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Item Adolescent anaemia status and non-haem iron source food use at the Beddawi refugee camp in North Lebanon : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nutritional Sciences at Massey University, Manawatū, New Zealand(Massey University, 2022) Soukieh, JasminePalestinian refugees at long-term Lebanese camps are at increased anaemia risk. Adolescent Palestinians at these camps, with their disproportionately high poverty burdens, are at particular risk, though little-to-no data are available to describe this. Anaemia in Lebanon has been attributed, largely, to inadequate intake of bioavailable iron. This may occur when a population is reliant on non-haem iron food sources to meet nutrient needs, as is often the case in long-term camp settings. No studies are currently available that describe adolescent Palestinian diets at Lebanese camps. There is also a dearth of studies exploring food preparation practices that may be harnessed to optimise iron bioavailability from consumed foods at these camps. This study used an embedded mixed-methods design to evaluate anaemia prevalence, iron source food consumption, and micronutrient dietary diversity (DDS-M) for a group of adolescent Palestinians (n = 66) at the Beddawi refugee camp in North Lebanon. The study also explored household plant-food use and preparation, with particular reference to dark leafy greens, and plant-food valuation with household food preparers (FPs). Anaemia prevalence for adolescents was 29%. Median DDS-M was 4 [IQR = 1.63, range = 2-6]. Grain-based foods were consumed by the largest proportion of adolescents (100%), followed by milk source foods (84.8%) and fruits (59.1%). Jute mallow, chicory, parsley and spinach were the dark leafy greens used by the largest proportions of households (> 80%). Household use of a subset of dark leafy greens was positively associated with adolescent DDS-M (rho = 0.31, S = 14303, p-value = 0.03). All FPs reported plant food valuation; however, FPs in households with non-anaemic adolescents related plant food valuation responses with more detailed nutrient and health rationales than FPs in households with anaemic adolescents. Lemon juice, capsicum and chilli were among foods commonly reported to be co-consumed with plant meals described by FPs. Soaking pulses ahead of use was also reported. Anaemia is a moderate public health concern for this group of adolescents, and the micronutrient content of their diets is insufficiently diverse. Increased consumption of accessible dark leafy greens and co-consumption of reported vitamin C-rich foods with non-haem iron meals, in combination with extending pulse-soaking practices to additional grains may contribute to optimising dietary and biochemical iron status for these adolescents.Item Instagram vs. reality : risk factors that make an adolescent more vulnerable to engage in an upwards social comparison on Instagram, resulting in poorer mental health : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Albany, New Zealand(Massey University, 2021) Gifford, NicoleAim: For the past two decades researchers have been trying to understand how social media is affecting an individual’s mental health, however, social media platforms are rapidly changing, and new social media platforms are being developed and integrated into an adolescent’s life at a rapid rate. Therefore, research is quickly becoming outdated with a significant lag between the literature and social media existing. Instagram is an increasingly popular photo sharing social media application that offers individuals the opportunity to post photos of their lives. A consequence of Instagram being photo based is that users often apply impression management strategies, so that only the best parts of their life are presented. This creates a ripe environment for upwards social comparisons to occur, as the Instagram user compares their realities to the unrealistic images presented on Instagram. In particular, adolescents may be at risk of engaging in upwards social comparisons on Instagram, as they are the largest consumers of social media, and they are at a developmental period where social comparisons are crucial for constructing one’s identity and navigating the social world. However, little is known about how the positively skewed Instagram environment is impacting an adolescent’s mental health, which is concerning given the poor adolescent mental health statistics in New Zealand. Preliminary research from Instagram and other social media platforms, suggests that when individuals engage in upwards social comparisons on social media, it can lead to psychological distress. However, research has also suggested a poor get poorer effect is occurring, meaning only individuals who have certain vulnerability factors are at risk of engaging in an upwards social comparison, and thus experiencing the adverse psychological outcomes. Therefore, scholars have called for research to identify these vulnerability factors to enable a more nuanced understanding to be established. The aim of the current study was to focus on what vulnerability factors make an adolescent at risk of engaging in an upwards social comparison on Instagram, and subsequently experience depression and worry symptoms. The vulnerability factors that were of interest include: self-esteem, social comparison orientation, self-concept clarity, passive Instagram use, intensity of Instagram use and gender. This research hopes to provide mental health professionals with information regarding modern triggers that may