3.1 Examine the health status of young people, including Aboriginal and Torres Strait Islander young people, using Australia’s Health and other health reports, graphs and tables

1. Defining health status in youth health data

Health status describes the overall health of a population using measurable indicators. For young people, the most useful indicators often focus on preventable harm and non-fatal conditions. This is because serious chronic disease and death are less common in this age group.

1.1 Mortality and leading causes of death

Mortality means deaths in a population. Youth mortality is low compared with older age groups, but it still matters because it shows which deaths are most preventable. For 15–24-year-olds, the death rate has been reported at around 38 per 100,000 in 2021. This shows that death is uncommon, but it still occurs.

Sex differences are clear. In 2021, the youth death rate has been reported at about 53 per 100,000 for males and 21 per 100,000 for females. Much of this difference is linked to preventable injury patterns, including suicide and transport-related deaths, rather than chronic disease.

1.2 Morbidity, incidence and prevalence

Morbidity means illness and injury. It is central to youth health status because many key issues reduce wellbeing, learning and participation without causing death.

• Incidence means the number of new cases over a set time period. It is often used for conditions tracked through notifications and new diagnoses, including many infections.
• Prevalence means how many people have a condition at a point in time. This is useful for mental health conditions, psychological distress, overweight and obesity, and nicotine use.

A strong examination goes beyond saying problems are just personal choices. It links patterns to access, stigma, service availability, family and school environments, and wider social conditions.

1.3 Burden of disease

Burden of disease combines early death with time lived in less than full health. It helps explain why youth health policy focuses on mental health, substance use and injury.

These issues do not always cause death, but they can reduce learning, functioning, participation and wellbeing during important developmental years. This is why burden of disease measures can show impact that mortality alone does not.

2. What the data shows in broad terms

National reports often describe young people as one of the healthiest age groups, especially when it comes to chronic diseases that usually develop in older adults.

However, young people do face clear health challenges. The main issues include mental health and distress, injury and preventable harm, and behaviours that can affect future health. Examples include not being active enough, nicotine dependence, risky drinking, and sexual health behaviours.

Youth health is strongly shaped by social context. Many issues are connected to development, peer influence, school and workplace pressures, digital environments, relationship safety, and access to services. This is why the determinants of health are essential for explaining trends.

NB: COVID-19 can complicate trend graphs because changes in notifications can reflect changes in testing and health care access, not only changes in incidence.

3. What are the trends in key health issues?

3.1 Injury, death and preventable harm

Australian data commonly shows that injury is the leading cause of death for young people. For Australians aged 15–24, injury has been reported to account for about two-thirds (around 69%) of deaths.

Within injury-related deaths, suicide is a major contributor and is often reported as the leading single cause of death in this age group. Land transport accidents are also a major cause.

This matters because it shows that youth mortality is driven more by external, preventable causes than by disease. It also explains why youth health policy focuses on road safety, violence prevention, and early mental health support during high-stress transitions.

Example: A newly licensed P-plate driver travelling home late with peers has a higher risk profile than the same driver travelling alone in daylight, because peer presence and night driving increase hazard exposure and can reduce cautious decision-making.

3.2 Mental health and wellbeing

Mental health is one of the most important trends in youth health status. National survey reporting has indicated that in 2020–2022, around 39% of Australians aged 16–24 experienced a mental disorder in the previous 12 months. Earlier reporting (for example, 2007) was closer to 26%.

The increase has been reported as especially high among young women. One report suggests about 46% of females aged 16–24 experienced a mental disorder in 2020–22. This trend also shows up in service use. In 2021–22, young people aged 12–24 made up around 23% of people receiving Medicare-subsidised mental health services, which is about 643,000 individuals. These figures can suggest both increased need and increased help-seeking. They are shaped by awareness, access, affordability, and whether it feels socially acceptable to talk about distress.

Mental health can also link with other trends. Psychological distress can contribute to risk-taking, substance use, disrupted sleep, disengagement from school, and reduced physical activity. Protective factors such as connection, supportive relationships, and timely access to services can interrupt this pathway.

3.3 Overweight, obesity, nutrition and physical inactivity

Lifestyle indicators show mixed patterns. Many young people play sport, but population reporting commonly shows that most adolescents do not meet recommended activity levels. One estimate suggests around 83% of adolescents aged 15–17 do not meet the daily activity guideline. sedentary behaviour is also important, because prolonged sitting and high recreational screen time can affect physical and mental wellbeing.

