pre-adolescence and adolescence. Neither the child's gender, birth order nor family size were associated with parental help seeking or the prevalence of DSM-III disorder in pre-adolescence at age 11. In adolescence at age 15, however, significantly more girls, first-borns and children from small families had DSM-III disorder, but the interactions between these factors were not significant. In particular, these associations were found with internalizing disorders. The appropriateness of further studies of birth order in relation to psychopathology is discussed.

Reading attainment and juvenile delinquency

Structural equation modelling was used with data from a longitudinal study of child development (N = 698) to examine relationships between early reading attainment and antisocial behaviour at ages 7 and 9 years and subsequent reading and delinquent behaviour in adolescence. While reading, analysed as a continuous variable, did not directly influence later delinquency, antisocial behaviour during the early school years was strongly predictive of delinquency at age 15 years, particularly for boys, and had a detrimental effect on reading. These findings were independent of social disadvantage, and were unchanged by adjusting reading scores for IQ. Reading disability at 9 years old, however, predicted conduct disorder at age 15 in boys.

DSM-III-R disorders in New Zealand 18-year-olds

The one-year prevalence and correlates of selected DSM-III-R disorders were determined in a sample of 930 18-year-olds. Using both diagnostic and impairment criteria 340 individuals (36.6%) were considered to have disorder. The most prevalent disorders were major depressive episode (16.7%), alcohol dependence (10.4%) and social phobia (11.1%). There was a high degree of co-morbidity among disorders; 46% of those with disorder had two or more. The prevalence of disorders was greater for females, with the exception of conduct disorder and alcohol or marijuana dependence. A variety of characteristics were associated with disorder, including poor social competence, disadvantage and self-rated health status. A third of those with disorder had their problems recognised by a "significant-other". The results are presented within the context of a perceived need for research in the area of adolescent and early adult mental health in order to minimise the toll of mental disorder in later life.

Who comes to skin checks?

AIM

To examine the characteristics of persons attending skin checks carried out by the Cancer Society of New Zealand.

METHODS

Persons aged 20 years or over attending three skin checks open to the public in the Taranaki region in the summer of 1991-2 were surveyed regarding the presence of risk factors for melanoma and reasons for attending the skin check.

RESULTS

Overall, more women (n = 159) than men (n = 120) attended the clinics. Questionnaire results were available for 197 of those attending (110 women and 87 men). The average age of the sample was 49.4 years; 99% were from a European background. Forty percent of the sample had two or more of the following risk factors for melanoma: sun-sensitive skin, history of severe burning, red or fair hair, being treated for a skin cancer, and a family history of skin cancer. Fifty-one percent reported at least one change in a mole over the last 12 months, and 42% gave the presence of a worrying mark on their skin as a reason for coming.

CONCLUSION

Those who attended the skin checks were likely to be at increased risk of skin cancer compared to the general population, and more often came because of a specific skin lesion than for a general skin check.

Self-reported inattention, impulsivity, and hyperactivity at ages 15 and 18 years in the general population

OBJECTIVE

Prevalence, impact, and continuity of self-reported attention deficit disorder (ADD) symptomology from ages 15 to 18 years were examined in a longitudinal study of a New Zealand birth cohort.

METHOD

At age 15, prevalence of ADD symptomology was estimated, with no gender differences found in self-reported symptomology. Four adolescents (0.5%) met full DSM-III criteria for ADD. Adolescents scoring higher than 1.5 SD above the sample mean on total ADD symptom score were identified as having high levels of ADD symptomology.

RESULTS

Male and female adolescents reporting ADD symptomology with (6% of males; 4% of females) and without history of behavior disorder (6% of males; 7% of females) did not differ in inattention and impulsivity, received more diagnoses other than ADD, and experienced more adverse educational and social outcomes at 15 and 18 years than did the nonADD group.

CONCLUSIONS

Findings pertaining to the ADD with history group were consistent with previous research on the outcome of hyperactive children, whereas the ADD without history group may be reflecting the onset of other pathology in adolescence. Results suggest adolescent self-report of attentional difficulties may be a clinically significant marker of adjustment difficulties for both males and females, but additional information likely is needed for accurate diagnosis.