be contributing to the high prevalence of youth depression and anxiety disorders, in order to guide prevention measures and interventions. Method: 853 adolescents in Auckland, New Zealand, between the ages of 13 and 19 years old completed an online questionnaire. The questionnaire consisted of standardised scales to measure the constructs of interest, demographic questions and questions regarding Instagram use. Structural Equation Modelling was then utilised to test the hypotheses using a mediation model and a moderated mediation model, to determine whether the data corresponded well to the hypothesised models. Results: The results offered evidence that supported the poor get poorer effect for personality factors only. As it was identified that adolescents who have the personality traits of: a tendency to compare their abilities with others and have a low self-concept clarity are more likely to engage in an upwards social comparison on Instagram, resulting in greater depression and worry symptoms. The Instagram usage variables of: passive Instagram use and using Instagram intensely were not identified as risk factors for engaging in an upwards social comparison on Instagram. When looking at the gender effects it was identified that vulnerable females experienced more dire outcomes than males, as comparing ones’ abilities with others was only a risk factor for females and low self-concept clarity was a greater risk factor for females than males. Conclusion: The current study supported the idea that the false positive impressions displayed on Instagram can be detrimental for some adolescents’ psychological wellbeing and could possibly be contributing to New Zealand’s poor adolescent mental health statistics. The current study highlights the negative psychological impact that Instagram can have on an adolescent’s mental health, when they compare their realities to the positively skewed environment. This is concerning as social media is becoming deeply embedded into many adolescents’ lives. Therefore, this research prompts future research to further identify adolescents who are considered at risk so public health messages and interventions can be targeted towards these individuals.Item The psychosocial interactions of adolescent and young adult (AYA) cancer survivors and the possible relationship with their development : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Palmerston North, New Zealand(Massey University, 2019) Cameron, NicoleAdolescents and Young Adults (AYAs) with cancer may be particularly affected by social interactions, as they can be grappling with both a serious illness and normal developmental challenges. The present research aims to increase the understanding of the psychosocial interactions of AYAs with cancer and how these interactions can be grouped and organised in relation to each other. Furthermore, this research hopes to examine the relationship that cancer has with the developmental trajectory of this population, and how social interactions influence this relationship. As development is an important aspect of this age group, it is appropriate to consider both psychosocial interactions and the development of AYA survivors. Qualitative interviews asked ten participants (aged 16-25 years) to describe their psychosocial interactions and examined how these might affect their development. Thematic analysis identified a range of themes including: the importance of personal privacy and controlled sharing of information, independence, identity formation, positivity, acknowledgement of cancer vs. being treated normally, and receiving support instead of supporting others. In the one year follow-up interviews with five participants, half of these themes remained constant; however the personal privacy, independence and supporting others themes changed. Development appeared to be impacted by cancer for both adolescents and young adults, but this impact lessened over a one-year period. A quantitative study followed, which involved asking thirty AYAs to sort psychosocial interactions using a GOPA card-sort process, resulting in a multidimensional model of interactions. Interactions were derived from a combination of the aforementioned interviews, and a similar model completed for an Honours thesis. This model showed that AYAs conceptualise interactions in two main ways: through their perception of emotional response (avoidance/discomfort interactions opposed support interactions) and empathy (empathic actions/encouragement interactions opposed thoughtlessness interactions). Unfortunately the sample size was too small to complete two separate models comparing age differences, and therefore an understanding of developmental disparities in conceptualising interactions was unable to occur. Overall, social interactions and developmental stage appear to influence AYAs’ experience of cancer. Together, these two studies provide an understanding of how AYAs in New Zealand experience and perceive psychosocial interactions. Furthermore, there is an enhanced understanding of the developmental impact that cancer has on AYAs’ interactions. This research proudly contributes to the body of knowledge on AYAs in New Zealand, their psychosocial needs and the way cancer impacts on their development.Item An exploration of the effects of the built environment on depression in the Wellington Region, New Zealand : a thesis submitted in fulfilment of the requirements of the degree of Master of Public Health at Massey University, Wellington, New Zealand(Massey University, 2019) Mwipiko, RosemaryBackground: Depression is a major