By early adulthood, the proportion above a healthy weight becomes substantial. Around 42% of young adults aged 18–24 were classified as overweight or obesity in 2022. This matters because above-healthy weight can increase future risk of type 2 diabetes and cardiovascular disease. It can also affect mental health through stigma, body dissatisfaction, and reduced participation.

Nutrition patterns can add to this trend. Many adolescents eat too few vegetables and too many discretionary foods. These habits can combine with high sedentary time linked to study and screen-based leisure.

Example: A Year 12 student may be meeting academic goals while building long periods of sedentary time that reduce physical activity and sleep quality, even if they still play sport once per week. Over time, this pattern aligns with population trends in inactivity and fatigue.

3.4 Alcohol, tobacco, vaping and other drug use

Substance use trends show both improvement and new concerns. Smoking rates among young people have dropped a lot. For example, daily smoking among 18–24-year-olds has been reported at around 4.9% in 2022–23. At the same time, vaping has become a major issue. Daily e-cigarette use has been reported at about 9.3% among 18–24-year-olds, which is higher than daily smoking in some datasets. This matters because nicotine dependence can develop early, and vaping can lead to longer-term nicotine use even when cigarette smoking is falling.

Alcohol patterns show a long-term decline in teenage drinking overall. However, risky episodic consumption is still strongly linked with injury and acute harm. In 2022, around 33.7% of young adults aged 18–24 reported having five or more standard drinks in one session at least monthly. This increases the risk of accidents, assault, unsafe sex, and acute poisoning.

Survey trends often show cannabis as the most commonly used illicit drug among young adults. Some reports suggest around 20–25% past-year use in the early twenties, with smaller proportions reporting other drugs. These patterns can overlap with mental health trends and contribute to injury risk, disengagement from school, and longer-term dependence.

3.5 Sexual and reproductive health

Sexual health trends are often examined using STI notifications and (less often) teenage pregnancy data. Young people are consistently overrepresented in STI notifications. Some national figures indicate that people aged 15–29 account for around two-thirds of chlamydia notifications and around half of gonorrhoea notifications. This can reflect higher partner change in adolescence and early adulthood, inconsistent condom use, and the fact that many STIs are asymptomatic. It also shows why access to confidential testing is important.

Australia’s teenage birth rate has declined over time, linked to improved education and contraceptive access. Higher rates still occur in some groups and settings.

3.6 Sleep and fatigue-related health impacts

Sleep is a key youth health issue because it is both a health outcome and a driver of other behaviours. During adolescence, sleep duration often drops because of later bedtimes, early school starts, study load, work commitments, and device use at night.

Insufficient sleep is linked with poorer concentration, lower learning, more irritability, higher risk-taking, lower physical activity, and increased vulnerability to anxiety and depression. When sleep disruption becomes long-term, some young people develop a delayed sleep pattern. This matters because one behaviour pattern can worsen several health status indicators at the same time.

Example: A student who scrolls on their phone in bed until 1.00 am may rely more on energy drinks, skip breakfast, disengage from sport, and feel more anxious. These behaviours can cluster around chronic sleep disruption.

3.7 Eating disorders, disordered eating and body image

Eating disorders and disordered eating are critical trends in youth health because they combine physical risk with a high mental health burden. Disordered eating is not limited to diagnosed conditions. It can include restrictive dieting, binge eating, purging behaviours, and compulsive exercise. One estimate suggests around 31.6% of Australian young people engage in disordered eating behaviours each year.

Body image concerns are closely linked. Some survey patterns show clear gender differences in how important weight and appearance feel to young people. This matters because it can lead to different risk pathways, including restrictive behaviours, compulsive exercise, and distress linked to comparison.

3.8 Relationships, violence and personal safety

Youth health reporting also includes relationship safety and personal safety because these affect wellbeing, mental health, learning engagement and help-seeking. Some national datasets report that experiences such as sexual harassment are common among young adults, with higher rates for young women.nHarassment or violence can increase distress, disrupt sleep, reduce school engagement, and increase coping behaviours such as substance use. Protective factors include respectful relationship norms, clear reporting pathways, culturally safe services, and trusted adults who respond early.

4. What are the causes and protective factors of key health issues?

Youth health trends usually have multiple interacting causes rather than one simple reason. Many issues share the same determinants, which is why risk behaviours can cluster (for example, sleep disruption, vaping uptake, reduced physical activity and rising distress).

