Publications relating to the Pacific Islands Families Study

This page lists more than 100 peer reviewed scientific papers published in national and international journals during the course of the Pacific Islands Families Study.

140. Parenting practices adopted by Pacific mothers in Aotearoa New Zealand: a longitudinal analysis of the Pacific Islands Families Study. Bowen, D., Swit, C., Tautolo,E.S., Schluter, P. (2026). Pacific Health Dialog, Pacific Health Dialog, 26(2).
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Introduction: Responsive parenting practices nurture emotional wellbeing and healthy child development. Yet, providing consistent nurturing care for young children can be challenging, especially for primary caregivers affected by stressors of immigration, acculturation, and health inequalities. Pacific families who have immigrated to Aotearoa New Zealand often report resilient mental health, attributed to heritage cultural values and strong social support. This study examines contextual factors associated with varying parenting behaviours to identify conditions that support health-promoting caregiving practices in contexts of intersecting social challenges. Methods: This study analysed longitudinal data from the Pacific Islands Families (PIF) Study. Participants included all Pacific mothers (primary caregivers) who participated in measurement waves at child ages 6-weeks (n=1,277), 2-years (n=1,062), and 4-years (n=972). Multilevel logistic modelling examined associations between mothers’ current parenting practices and socioecological factors, including childhood parenting history, cultural adaptation, immigration, education, and income. Results: Nurturing parenting practices were positively associated with emotionally supportive upbringings, education, and connection with local culture. Odds of frequent use of nurturing parenting practices were significantly greater for mothers who recalled often, rather than rarely, receiving emotional support from primary caregivers in childhood. Use of harsh disciplinary parenting practices was associated with current social stressors including lower income, higher childcare burden, and recent immigration. No association was observed with adverse childhood parenting experiences. Conclusions: Childhood experience of nurturing care may predict nurturing parenting practices in the next generation. Access to education and parenting support may also reinforce patterns of adaptive parenting practices, while economic stability and proximal parenting support appear crucial to reducing use of harsh disciplinary practices. Public health strategies that strengthen parenting self-efficacy and social connectedness may enhance parental capacity to nurture child mental health resilience. Prevention-focused, culturally responsive support and improved access to parenting resources could advance health equity for families and communities.
139. Life Course Trajectories for Young Pasifika in Aotearoa: Protocol for the 25-Year Follow-Up of the Pacific Islands Families Study Cohort. Tautolo E.S., Bakir-Demir T., Jalili-Moghaddam S., Savila F., Kokaua J., Schluter P.J., Ofe-Grant M.B., Rush E., Mohammed J., Vaka S., Tiatia-Siau J., Cammock R., Te Ao B., Fa'alili-Fidow J., Fifita M.E., Manuela S., Iusitini L. (2025). JMIR Research Protocols, 14:e77460. https://doi.org/10.2196/77460
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Background: From birth, many young Pacific people in Aotearoa New Zealand experience a disproportionately high burden of psychological distress, metabolic disease, and socioeconomic disparities within education and employment which contribute to significant health inequalities. Further research is needed to understand the drivers influencing these outcomes. Objective: This paper provides a comprehensive overview of the quantitative component of the Pacific Island Families Study: Ala mo Tupulaga Pasifika Aotearoa (PIF:ATP; Life Course Trajectories for Young Pasifika in Aotearoa), the latest follow-up of the longitudinal PIF birth cohort study, which uses a mixed-methods approach. Methods: The PIF Study is a multidisciplinary longitudinal study that tracks the health and development of 1398 Pacific children born in 2000 at Middlemore Hospital, South Auckland, Aotearoa, New Zealand. Data collection has occurred at 10 time points from infancy through young adulthood, with this PIF:ATP assessment phase occurring at ages 25‐26 years, which aims to reach at least 750 cohort members. The assessments will take place at participants’ homes or at Auckland University of Technology for those residing in Auckland. Data collection will be conducted across multiple sites, including Auckland, Wellington, Hamilton, and Whangārei in Aotearoa New Zealand, as well as Brisbane, Sydney, and Melbourne in Australia. Physical measurements such as weight, height, waist and hip circumferences, grip strength, body fat mass and muscle mass, blood pressure and pulse, glucose and lipid screening, and skin carotenoid concentration will be undertaken. In addition, self-reported data will be collected on psychological well-being (eg, depression, anxiety, and family functioning), nutritional and metabolic well-being (eg, food intake and physical activity), and economic well-being (eg, educational attainment, employment status, and job occupation and industry). Results: Data collection is scheduled to commence in June 2025 and conclude by December 2026. The first set of results and analysis is expected to be published from December 2027 onward. Reporting of all results will comply with the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines. Conclusions: This paper presents the protocol for the 25-year follow-up of the first Pacific longitudinal cohort study, which will comprehensively examine psychological, nutritional, metabolic, and economic well-being of Pacific young adults. With 25 years of longitudinal data and extensive expertise in life course research, this protocol outlines the design, methodology, and scope of the quantitative component of the PIF:ATP research program. This phase is uniquely positioned to address key issues identified by Pacific communities and generate evidence to inform meaningful interventions and guide policy development while providing robust, contemporary, high-quality empirical evidence.