epidemic affecting millions of people globally. One of the most widely recognised contributors to this global epidemic is the decline in active transport and physical activity. To address this issue research has focused considerably on quantifying the walkability of neighbourhood areas in an attempt to measure the influence of the built environment on active transport and physical activity. A large proportion of this research has exclusively focused on adults, leaving a significant gap in knowledge in terms of the influence of the built environment on young people’s mental health. Young people are highly susceptible to the effects of their built environments as they can have restricted mobility due to those under 16 years being unable to drive. The aim of this research was to investigate the relationship between the built environment and depression amongst adolescents aged 12 to 18 years in the Wellington Region, New Zealand (NZ). Methods: A measure of the built environment was obtained by developing a walkability index, based on previously developed indices and measures. The measures used in this research were dwelling density, intersection density, mean normalized difference vegetation index (NDVI), average traffic volume and land-use mix. Both Euclidean and network buffer methods were employed as measures of the neighbourhood area, using a weighted population centroid with a distance of 800m. Depression was measured using the Reynold Adolescent Scale, sourced from the Youth’12 National Youth Health Survey by The University of Auckland Adolescent Health Research Group. Zero-inflated negative binomial regression was used to investigate any possible associations. Sex, age, prioritised ethnicity and household deprivation were included in the analysis as confounders. Results: The results obtained from the index validation process indicate that the built environment is associated with an increased likelihood of active travel to work for the 800m Euclidean buffer after accounting for sex, age, ethnicity, and socioeconomic factors. While the network-based buffer showed no significant association for both the count and zero-inflated models. Findings from the regression analysis between walkability (Euclidean buffer) and adolescent depression suggest that as walkability increases depressive symptoms in adolescent decrease. These suggest that living in a walkable neighbourhood results in lower depressive symptoms. Conclusions: The results add to the body of evidence that improving walkability has a positive impact on young people’s mental health.Item Secondary school students and caffeine : consumption habits, motivations and experiences : a thesis presented in partial fulfilment of the requirements of the degree of Master of Science in Nutrition and Dietetics(Massey University, 2019) Turner, SophieBackground: Recently, concerns have been raised about adolescent caffeine consumption due to its potentially serious physiological and psychological effects. Adolescents are vulnerable to the effects of caffeine due to their lack of habituation, smaller body mass and changing brain physiology. Increasing independence also exposes adolescents to new caffeinated products and provides greater freedom in their food and beverage decision making. The motivations that drive caffeine intake among adolescents are not well understood, but they are important in order to develop and implement public health strategies to reduce any harmful behavioural patterns and potential adverse effects. Therefore, it is important to determine which groups of adolescents if any are at increased at risk of caffeine-related harm, particularly as previous studies investigating adolescent caffeine intake are limited and outdated, especially within the New Zealand context. Aim: The aim of this study is to explore the caffeine consumption habits of New Zealand adolescents 15 to 18 years; the factors that motivate consumption and reasons for avoiding caffeine, over a range of caffeinated products. Methods: A previously validated caffeine consumption questionnaire (CaffCo) was administered to 217 participants 15 to 18 years via the online survey software Qualtrics. Results: Most (94.9%) New Zealand adolescents consume at least one caffeinated product daily, the most commonly consumed sources being chocolate, coffee, tea and kola drinks. The median daily caffeine intake was 68 mg.day⁻¹. Gender and employment status influence the pattern, but not overall amount of caffeine consumed. Energy drink consumption has risen dramatically over the past decade. One fifth (21.2%) of adolescents consume above the European Food Safety Authority (EFSA) safe level for caffeine intake of 3 mg.kg.⁻¹day⁻¹. Taste, energy and cold temperature were the main motivators for adolescent caffeine consumption. Increased energy, feeling excited, restlessness and sleep disturbances were frequently reported effects following caffeine consumption. Conclusions: This study gives an updated and more detailed view of caffeinated product consumption among New Zealand adolescents. A subset of adolescents consumes caffeine above the EFSA safe level and may benefit from public health strategies to reduce caffeine-related harm. Potential strategies may include education to improve “caffeine literacy” and improved regulations for labelling and advertising.Item Sexual violence and secondary prevention : an exploration of opportunities and barriers to implementing a secondary prevention approach to harmful sexual behaviour in New Zealand : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University, Wellington, New