A common causal factor across mental health, substance use, disordered eating and unsafe behaviours is high stress load without enough support. Academic pressure, family conflict, financial stress and uncertainty can build up, especially when routines and connectedness are weak and services are hard to access.

Peer influence can increase risk when group norms reward risk-taking, intoxication or unsafe sex. Digital environments can also shape risk through sleep displacement, social comparison and exposure to harmful content. They can also be protective by making information and help-seeking easier.

Protective factors reduce risk, buffer stress and support healthier choices. Connectedness to family, school, sport, community and culture is protective because it increases belonging and help-seeking. Stable routines, especially protecting sleep, can reduce impulsive decisions and improve mood regulation. Youth-friendly services that are confidential, affordable and culturally safe support early intervention. Early support can prevent issues from becoming more severe.

Example: A Year 12 student under sustained exam pressure may sleep poorly and start vaping to cope. If a trusted teacher notices early and supports the student into counselling and sleep routines, the same situation can shift from escalating distress to stabilised functioning and reduced risk behaviours.

5. How do the determinants of health affect health-related behaviours

Determinants of health are the conditions that shape how young people live, learn, connect and access support. They influence behaviour by shaping stress, opportunity, safety, and how easy it is to use protective resources.

5.1 Broad features of society

Broad features of society shape health behaviours by deciding what resources and systems are available. Political systems and social policies decide whether young people can access affordable healthcare, mental health services, or sexual health clinics. Cultural values influence whether seeking help is seen as acceptable or stigmatised. Economic stability affects whether families can afford healthy food, transport to services, or safe housing, all of which directly influence diet, physical activity, and sleep patterns.

Example: A government policy that removes bulk-billing for youth mental health services can negatively affect health behaviours by creating a financial barrier. Young people experiencing distress may delay or avoid help-seeking, leading to increased self-medication through substance use, poorer sleep, and disengagement from school and physical activity.

On the other hand, a policy that funds free, confidential sexual health clinics in schools can positively affect health behaviours by making STI testing accessible and normalised. This increases early detection, reduces transmission, and supports safer sexual health practices among young people who might otherwise avoid seeking care due to cost, transport barriers, or stigma.

Cultural determinants: Especially for Aboriginal and Torres Strait Islanders

Cultural determinants influence whether young people engage in protective or risky behaviours by shaping identity, trust, and help-seeking. Cultural connection can protect wellbeing by strengthening belonging and purpose. However, stigma around mental health or sexuality in some cultural contexts can reduce help-seeking and delay early intervention. Cultural safety in services determines whether young people feel respected enough to access sexual health testing, mental health care, or drug and alcohol support, directly affecting whether they engage in these protective behaviours.

Example: A young Aboriginal person experiencing distress may avoid seeking mental health support if available services lack cultural safety, for example, if there are no Aboriginal staff, no acknowledgment of cultural identity, or a history of discriminatory treatment in that service. The young person may fear being misunderstood, judged, or having their family or community contacted without consent. This cultural barrier can negatively affect health behaviours by increasing social isolation, delaying help-seeking, and leading to coping strategies such as substance use or disengagement from school. Without culturally safe services, the young person may not access sexual health testing either, due to concerns about confidentiality and respectful care, increasing the risk of untreated STIs.

On the other hand, a young Aboriginal person connected to a local Aboriginal Community Controlled Health Organisation (ACCHO) that employs Aboriginal health workers, offers confidential youth clinics, and integrates cultural protocols into care is more likely to seek support early when experiencing distress. The cultural determinant (trust, respect, and cultural safety) positively affects health behaviours by making help-seeking feel safe and appropriate. This young person is more likely to access mental health counselling, sexual health testing, and health education, and to maintain connection with services over time. Strong cultural connection through family, Elders, and community activities also supports identity and belonging, which are protective factors that reduce psychological distress and buffer against risk behaviours such as substance use or unsafe sexual practices.

5.2 Environmental factors

Environmental factors make certain behaviours easier or harder depending on where young people live. Neighbourhood safety determines whether young people feel safe exercising outdoors or walking to services. The presence of recreational spaces makes regular physical activity more likely. In rural and remote areas, longer distances to services create barriers to accessing sexual health care and mental health support, which can delay help-seeking and increase risky behaviours like unprotected sex or untreated distress.

Example: A young person living in a regional town with no public transport and a sexual health clinic 80 km away may avoid STI testing due to distance and lack of confidentiality in a small community. This can negatively affect health behaviours by increasing the likelihood of untreated infections, continued transmission, and delayed treatment-seeking even when symptoms appear. Another young person may also reduce physical activity if there are no safe parks or sports facilities nearby, and may spend more time indoors on devices, which can disrupt sleep and increase social isolation.