138. Pacific Islands Families Study: Serum Uric Acid in Pacific Youth and the Associations with Free-Sugar Intake and Appendicular Skeletal Muscle Mass.Jalili-Moghaddam, S., Mearns, G., Plank, L.D., Tautolo, E.S., Rush, E. (2025). Nutrients, 17(1):54. https://doi.org/10.3390/nu17010054
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Background: Fructose (50% of sucrose/sugar) is one component of free-sugars and is metabolized to uric acid, which is a known risk factor for gout and metabolic syndrome. Pacific peoples in New Zealand experience a higher prevalence of gout, type 2 diabetes, and overweight/obesity than other ethnic groups. Interestingly, despite having a similar body mass index (BMI), they tend to have a higher proportion of appendicular skeletal muscle mass (ASMM) and less fat than other ethnic groups. Given this context, this study aimed to evaluate the associations between serum uric acid (SUA), free-sugar intake, and ASMM. Methods: In a nested sub-study from the Pacific Islands Families birth-cohort study, 101 boys and 99 girls (all aged 14 and 15 years) self-reported how often they had consumed foods containing sugar in the past month. Anthropometry, body fatness, and ASMM by dual-energy X-ray absorptiometry and metabolic risk factors, including SUA were measured. Results: Overall, 43% of girls and 57% of boys consumed ‘sugary drinks’ twice or more a day. When analyzed by group, ASMM was positively related to SUA for both boys and girls (r = 0.593, p < 0.0001). The effect of the intake of ‘sugary drinks’ on SUA (r = 0.176, p = 0.013) was reduced when ASMM was considered in the relationships. Conclusions: This study shows high SUA levels in Pacific adolescents, with a positive association between ASMM and SUA in both genders. Sugary drink intake was positively associated with SUA in both boys and girls. High ASMM in Pacific people and an increased risk for raised SUA make it important to work with Pacific communities to reduce added sugar intake and adopt integrated, family-based, culturally centered, and life-course approaches to prevent chronic diseases, including gout.
137. Pacific Islands Families Study: Food insecurity during pregnancy and secondary school educational achievement. Rush E., Iuistini L., Tautolo E.S., Plank L. (2024). Proceedings of the Nutrition Society, 83(OCE1):E114. https://doi:10.1017/S0029665124001320
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The nutritional environment in early life is a key factor for brain development and function. It is important to understand the relationship between early life nutrition and academic achievement in adolescence. The Pacific Islands families (PIF) birth cohort(1) were born in the year 2000. When their child was 6 weeks old mothers were asked questions concerning food security over the last year. Two binary measures of food security were derived as previously used in PIF and also by the Ministry of Health (MOH). Records of academic achievement for 649 youth were obtained from the National Certificate of Educational Achievement database in 2019. Highest qualifications and a composite ranking score allowed achievement to be assessed at levels 1, 2 and 3 of NCEA and for University Entrance (UE, lowest to highest). More females (27%) than males (18%) achieved UE as their highest qualification and more males (40%) than females (31%) achieved level 1 or 2 as their highest qualification. UE was achieved by 25% of those born into food secure households and 17% from food insecure households. Logistic regression demonstrated that being female increased the odds of achieving UE 1.8 fold and food security a further 1.6 fold. The prevalence of food insecurity was not different by sex but high at 29% and 42% using the PIF and MOH measure of food insecurity respectively. This work emphasises the importance of maternal and early life food security for subsequent academic achievement and the well-being of future generations.
