The ARCHER study of health and wellbeing in young rural … Georgin… · Hormones change sweet...

The ARCHER study of health and wellbeing in young rural Australians

14th National Rural Health Conference 29th April 2017

The University of Sydney

Authors

Georgina Luscombe1 Helen Cheng2 Ben Balzer3 Chin Moi Chow4 Karen Paxton5 Katharine Steinbeck2

Catherine Hawke1 1 School of Rural Health, Orange, NSW 2 Discipline of Paediatrics and Child Health, The University of Sydney at The Children’s Hospital Westmead, NSW 3 Sydney Medical School, Sydney, NSW 4 Faculty of Health Sciences, Lidcombe, NSW 5 School of Rural Health, Dubbo, NSW


Why do we need to study adolescence?

– A critical time of life

– Rapid physical, social and emotional changes

– Establish patterns of behaviour; make lifestyle choices with long-term health repercussions

– Mental health problems become prevalent

– Family, friends, school, community and environment all contribute to health and behaviour


Our future: a Lancet commission on adolescent health and wellbeing Patton et al., Lancet 2016; 387:2423-78

DOI: (10.1016/S0140-6736(16)00579-1)

“This generation of adolescents and young adults can transform all our futures; there is no more pressing task in global health than ensuring they have the resources to do so.”

Copyright © 2016 Elsevier Ltd Terms and Conditions


Multiple connections

SLEEP

obesity

depression

accidents & injury

family environment

school performance

Internet

mobile phones

physical inactivity

risky behaviours

Modified from the


What part do hormones play?


Widespread assumptions …….

Hormones change sweet children into unpredictable and impossible teenagers who do unexpected and sometimes dangerous things. But, the evidence for a true impact of puberty hormones on adolescent health, wellbeing and behaviour is close to non-existent.

With thanks to Maurice Sendak

Testosterone

Oestradiol

DHEAs

Growth hormone


Adolescent Rural Cohort study of Hormones, Health, Education, Environment and Relationships


ARCHER aims

– determine the true biological effects of puberty hormones on health, wellbeing and behaviour in adolescents

– describe interactions of individual, family, community and environmental factors on adolescent health outcomes

– increase knowledge of adolescent health and its determinants in rural NSW

– improve understanding of protective and risk factors

– Inform early prevention / intervention strategies


Methods

• Annual parent and young person questionnaires; anthropometry; blood samples

• Urine samples every 3 months


281 Wave 4

296 Wave 3

314 Wave 2

342 Wave 1

Overall retention 82% Loss between waves 5 to 8%

Results Recruited adolescents (9 to 14 years old) and a parent/guardian


Who was the typical ARCHER adolescent?

– 11 years old

– male (55%)

– at a government school (43%)

– inner regional (91%)

– speaking English at home (98%)

– living with both parents (85%), in a smoke-free home (79%) with a mortgage (63%)


Did we catch them in early puberty? Mostly yes!

77% 9-10 yo

52% 11-12 yo

8% 13-14 yo

88

202

49


How did they view their pubertal stage compared to others?

6%

22%

33%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

13 to 14 years

11 to 12 years

9 to 10 years

Females

in front same behind

0%

10%

16%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

13 to 14 years

11 to 12 years

9 to 10 years

Males

in front same behind


Short Mood and Feelings Questionnaire


Obesity: International Obesity Task Force BMI grades

28% 26%

30%

29%

32%

33%

23%

25%

24%

25%

Wave 1

Wave 2

Wave 4

Wave 3


Risky behaviours: substances

8% 3% 2% 1.5%

Ever smoked (more than just a few puffs)

Ever drank alcohol (beyond a few sips)

25% 10% 6% 2%

Illicit substance use was uncommon (e.g. 3% or 9 YP reporting marijuana use at Wave 4).


Sleep

8.8 9 9.5 10

School night total sleep hours

Weekend total sleep hours

9 9 9 9.3

Sleep compensation (at least one hour more sleep on weekends)

27% 27% 31%

41%

0%

10%

20%

30%

40%

50%

Wave 1 Wave 2 Wave 3 Wave 4


– Depressive symptoms by Tanner stage and sex

How do they all fit together?


– Depressive symptoms by COMPARATIVE pubertal stage, and by sex


What factors were associated with significant depressive symptoms?

Females … less risk if – higher socioeconomic status – more hours slept school nights – (older, in model with

comparative pubertal stage)

But no relationship with – Age (in Tanner stage model),

physical activity, Tanner stage, comparative pubertal stage

Males … less risk if – comparative pubertal stage

‘same’ (compared to ‘behind’)

But no relationship with – age, SES, physical activity,

hours slept, Tanner stage


What factors were associated with overweight and obesity?

Females .. less risk of O&O if – older – more physical activity – lower Tanner stage – Comparative pubertal stage

‘behind’ (compared with ‘same’ or ‘in front’)

But no relationship with – SES, hours slept (school night

or weekend)

Males … less risk of O&O if – more physical activity – more weekend hours slept

But no relationship with – age, SES, hours slept school

nights, Tanner stage, comparative pubertal stage


What does all this mean? What do we still need to do?

– substantial proportion of the cohort in early puberty (needed to study longitudinal relationship between puberty and health)

– we demonstrated known relationships (e.g. pubertal stage and obesity in females; sleep related to both mental health and O&O)

– predictive models demonstrated complex inter-relationships between physical and social determinants of health

– BUT we still need to include hormones in models …

– Then we hope to understand for the first time the true biological effects of puberty hormones on health, wellbeing and behaviour in adolescents


Where to from here?

– This is a unique cohort with the potential to help us further understand the multiple determinants of health of rural young people

– We may be able to identify risky patterns of puberty (in terms of timing and tempo) [chronological age vs hormonal stage?]

– We would never suggest that normal puberty should be manipulated

– this is an opportunity for prevention and early intervention


Acknowledgements

The ARCHER study is supported by an Australian National Health and Medical Research Council (NH&MRC) peer reviewed Project Grant #1003312. We also gratefully acknowledge the contributions of: – ARCHER participants and their families – Central West NSW schools and communities – Janet Symons (USyd)

– Lisa Riley (USyd)

– Philip Hazell (Rivendell Child, Adolescent and Family Mental Health Service; USyd; Sydney LHD)

– Rachel Skinner (Children’s Hospital, Westmead; USyd)

– Rebecca Ivers (The George Institute for Global Health; USyd)

– Robert Booy (Children’s Hospital, Westmead; USyd)

– Andrew Martin (UNSW)


More on the ARCHER study …

Steinbeck K, Hazell P, Cumming RG, Skinner SR, Ivers R, Booy R, Fulcher G, Handelsman DJ, Martin AJ, Morgan G, Starling J, Bauman A, Rawsthorne ML, Bennett DL, Chow CM, Lam MK, Kelly P, Brown NJ, Paxton K, Hawke C: The study design and methodology for the ARCHER study - adolescent rural cohort study of hormones, health, education, environments and relationships. BMC Pediatrics 2012, 12:143.

See also: www.sydney.edu.au/medicine/rural-health/research/ARCHER/cohort.php

How to contact us: A/Prof Catherine Hawke [email protected] Dr Georgina Luscombe [email protected]

The ARCHER study of health and wellbeing in young rural … Georgin… · Hormones change sweet...

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