On the other hand, a young person living in an urban area with a youth health clinic within walking distance, multiple parks, bike paths, and free community sports programs is more likely to engage in regular physical activity, access confidential sexual health testing, and seek early support for mental health concerns. The environmental factor (proximity and access to safe spaces and services) directly shapes whether protective or risky health behaviours are easier to adopt.

5.3 Socioeconomic characteristics

Socioeconomic characteristics affect health behaviours through stress and resource access. Economic stress and housing instability can trigger anxiety, which may lead to coping behaviours like substance use or disordered eating. Limited income restricts access to healthy food, sports programs, healthcare, and transport, making it harder to maintain protective behaviours. Overcrowded housing disrupts sleep routines and increases conflict, which can worsen mental health and reduce school engagement. Family functioning, peer networks, and experiences of bullying or discrimination shape whether young people engage in risk-taking behaviours or seek support when struggling.

Example: A young person living in a household experiencing financial stress may face overcrowded housing conditions where multiple family members share one bedroom, making it difficult to maintain a regular sleep routine. This sleep disruption can lead to increased fatigue, reduced concentration at school, and higher irritability. To cope with stress and exhaustion, the young person may turn to energy drinks or begin vaping with peers. Limited family income means they cannot afford gym memberships or organised sports, reducing opportunities for physical activity. When mental health concerns arise, they may avoid seeking help due to cost barriers and transport difficulties in reaching bulk-billing services. This shows how socioeconomic characteristics can negatively affect multiple health behaviours at once: sleep, substance use, physical activity, and help-seeking.

On the other hand, a young person living in a stable household with adequate income may have their own bedroom, supporting consistent sleep routines and better mood regulation. Their family can afford healthy groceries, sports club fees, and transport to activities and healthcare appointments. When the young person experiences exam stress, a parent can book them into a bulk-billing youth mental health service and drive them there. The family environment includes open communication and positive peer connections through sport and community activities, making it more likely the young person will seek support early and engage in protective behaviours like regular exercise, balanced eating, and adequate sleep. This shows how socioeconomic characteristics can positively affect health behaviours by reducing barriers and increasing access to protective resources.

5.4 Health behaviours

Health behaviours themselves are influenced by all other determinants. Physical activity levels, diet quality, substance use, sleep patterns, sexual health practices, and help-seeking are not just individual choices. They’re shaped by stress, opportunity, peer norms, service access, and cultural context. These behaviours can either increase protection (like regular sleep and exercise) or amplify risk (like substance use as a coping strategy).

Example: A young person experiencing high academic pressure, peer conflict, and limited family support may develop a pattern of staying up late scrolling social media to avoid stress. This disrupts their sleep, leading to increased fatigue and irritability. To cope, they may begin skipping breakfast, reducing physical activity due to low energy, and eventually start vaping with peers during breaks. When anxiety worsens, they avoid seeking help due to stigma and fear of judgment. This shows how health behaviours can negatively affect each other in a cycle: poor sleep leads to reduced physical activity and increased substance use, which further worsens mental health and reduces help-seeking.

On the other hand, a young person who maintains a regular sleep routine of 8-9 hours per night is more likely to wake up with energy, eat a balanced breakfast, and engage in morning exercise or sport. Good sleep supports better mood regulation, making them less likely to seek coping mechanisms like vaping or energy drinks. When they experience stress, they are more likely to recognise it early and talk to a trusted adult or access a school counsellor, because their baseline wellbeing is higher and they have the energy and clarity to seek support. This shows how health behaviours can positively reinforce each other: adequate sleep supports physical activity, balanced eating, and proactive help-seeking, creating a protective cycle that buffers against risk.

5.5 Biomedical factors

Biomedical factors interact with behaviours and other determinants. Adolescent developmental changes affect sleep patterns, mood regulation, and risk-taking. Existing health conditions may limit physical activity options or require more healthcare visits. Genetic factors can influence vulnerability to mental health conditions or substance dependence, but their impact is always shaped by environmental and social conditions.

Example: A young person with asthma may experience limited participation in high-intensity sports at school, leading to reduced physical activity levels and increased sedentary time. During stressful periods like exams, their asthma symptoms may worsen due to anxiety, disrupting sleep and making it harder to maintain regular routines. If they also have a family history of depression, the combination of reduced activity, poor sleep, and genetic vulnerability may increase their risk of developing mental health concerns. Without accessible healthcare, they may avoid seeking medical support for asthma management, leading to a cycle where biomedical factors negatively affect multiple health behaviours: physical activity, sleep, and help-seeking.