136. Understanding suicidality in Pacific adolescents in New Zealand using network analysis. Gossage, L.E., Narayanan, A,, Dipnall, J.F., et al. (2023). Suicide and Life-Threatening Behavior, 53, 826–842. https://doi.org/10.1111/sltb.12986
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Introduction: Pacific adolescents in New Zealand (NZ) are three to four timesmore likely than NZ European adolescents to report suicide attempts and havehigher rates of suicidal plans. Suicidal thoughts, plans, and attempts, termed sui-cidality in this study, result from a complex dynamic interplay of factors, whichemerging methodologies like network analysis aim to capture.Methods: This study used cross-sectional network analysis to model the relation-ships between suicidality, self-harm, and individual depression symptoms, whilstconditioning on a multi-dimensional set of variables relevant to suicidality. Aseries of network models were fitted to data from a community sample of NewZealand-born Pacific adolescents (n = 550; 51% male; Mean age (SD) = 17 (0.35)).Results: Self-harm and the depression symptom measuring pessimism had thestrongest associations with suicidality, followed by symptoms related to having anegative self- image about looks and sadness. Nonsymptom risk factors for self-harm and suicidality differed markedly. Conclusions: Depression symptoms varied widely in terms of their contribu-tion to suicidality, highlighting the valuable information gained from analys-ing depression at the symptom-item level. Reducing the sources of pessimismand building self-esteem presented as potential targets for alleviating suicidalityamongst Pacific adolescents in New Zealand. Suicide prevention strategies needto include risk factors for self-harm
style="text-align:justify">135. Respiratory Health of Pacific Youth: Nutrition Resilience and Risk in Childhood. Zhai, S., Vandal, A. C., Jalili-Moghaddam, S., Byrnes, C. A., Wong, C., Iusitini, L., & Tautolo, E.S. (2023). Medical Sciences Forum, 18(1), 27. https://doi.org/10.3390/msf2023018027
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In New Zealand, 7% of deaths are related to respiratory diseases, and Pacific people are at higher risk. This work investigated the causal effects of early-life nutritional factors on early-adulthood lung function among Pacific Islands Families Study cohort members, who consist of the 1398 individuals born from Pacific Island families in Middlemore Hospital between March and December 2000.A total of 466 people from the cohort participated in the respiratory study. The primary outcome was the forced expiratory volume in 1 s (FEV1) z-score at age 18 years. FEV1 and healthy lung function (HLF), defined as the z-score being larger than −1.64, were secondary outcomes. Nutrition and other information were previously collected in 4 measurement waves at ages 4, 6, 9, and 14 years. Food portions consumed daily were totaled within each of the 12 food categories at each measurement wave. Exploratory and multi-group confirmatory factor analyses identified 4 eating patterns represented by nutritional factor scores (NFS), identified as “Occasional”, “Seafood”, “Fruit and vegetables”, and “Meat”. The NFS were scaled to portions per day. Confounders were identified using a causal-directed acyclical graph. Semi-parametric linear and relative risk regression models were fitted to estimate the causal effects of NFS on respiratory outcomes, using estimated weights compensating for attrition-induced selection bias. The population-attributable fractions of HLF for each NFS were estimated for each measurement wave. HLF cohort prevalence was estimated at 90% (95% confidence interval [CI] [0.86, 1.00]), lower than the expected 95%. Only the “Fruit and vegetables” eating pattern at 9 years was found to have a statistically significant causal effect on the FEV1 z-score in early adulthood (change in FEV1 z-score: +0.25, 95%CI [0.00, 0.43]). The proportion of HLF attributable to the “Fruit and vegetables” eating pattern at 9 years was estimated at 11% (95%CI [0.00, 0.19]). Results suggest a positive impact of consuming more fruit and vegetables during childhood on respiratory health later in life. There is a need to support healthier food environments for Pacific children and provide access to healthier food choices.