Zealand(Massey University, 2019) Hutton, HeathSexual violence is a highly prevalent issue that has wide-ranging social and economic impacts. Research suggests that approximately one in three women and one in seven men experience sexual victimisation during their lifetime. Victimisation is related to various lifelong impacts on physical and mental health. Research has shown that children and youth are responsible for a significant proportion of harmful sexual behaviour, including approximately 50% of all offences against children. With an increasing focus on the public health approach to the prevention of sexual violence, it is timely to explore the opportunities that secondary prevention presents. This thesis interviewed eight clinicians about their views on implementing secondary targeted prevention approaches in New Zealand. Thematic analysis identified two main themes in their responses, comprehensiveness and early intervention. These are discussed in relation to what clinicians thought was needed in New Zealand, and what barriers and opportunities existed to the realisation of this approach. This thesis provides an overview of the key issues that need to be considered by policy makers in the development of new prevention strategies and initiatives in the area of sexual violence. It highlights the various socio-cultural factors that will need to be adequately addressed by any approach that hopes to meet the diverse, and often conflicting, needs of individuals, families, and communities.Item Sexual health knowledge, attitudes and behaviour of Sāmoan youth in Aotearoa New Zealand : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Public Policy at Massey University, Albany, New Zealand(Massey University, 2017) Veukiso-Ulugia, AnalosaSex and sexuality in many cultures are sensitive topics. For many Pacific communities where sex is often regarded as tapu (sacred), cultural and religious values largely frame how sexuality and pregnancy are understood. For many Sāmoans, sex is regarded as a taboo subject. While sexual activity may be a pleasurable experience, its consequences can be life-altering. In New Zealand, the sexual health status of teenagers, particularly Pacific young people, is concerning. Compared with other countries, the rates of sexually transmitted infections (STIs), unintended teenage pregnancies and suboptimal levels of contraceptive use in New Zealand are high. From a public health perspective, these issues pose serious social, economic and health risks. For teenagers, early sexual involvement and pregnancy can drastically affect their social, educational and emotional development and life chances. In an attempt to understand and address these sexual health issues, public policy agents seek appropriate information that can assist them in designing responsive interventions. This mixed methods study explores the factors that influence the sexual health knowledge, attitudes and behaviours of Sāmoan secondary school students in Aotearoa New Zealand. An analysis of information from 535 Sāmoan students that participated in the Youth ‘07 health survey was undertaken. Individual interviews with eight key informants, and eight focus groups comprised of 55 Auckland Sāmoan secondary school students were carried out. This study presents a comprehensive picture of the sexual health patterns and issues unique to Sāmoan youth living in Aotearoa New Zealand. Three broad factors - the individual, family and wider environment - influence the sexual health knowledge, attitudes and behaviours of Sāmoan youth. This study proposes that to address sexual health issues for Sāmoan communities requires an understanding of three essential concepts: ‘Context’, ‘Communication’ and ‘Co-ordination’. The significance of this research and its findings extend to a range of audiences including Sāmoan young people, families, schools, health and social service providers and policy agents.Item A cognitive behavioural intervention for problematic substance use in adolescence : a pilot study : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University(Massey University, 2006) Morrison, CaraExperimentation with substance use in adolescence is common, yet there is often concern when it appears to become more than experimentation. New Zealand youth, in particular, have some of the highest rates of substance abuse in the Western world. The main goal of this study was to determine if a brief manualised integration of cognitive behavioural therapy and motivational interviewing for adolescents was effective in reducing the harm caused by problematic substance use. The aim of the intervention was to reduce current and future difficulties with AOD use for adolescents. Four individual case studies and within subject comparisons were used to measure the effectiveness of this intervention in an educational setting. A battery of psychometric measures were used, including a structured diagnostic interview. Results indicated improvements in motivation and coping skills, and some short term reduction in substance use. Research issues are discussed, including the applicability of the DSM-IV criteria for substance use disorders in adolescence, and our understanding of 'risk'. The current study highlights the need for adolescent substance use interventions to be holistic and systemic in nature to successfully reduce substance related harm. The limitations of the current study are also discussed.Item Ludic reading in adolescence : prevalence, practices and preferences : a thesis presented in partial fulfilment of the requirements for