On the other hand, a young person with well-managed type 1 diabetes may develop strong health literacy and self-management skills through regular contact with healthcare providers. They learn to monitor their blood glucose levels, maintain consistent meal and sleep routines, and recognise early warning signs of physical and mental health changes. This regular engagement with healthcare builds confidence in help-seeking and creates a protective routine that supports balanced eating, adequate sleep, and proactive management of stress. The biomedical factor (a chronic condition requiring ongoing care) positively affects health behaviours by building skills, routines, and a trusting relationship with health services that can buffer against other risks.

6. Health status of Aboriginal and Torres Strait Islander young people

When looking at Aboriginal and Torres Strait Islander young people’s health, we need to recognise both the health challenges they face and the cultural strengths that protect their wellbeing. We also need to use a holistic view of health, which includes social and emotional wellbeing, cultural identity, spirituality, community and connection to Country.

It’s important to understand the relationship between health and connection to Country. For many Aboriginal and Torres Strait Islander young people, connection to Country, culture, kinship and community are not just extra things that affect health. They are core factors and protective strengths that support identity, belonging, purpose and coping.

6.1 What are the trends in key health issues?

Across many measures, Aboriginal and Torres Strait Islander young people experience higher levels of preventable harm than non-Indigenous young people. While the exact rates vary by area and year, the pattern is consistent: injury and mental health-related harm account for a large share of health loss in adolescence and early adulthood.

Youth mortality has been higher in several reporting periods, and injury remains a main cause. For example, in the period 2011–2015, there were 674 deaths among Aboriginal and Torres Strait Islander people aged 10–24, with injury and poisoning accounting for most deaths, including suicide and road accidents. In the same period, around 83% of deaths were classified as avoidable, showing that many deaths could have been prevented with better protection and earlier support.

Suicide is a major contributor to youth mortality and to preventable harm. AIHW suicide monitoring reports that among First Nations people aged 0–24, the suicide death rate was 13.9 per 100,000, and for those aged 0–24 the rate was around 1.8 times the non-Indigenous rate (with the gap even larger in some other age groups).

Mental health patterns should be understood in the context of exposure to grief, trauma and racism, alongside barriers to culturally safe care. Recent ABS data shows that psychological distress is common among young adults. In 2022–23, 35.9% of Aboriginal and Torres Strait Islander people aged 18–24 experienced high or very high psychological distress in the last 4 weeks. The proportion was higher in non-remote areas (35.9%) than in remote areas (27.8%), which is relevant when looking at how access, overcrowding, service availability and community supports interact with distress patterns.

Racism is not only a social issue but a measurable health factor. ABS reporting drawing on the Mayi Kuwayu study shows higher distress among people experiencing everyday racial discrimination (for example, 49% compared with 32% among those not reporting everyday racial discrimination).

Sexual health data often shows much higher STI notification rates among Aboriginal and Torres Strait Islander young people aged 15–24, especially when confidential and culturally safe services are limited. The Indigenous Health Performance Framework notes that in 2020–2022, 15–24-year-olds had the highest notification rates for chlamydia and gonorrhoea among First Nations people.

Recent Kirby Institute surveillance also shows how large the gap is at the population level.

• In 2024, the chlamydia notification rate among Aboriginal and Torres Strait Islander peoples was 950.6 per 100,000, more than twice the non-Indigenous rate (369.4 per 100,000).
• For gonorrhoea, in 2023 the notification rate among Aboriginal and Torres Strait Islander peoples was 541.0 per 100,000, more than four times the non-Indigenous rate (134.9 per 100,000).
• For infectious syphilis, in 2024 the notification rate among Aboriginal and Torres Strait Islander peoples was 100.7 per 100,000, more than five times the non-Indigenous rate (18.9 per 100,000).

These differences align with the explanation that service access, confidentiality, workforce availability, and cultural safety strongly affect testing, treatment and ongoing transmission.

Some lifestyle indicators, such as smoking, are also higher in many datasets, particularly in some remote contexts. For example, AIHW reporting on alcohol and other drugs among First Nations people notes that in 2022–23, 29% of First Nations people aged 15 and over smoked tobacco daily (excluding vaping), down from 37% in 2018–19. For adolescents, the Indigenous HPF reports that in 2018–19, smoking prevalence was lowest in the 15–17 age group (reported as 13%).