134. Pacific Islands Families Study: Household Food Security during Pregnancy and Secondary School Educational Achievement. Iusitini L., Tautolo E.S., Plank L.D., Rush E. (2023). Nutrients, 15(19), 4131; https://doi.org/10.3390/nu15194131
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Nutritional environment in early life is a key factor for brain development and function. It is important to understand the relationship between nutrition in early life and academic achievement in adolescence. The birth cohort of the Pacific Islands Families (PIF) study was born in the year 2000. When their child was six weeks old, mothers were asked questions concerning food security over the past year. Two binary measures of food security were derived as previously used in PIF and also by the Ministry of Health (MOH). In 2020, records of academic achievement from the National Certificate of Educational Achievement (NCEA) for 649 (317 female, 332 male) cohort members showed progressive achievement at levels 1, 2, and 3 of NCEA and allowed University Entrance (UE) to be assessed. The prevalence of food insecurity was not different for sex but high at 29% and 42% using the PIF and MOH definitions of food insecurity, respectively. More females (27%) than males (18%) achieved UE as their highest qualification, and more males (40%) than females (31%) achieved NCEA levels 1 or 2 as their highest qualification. UE was achieved by 25% of those born into food-secure households and 17% from food-insecure households. Logistic regression demonstrated that the odds of achieving UE were 1.8-fold (95% CI 1.2, 2.6, p = 0.003) higher in females than males and, independently, 1.6-fold (95% CI 1.1, 2.5 p = 0.026) higher if the household was food secure. This work emphasises the importance of maternal and early-life food security for subsequent academic achievement and the well-being of future generations.
133. The relationship between sleep duration and health among Pacific adolescents within New Zealand: Findings from the Pacific Islands families study. McLay L., Tautolo E.S., Iusitini L., Richards R., Galland, B., Schluter, P.J. (2023). Australian and New Zealand Journal of Public Health, 47 (2); https://doi.org/10.1016/j.anzjph.2023.100021.
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Objective: Sleep insufficiency is bi-directionally associated with adverse behavioural, physical and mental health outcomes in paediatric populations. However, little is known about the degree of sleep insufficiency and its effect on Pacific adolescents’ wellbeing. Methods: A cross-sectional study of 14-year old Pacific adolescents nested within a longitudinal birth cohort was conducted. Self-reported\ sleep duration was related to sentinel physical, mental, and risk-taking behaviour measures in crude and adjusted logistic regression models. Complete case and multiple imputed analyses were conducted. Results: 916 Pacific adolescents were eligible, with a mean age of 14.2 years. Valid sleep data were available from 828 (90.4%) participants, with only 220 (26.6%) meeting the recommended amount of sleep. Insufficient sleep duration was associated with significantly higher rates of depressive symptoms and risk-taking behaviours. In multiple imputed analyses, increased body mass index was also significantly related. Conclusions: Sleep insufficiency is ubiquitous among Pacific adolescents and associated with negative impacts on their health and wellbeing. Implications for public health: Insufficient sleep duration is amenable to change. Bespoke, culturally responsive public health strategies that draw attention to the importance of positive sleep practices are needed. Particularly, among adolescents who are at risk of experiencing the greatest burden of insufficient sleep.
132. Depression, anxiety and worry in young Pacific adults in New Zealand during the COVID-19 pandemic. Siegert R.J., Narayanan A., Dipnall J., et al. (2022). Australian & New Zealand Journal of Psychiatry, 57(5):698-709. https://doi.10.1177/00048674221115641
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Objective: To measure symptoms of anxiety, depression and hopelessness in a sample of young Pacific adults living in Auckland, New Zealand during the 2020/2021 COVID-19 pandemic and identify protective factors. Methods: Participants were 267 Pacific adults (58% female) who completed a survey online. Analyses included descriptive statistics, correlations, linear regression and symptom network analysis. Results: Around 25% of the sample scored in the range for moderate to severe anxiety and 10% for moderate to severe depression on standard measures. Almost 40% indicated that they found the first lockdown very stressful and 55% noted that some members of their family found it stressful. Only 16% worried about COVID-19 and their future quite a bit or constantly, while another 25% worried sometimes. Self-compassion and Pacific Identity had moderate, negative correlations, and Worry about COVID-19 had weak positive correlations, with anxiety, depression, hopelessness and perceived stress. Conclusion: These results suggest that, while the prevalence of depression and anxiety are quite high among this population, fostering ethnic identity and self-compassion in Pacific children and adolescents might protect against developing depression and anxiety.
131. Relationship between perceived and measured body size among Pacific 14-year-olds in Aotearoa | New Zealand: findings from the Pacific Islands Families Study. Lousich K.L., Tautolo E.S., Schluter P.J. (2023). Journal of Paediatrics and Child Health, 2023;59(8):968-973. doi: 10.1111/JPC.16442.