the degree of Master of Education at Massey University(Massey University, 1992) Bardsley, DianneThis thesis is a study of adolescent readers who read spontaneously and voraciously to satisfy a variety of felt needs. An initial comparative study is made of the differential reading attitudes, interests, preferences and practices of ludic, moderate and reluctant readers among more than 2,200 New Zealand fourth and sixth formers. More specifically recorded are the preferences and practices of sixteen ludic readers, examined over a twelve month period. To the adolescent ludic reader, the important element of a book is its trance potential, which accounts for the pre-ordinance of fiction over non-fiction. Vivid imagery is found to be a characteristic of ludic reading among adolescents. The genre most favoured are horror, romance, adventure and fantasy. Genre preferences were found to remain stable over a twelve-month period, particularly among male ludic readers. Factors most strongly related to ludic reading are gender, ethnicity, family occupational status and home reading background. Less strongly related are birth order and family size. A strong relationship exists between school academic success and ludic reading. Higher than average occupational aspirations are also related to ludic levels of reading. Habitual ludic reading is found to decrease only slightly with age in adolescence with increasing work and study commitments, accompanied by increasing economic and social independence. Adolescent ludic readers are found to have a variety of leisure pursuits, including television-viewing. Personality and environmental influences determine quite individual differences in motivation, satisfactions, practices and preferences of ludic readers. The case study readers perceived literary quality to be inversely related to reading pleasure. Ludic readers experience a variety of emotions while reading a book and happy endings are not found to be relevant or a necessary requisite for enjoyment. Re-reading particular books is a feature of the reading habits of this group of adolescent readers. The popular perception of the ludic reader as an introverted, passive and solitary individual is not supported in this study.Item Dietary intake and nutrition knowledge of physically active adolescents : a project completed as partial fulfilment for the requirements of a Master of Science in Nutritional Science, Massey University(Massey University, 2006) Cairncross, CarolynAdditional nutrient demands are encountered during adolescence, the major period of growth during the human life cycle. In order that these demands are met and healthy eating habits established to lead into adulthood, it is vital to be able to accurately assess current dietary intake and nutrition knowledge levels of this population. There are very few studies that have assessed the dietary intake and level of nutrition knowledge of active adolescents. The aim of this study was to assess the nutrition knowledge level, and dietary intake, of the subjects. A new nutrition knowledge questionnaire was developed and validated for this purpose. Dietary intake data was collected and compared to current dietary recommendations. This data was then used to investigate any link between nutrition knowledge level and dietary behaviour in the active adolescent subjects. One hundred and twenty-four adolescents of ages 14-18 years were recruited for the study from schools and competitive sporting teams in the Auckland region. Participants completed the nutrition knowledge questionnaire and were requested to complete a three-day food diary (two weekdays, one weekend day). Physical activity was recorded qualitatively by the subjects for the week in which dietary intake was measured. Body composition was assessed by calibrated digital scales and height measurement. The nutrition knowledge of the active adolescents of this study was found to be poor, with a mean score of 55% achieved by the group. The interest of these subjects in sport was illustrated with a slightly higher nutrition knowledge score on the sport nutrition section of the questionnaire than the general nutrition section, 57% v 54%, p<0.05. The nutrition knowledge level of females was found to be significantly higher than males, 58% v 53%, p<0.05. Forly-six of the subjects returned completed food diaries (respondant rate 37%). It was found that subjects underreported energy intake between 11 - 14%. The reported dietary intakes of macronutrients of the group met New Zealand and United States dietary recommendations. However, the reported intakes of several micronutrients were found to be below these recommendations. In the comparison of nutrition knowledge level and dietary intake of the subjects, no link was found between knowledge level and dietary behaviour. The low level of nutrition knowledge of these subjects is consistent with previous studies of nutrition knowledge in adolescents. It highlights the need for further nutrition education during the adolescent period, especially for adolescents who are physically active . The underreported energy intake reflects previous study findings with the difference speculated to be primarily due to the inaccurate reporting of intake typified by this adolescent age group. The dietary intake of these adolescents met the majority of dietary intake recommendations, which may reflect the high socio-economic status and high interest in sport of the subjects. These may also be a factor in the lack of correlation between nutrition knowledge level and dietary behaviour found in this study.