These figures support a balanced examination: progress is happening, but significant exposure remains.

It’s important to recognise variation within these trends. Population patterns do not predict individual outcomes. Many Aboriginal and Torres Strait Islander young people experience strong wellbeing, especially when cultural connection and service access are strong.

6.2 What are the causes of key health issues?

Key youth health issues for Aboriginal and Torres Strait Islander young people have multiple causes rather than one simple explanation. Many causes are linked to historical and ongoing structural factors, alongside current social conditions.

The impacts of colonisation and dispossession have contributed to intergenerational trauma, disrupted family and community structures, and reduced access to resources that support health. Racism, including interpersonal and systemic racism, can affect health directly through stress responses and psychological distress, and indirectly by reducing trust in services and making help-seeking less likely. The link between racial discrimination and higher psychological distress reported in national data supports the argument that racism is a measurable driver of poorer wellbeing outcomes.

Access barriers also contribute to preventable harm. When services are not culturally safe, affordable, youth-friendly, or easy to reach, conditions may go untreated for longer and risk behaviours may be harder to change. This is particularly important in rural and remote contexts, where there may be fewer services overall, longer travel times, workforce shortages, and reduced access to specialist care.

Injury risk can be shaped by environmental factors such as road conditions, transport availability, and long travel distances. The high proportion of avoidable deaths in earlier youth mortality data is consistent with this pattern, because many injury-related deaths could be prevented through safer environments, stronger community supports, and effective early support.

Higher STI notifications can be linked to reduced access to confidential testing and treatment, limited availability of culturally safe sexual health services, and broader factors such as housing instability and school disengagement. Surveillance data showing large gaps in chlamydia, gonorrhoea and syphilis notification rates supports the need to interpret STI trends through service access and determinants, not only individual behaviour.

6.3 What are the protective factors of key health issues?

Connection to Country and culture is a major protective factor because it strengthens identity, belonging, meaning and coping. In practical terms, cultural continuity and time on Country can support wellbeing by strengthening relationships, routines, and a sense of safety and purpose. This protective effect is consistent with national findings showing lower distress where people report stronger cultural knowledge and connection.

Strong kinship networks, community cohesion, and guidance from Elders can buffer stress, support healthy decision-making, and promote help-seeking. Aboriginal Community Controlled Health Organisations (ACCHOs), Aboriginal Medical Services, and other culturally safe services can improve engagement, early presentation, follow-up, and continuity of care. This matters for youth because earlier contact and culturally safe care can interrupt escalation in mental health, improve STI testing and treatment uptake, and support smoking cessation in ways that are sustainable.

Protective environments also include schools and communities that are culturally safe, that actively address racism, and that provide strong pastoral support and clear pathways into health and wellbeing services.

Example: A young person who participates in an on-Country programme with Elders may develop stronger cultural identity, routine, and connection. These protective factors can reduce isolation, increase help-seeking, and support healthier choices, even when other determinants such as economic disadvantage remain present.

6.4 How do the determinants of health affect health-related behaviours?

Determinants of health shape health-related behaviours by influencing stress, opportunity, safety, and access to protective resources.

Structural and historical determinants underpin many inequities. The impacts of colonisation, dispossession and intergenerational trauma shape many social and economic conditions today. Social determinants such as experiences of racism, exclusion, and grief can increase psychological distress and disrupt sleep, which can then contribute to clustered risk behaviours such as smoking or substance use, reduced physical activity, and disengagement from school. This link is strengthened by evidence showing higher distress among those experiencing racial discrimination.

Economic determinants such as low income, unemployment, and housing stress can limit access to healthy food, sport, transport and health care. Overcrowding can reduce sleep quality, increase infection risk, and increase stress. Environmental determinants, including geographic isolation, can reduce access to specialist services, particularly for mental health and sexual health. Long travel distances can delay care and can also increase injury exposure.

Access to health services is therefore a key determinant of behaviour as well as outcomes. When young people can reach youth-friendly, confidential, culturally safe services (including Aboriginal Medical Services), they are more likely to test and treat STIs, engage in mental health support earlier, and get follow-up care. When access is limited, help-seeking may be delayed and risk behaviours may become more entrenched, contributing to the higher notification and distress patterns observed in national surveillance and survey data.

Cultural determinants can be strongly protective when young people have a strong cultural identity and connection. Cultural safety within services and schools also affects whether young people feel respected and are willing to seek support early.