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Aim: Pacific people carry a disproportionate burden of socio-cultural and economic determinants of health in Aotearoa | New Zealand (NZ), and 61.7% of Pacific children aged 0–14 years are overweight or obese. Yet Pacific children's self-perception of their body size is unknown. This population-based study aimed to investigate the concordance between measured and perceived body size in a cohort of Pacific 14-year-olds in NZ, and to assess how this relationship is influenced by their cultural orientation, socio-economic deprivation and degree of recreational internet use. Methods: The Pacific Islands Families Study tracks a cohort of Pacific infants born in the year 2000 at Middlemore Hospital, South Auckland. This study is a nested cross-section of participants at the 14-year postpartum measurement wave. Following strict measurement protocols, body mass index was measured and categorised according to the World Health Organization classifications. Agreement and logistic regression analysis methods were employed. Results: Of 834 participants with valid measures, 3 (0.4%) were measured as being underweight, 183 (21.9%) as normal, 235 (28.2%) as overweight and 413 (49.5%) as obese. Overall, 499 (59.8%) perceived their body size to have a lower classification than that when measured. Neither cultural orientation nor deprivation was significantly related to weight misconception but recreational internet use was, with higher use associated with increased misconception. Conclusions: Improving body size awareness together with the risk of higher recreational internet use is likely to be an important component in any population-based healthy weight intervention formulation for Pacific adolescents.
130. Environmental Influences on the Behavioural and Emotional Outcomes of Children: A Network Analysis. Karatela, S., Ward, N. I., Paterson, J., & Zeng, I. S. (2022). International Journal of Environmental Research and Public Health, 19(14), 8479. http://dx.doi.org/10.3390/ijerph19148479
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Background: Intellectual developmental disorders are a serious source of health morbidity with negative consequences for adults as well as children. However, there is limited evidence on the environmental, trace element, behavioural, and emotional outcomes in children. Here, we investigated whether there is any association between child behaviour and emotional outcomes and micronutrients using network analysis. Methods: A cross-sectional study was conducted in 9-year-old children within a Pacific Island Families study birth cohort. Elemental concentration was determined in children’s toenails after acid digestion and analysed using inductively coupled plasma mass spectrometry. We used network analysis to identify closely associated trace elements and tested the directions and strength of these trace elements. MANCOVA were used to identify the significant associations between individual elements and the behavioural/emotional function of the children using the children behaviour checklist (CBCL). At the final step, quantile regression analysis was used to assess and quantify the identified associations between CBCL function scores and manganese, adjusted by sex, ethnicity, and standardized BMI. Results: Three major nutrient networks were identified. In the Mn network, Mn was strongly positively associated with Al (0.63) and Fe (r = 0.65) and moderately associated with Pb (r = 0.45) and Sb (r = 0.42). Al was also strongly associated with Fe (r = 0.9). Children in the second or third clinical group, with an elevated externalized CBCL score, had a much higher mean and median level of Mn as compared to the normal range group. The aggression score was significantly associated with Mn concentration and sex. Higher Mn concentrations were associated with a higher aggression score. A 1 ug/g unit increase in Mn was associated with a 2.44-fold increase (95% confidence interval: 1.55–4.21) in aggression score, and boys had higher median aggression score than girls (difference: 1.7, 95% CI: 0.9–2.8). Attention and rule breaking scores were both significantly associated with Mn concentration. Higher Mn concentrations were associated with higher attention behaviour problem and rule breaking scores. A 1 ug/g unit increase in Mn was found to be associated with a 1.80-fold increase (95% confidence interval: 1.37–2.82) in attention score, and a 1.46-fold increase (95% confidence interval: 1.01–1.74) in the rule breaking score. Thought score was not significantly associated with Mn concentration (p = 0.13) but was significantly lower in boys (p = 0.004). Conclusions: Exceeding Mn levels is potentially toxic and has been identified to be associated with worse externalized children’s behavioural health and emotional well-being. Future studies are necessary to find the exposure paths so that advice shall be provided to family and care providers in public health and environmental protection.
129. Parental education related to their children’s health in late childhood and early adolescence for Pacific families within New Zealand. Schluter P.J., Kokaua J., Tautolo E.S., Iusitini L., Richards R., Ruhe T. (2022). Scientific Reports, 12(1):5313. doi: 10.1038/s41598-022-09282-x.