Depression and the development of cancer: a meta-analysis

There is considerable support among members of the public and health professionals for the view that depression is an aetiological factor in the development of cancer. We review evidence for this hypothesis based upon prospective longitudinal studies measuring depression at time 1 and subsequent incidence of cancer over the intervening period to time 2. A meta-analysis of available studies indicates a small, but marginally statistically significant association between depression and the later development of cancer. However, the practical significance of this association for the prevention of cancer is negligible.

Mental health disorders from age 15 to age 18 years

OBJECTIVE

To determine the strength of association between mental health disorders in adolescence and disorder in early adulthood.

METHOD

The study used mental health data from a longitudinal investigation of a New Zealand birth cohort. Of the 943 with prevalence data for DSM-III disorder at age 15, 890 had prevalence data for DSM-III-R disorder when aged 18 years.

RESULTS

Two-thirds of those with disorder at age 15 had disorder at age 18. The residual form of attention deficit disorder, simple phobias, and oppositional disorders (with no other accompanying disorders) were associated with the lowest risk of later disorder and conduct disorder with the highest. With the exception of the overall symptom level, a variety of characteristics examined (e.g., social competence and adversity) could not differentiate between those with transient disorder and those with disorder at both ages. Comparisons of those with recurring disorder and those with new disorder at age 18 showed that in addition to characteristics of the disorder, disadvantage was strongly associated with recurrent disorder.

CONCLUSIONS

The risk of later disorder for those with disorder in adolescence was high and differed across type of disorder. Findings suggest that to reduce the risk of disorder in early adulthood, clinicians could play a more active role in community interventions with direct social outcomes.

The importance of conduct problems and depressive symptoms in predicting adolescent substance use

The current study assessed the relative importance of conduct problems and depressive symptoms, measured at two ages (11 and 15), for predicting substance use at age 15 in an unselected birth cohort of New Zealand adolescents. Among males, when the relative predictive utility of both conduct problems and depressive symptoms was assessed, only pre-adolescent depressive symptoms were found to predict multiple drug use 4 years later. No predictive relation was found between early symptomatology and later substance use among females. The strongest association between predictors and substance use emerged between age 15 multiple drug use and concurrent conduct problems for both males and females. Finally, both conduct problems and depressive symptoms at age 15 were also found to be associated with concurrent "self-medication" among females.

Helping agency contact for emotional problems in childhood and early adolescence and the risk of later disorder

Despite waning enthusiasm for labelling theories in the development of psychopathology, it has been claimed that contact with professional agencies in childhood can be associated with increased levels of later problem behaviour. In this study, help-seeking by parents for children with behaviour problems was examined using a birth cohort followed longitudinally to age 15 years. No evidence was found to support the hypothesis that agency contact increased the risk of later mental health disorder, either in childhood or adolescence. Rather, the results suggested that help-seeking was associated with a reduction in both the risk of DSM-III disorder and problem behaviour scores, up to five years after agency contact.

Reasons for smoking or not smoking in early adolescence

Previous studies of smokers' and nonsmokers' reasons have not compared their reasons for smoking and their reasons for not smoking, or examined the extent of change or stability in these reasons over time. We examined reasons for smoking and not smoking in a large sample of 13-year-olds from the general population. Factor structures of reasons differed according to whether adolescents were smokers or nonsmokers. Nonsmokers were found to be less discriminating than smokers about the reasons for smoking. Smokers and nonsmokers tended to show more agreement about the reasons for not smoking. Recency of smoking was differentially related to the factors for smoking and the factors for not smoking. "Image" was a more important reason for smoking at age 11 than at age 13. "Friends" as a reason for smoking showed a small degree of consistency across age, whereas reasons involving relaxation and pleasure showed a relatively higher degree of consistency. Health, as a reason not to smoke, showed only a small degree of consistency, while social context, effects and access were moderately consistent as reasons not to smoke at ages 11 and 13.

Allergic disorders and attention deficit disorder in children

It has been suggested that children with attention deficit disorder-hyperactivity (ADDH) are likely to show allergic disorders, and that both ADDH and allergic disorders may share a common biological background. In a large sample of children from the general population we found no association between parent, teacher, and self-reports of ADDH behaviors and a history of allergic disorders (asthma, eczema, rhinitis, and urticaria) at ages 9 or 13 years. Similarly, reports of ADDH behaviors at age 13 years were not related to level of atopic responsiveness by skin test or serum IgE levels. Our findings call into question the hypothesis that there is a relationship between ADDH and allergic disorder.