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Pacific people continue to carry a disproportionately heavy social and health burden relative to their non-Pacific peers in New Zealand, and those with less formal education are experiencing social and health declines. Improving education and educational needs is seen as being central to decreasing these health inequities. While expansive, the empirical evidence-base supporting this stance is relatively weak and increasingly conflicting. Using a large birth cohort of 1,368 eligible Pacific children, together with their mothers and fathers, this study longitudinally investigates the relationship between paternal education levels and sentinel measures of their children’s physical health, mental health and health risk taking behaviours during late childhood and early adolescence. In adjusted analyses, it was found that mothers and fathers who undertook further schooling over the 0–6 years postpartum period had children with significantly lower logarithmically transformed body mass index increases at 11-years and 14-years measurement waves compared to 9-years levels than those who did not study (p = 0.017 and p = 0.022, respectively). Furthermore, fathers who undertook further schooling over this 0–6 years postpartum period also had children with significantly lower odds of risk taking behaviours (p = 0.013). These results support policy aimed at increasing educational opportunities for Pacific people in New Zealand.
128. Relationships between physical function, body composition and metabolic health in Pacific Island youth. Rush, E.C., Coppinger, T., Jalili-Moghaddam, S., Tautolo, E.S., Plank, L.D. (2021). PloS One. Published on February 17, 2022. https://doi.org/10.1371/journal.pone.0260203
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The Pacific Islands Families (PIF) study is a birth cohort study designed to increase knowledge about the growth and development of Pacific children living in Auckland, New Zealand. Adolescence is a critical time of growth and development, yet the roles of physical function and body composition in metabolic health at this life stage are not clear. We aimed to investigate associations between measures of physical function (the 6-minute-walk-test (6MWT)), heart rate changes before and after the 6MWT, handgrip strength, body composition including appendicular skeletal muscle mass (ASMM) measured by dual-energy X-ray absorptiometry and biomarkers of metabolic health from a fasting blood sample.A total of 200 youth (98 girls, 102 boys) aged 14–15 years, from the birth-cohort of children in the Pacific Islands families study were measured. In girls, the proportion of ASMM was lower and fat higher than in boys. Controlling for age, a 1% increase in ASMM predicted a longer walk distance (+6.3, 95%CI 2.2, 10.4 m in girls; +7.1, 95%CI 4.4, 9.1 m in boys) and lower heart rate following the 6MWT. ASMM and fat mass were independently predictive of maximal handgrip strength which was increased by 1.4 (1.0,1.8) kg in girls and 1.7 (1.3, 2.0) kg in boys for each kg increase in ASMM and reduced by 0.23 (0.08, 0.38) kg in girls and 0.26 (0.14, 0.37) kg in boys for each kg increase in fat mass. Lower total cholesterol and LDL were associated with an increase in distance walked in boys only. For each year of age, distance walked was reduced by 34 (15, 53) m in girls and 59 (36,84) m in boys. These findings should be explored further in the context of other influences such as food security, opportunities for physical activity and cultural expectations.
127. Pacific Islands Families Study: adverse impact of food insecurity on child body composition. Oyama, S., Tautolo, E.S., Tukuitonga, C., Rush, E.C. (2021). The New Zealand Medical Journal, 134 (1543), 3-38
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Aim: COVID-19 has exacerbated food insecurity, unemployment, inequities and poverty in Aotearoa. Here, we tested the hypothesis that exposure to malnutrition due to household food insecurity during foetal life and early infancy is associated with body composition in adolescence. Methods: As part of the Pacific Islands Families Study, 1,376 Pacific Island mothers were asked questions about food security at six weeks postpartum in the year 2000. At age 14 years, 931 youth completed in-school assessments of height and weight. Of these youth, 10 girls and 10 boys from each weight decile were randomly selected to participate in a nested sub-study involving dual x-ray absorptiometry measurements, which included appendicular skeletal muscle mass (ASMM) and visceral adipose tissue (VAT). Results: Boys born to families experiencing food insecurity had greater birthweights and greater % fat, less % ASMM and greater % VAT of total weight at age 14 years compared to boys born into food secure households. In contrast, there were no differences in birthweight or body composition at age 14 years by household food insecurity status among girls. Conclusion: This study shows that household food insecurity during early development is associated with higher abdominal and visceral fat in boys, which may have health risks in later life.
126. Visual impairment and its correction among Pacific youth in Aotearoa: findings from the Pacific Islands Families Study. Hamm, L.M., Johnson, I.A., Jacobs, R.J., Paterson, J.E., Tautolo, E.S., Iusitini, L., Garrett, L. Purdy, S.C. (2021). The New Zealand Medical Journal, 134 (1543), 39-50.
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Aim: Childhood visual impairment has a life-long impact that, with early access to eyecare, is largely avoidable. We aimed to understand visual impairment and its correction among Pacific youth in Aotearoa New Zealand. Method: The Pacific Islands Families Study is a birth cohort study that tracks an original sample of 1,398 Pacific children born at Middlemore Hospital (Auckland). This analysis focuses on assessed visual acuity (at 9- and 18-years, using 0.3logMAR or 6/12 as the cut-off for visual impairment) and participants' self-reports about accessing eyecare services. Results: Less than a fifth of children (111/729, 15.2%) and teens (86/457, 18.8%) reported having sought eyecare. The percentage of participants with refractive correction was 3.6% (32/887) at 9-years and 14.3% (66/463) at 18-years. At 9-years, 1.9% of children (16/853) had visual impairment in one eye only, and 0.9% (8/853) had visual impairment impacting both eyes. By 18-years these values increased to 7.9% (36/456) and 4.2% (19/456), respectively. Among those with visual impairment, most children (15/24, 62.5%) and teens (32/55, 58.2%) reported they did not have refractive correction. Conclusion: Although prevalence of visual impairment is relatively low compared to non-Pacific youth, much of the reported impairment appears to be avoidable with improved eyecare.
125. Pre-teen gang involvement is associated with teenage gambling behaviour: Exploratory findings from a longitudinal cohort study of Pacific youth in New Zealand.Bellringer, M. E., Pearson, J., & Iusitini, L. (2021). Asia Pacific Journal of Public Health, 34(1), 72–78. https://doi.org/10.1177%2F10105395211041183
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Pacific youth in New Zealand have a disproportionately high risk for gambling and gang involvement compared with New Zealand European youth. Limited evidence indicates that youth gang involvement is associated with problem gambling; no research shows if it is associated with gambling. We conducted exploratory secondary analyses of data from 1063 Pacific youth and their mothers using data from two time points (age nine and 14 years) from a longitudinal cohort study. Gang involvement at age nine years was significantly associated with gambling at age 14 years, with adjusted odds of 2.25 (95% CI [1.16, 4.37]). Of confounders, having a mother with a partner and Cook Islands ethnicity appeared protective against gambling at age 14 years. Despite some study limitations, as youth gambling can lead to subsequent adult problem gambling, our findings highlight the importance of understanding why Pacific youth join gangs, to inform public health policies to reduce the potential for future development of harmful behaviors
124. Respiratory Health of Pacific Youth: An Observational Study of Associated Risk and Protective Factors Throughout Childhood. Tautolo, E., Wong C., Vandal, A., Jalili-Moghaddam, S., Griffiths, E., Iusitini, L., Trenholme, A., Byrnes, C. (2020). JMIR Research Protocols, 9(10):e18916. URL: https://www.researchprotocols.org/2020/10/e18916. DOI: 10.2196/18916
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Background: Respiratory disease is the third most common cause of death in New Zealand, with Pacific people living in New Zealand bearing the greatest burden of this type of disease. Although some epidemiological outcomes are known, we lack the specifics required to formulate targeted and effective public health interventions. The Pacific Islands Families (PIF) birth cohort study is a study that provides a unique source of data to assess lung function and current respiratory health among participants entering early adulthood and to examine associations with early life events during critical periods of growth. Objective: This paper aims to provide an overview of the design, methods, and scope of the Respiratory Health of Pacific Youth Study, which uses the overall PIF study cohort aged 18-19 years. Methods: From 2000-2019, the PIF study has followed, from birth, the growth, and the development of 1398 Pacific children born in Auckland, New Zealand. Participants were nested within the overall PIF study (at ages 18-19 years) from June 2018, and assessments were undertaken until mid-November 2019. The assessments included respiratory and general medical histories, a general physical examination, assessment of lung function (forced expiratory volume and forced vital capacity), self-completed questionnaires (St George’s Respiratory Questionnaire, European Quality of Life 5 Dimensions-3 Level, Epworth Sleepiness Scale for Children and Adolescents, and Leicester Cough Questionnaire), blood tests (eosinophils, Immunoglobulin E, Immunoglobulin G, Immunoglobulin A, Immunoglobulin M, and C-reactive protein), and chest x-rays. Noninferential analyses will be carried out on dimensionally reduced risk and protective factors and confounders. Results: Data collection began in June 2018 and ended in November 2019, with a total of 466 participants recruited for submission of the paper. Collection and collation of chest x-ray data is still underway, and data analysis and expected results will be published by November 2020. Conclusions: This is the first longitudinal observational study to address the burden of respiratory disease among Pacific youth by determining factors in early life that impose long-term detriments in lung function and are associated with the presence of respiratory illness. Identifying risk factors and the magnitude of their effects will help in adopting preventative measures, establishing whether any avoidable risks can be modified by later resilient behaviors, and provide baseline measurements for the development of respiratory disease in later adult life. The study results can be translated into practice guidelines and inform health strategies with immediate national and international impact.
123. The Importance of Pedestrian Network Connectivity for Adolescent Health: A Cross-sectional Examination of Associations between Neighbourhood Built Environments and Metabolic Health in the Pacific Islands Families Birth Cohort Study. Smith, M., Obolonkin, V., Plank, L., Iusitini, L., Forsyth, E., Stewart, T., Paterson, J., et al. (2019). International Journal of Environmental Research and Public Health, 16(18), 3375. MDPI AG. Retrieved from http://dx.doi.org/10.3390/ijerph16183375
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The research aim was to investigate associations between objectively-assessed built environment attributes and metabolic risk in adolescents of Pacific Islands ethnicity, and to consider the possible mediating effect of physical activity and sedentary time. Youth (n = 204) undertook a suite of physical assessments including body composition, blood sampling, and blood pressure measurements, and seven day accelerometry. Objective measures of the neighbourhood built environment were generated around individual addresses. Logistic regression and linear modelling were used to assess associations between environment measures and metabolic health, accounting for physical activity behaviours. Higher pedestrian connectivity was associated with an increase in the chance of having any International Diabetes Federation metabolic risk factors for males only. Pedestrian connectivity was related to fat free mass in males in unadjusted analyses only. This study provides evidence for the importance of pedestrian network connectivity for health in adolescent males. Future research is required to expand the limited evidence in neighbourhood environments and adolescent metabolic health
122. A Prediction Model for Childhood Obesity in New Zealand. Butler, É.M., Pillai, A., Morton, S.M.B., Seers, B.M., Walker, C.G., Ly, K., Tautolo, E., Glover, M., Taylor, R.W., Cutfield, W.S., Derraik, J.G.B., COPABS Collaborators. (2021). Scientific Reports, 11(1):6380. doi: 10.1038/s41598-021-85557-z
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Several early childhood obesity prediction models have been developed, but none for New Zealand's diverse population. We aimed to develop and validate a model for predicting obesity in 4–5-year-old New Zealand children, using parental and infant data from the Growing Up in New Zealand (GUiNZ) cohort. Obesity was defined as body mass index (BMI) for age and sex ≥ 95th percentile. Data on GUiNZ children were used for derivation (n = 1731) and internal validation (n = 713). External validation was performed using data from the Prevention of Overweight in Infancy Study (POI, n = 383) and Pacific Islands Families Study (PIF, n = 135) cohorts. The final model included: birth weight, maternal smoking during pregnancy, maternal pre-pregnancy BMI, paternal BMI, and infant weight gain. Discrimination accuracy was adequate [AUROC = 0.74 (0.71–0.77)], remained so when validated internally [AUROC = 0.73 (0.68–0.78)] and externally on PIF [AUROC = 0.74 [0.66–0.82)] and POI [AUROC = 0.80 (0.71–0.90)]. Positive predictive values were variable but low across the risk threshold range (GUiNZ derivation 19–54%; GUiNZ validation 19–48%; and POI 8–24%), although more consistent in the PIF cohort (52–61%), all indicating high rates of false positives. Although this early childhood obesity prediction model could inform early obesity prevention, high rates of false positives might create unwarranted anxiety for families.
121. The Association Between Hearing Impairment and Problem Behaviors in 11-Year-Old Pacific Children Living in New Zealand. Paterson, J., Purdy, S., Tautolo, E., Iusitini, L., Schluter, P.J., Sisk, R. (2020). Ear and Hearing, 41 (3), 539-548. doi: 10.1097/AUD.0000000000000777
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Objectives: Hearing impairment in childhood is a serious disability that can impose a heavy social and economic burden on individuals and families. It was hypothesized that hearing loss or middle ear disease in 11-year-old Pacific children living in New Zealand would be associated with higher levels of engagement in (1) delinquent behaviors, and (2) clinical level internalizing and externalizing problem behaviors than Pacific children with no hearing loss or middle ear disease. Based on earlier findings, peer pressure, self-perception, physical punishment (slapping), sex, and ethnicity were controlled for in the association between hearing difficulties and behavioral outcomes. Design: In the school setting, pure-tone audiometry and immittance audiometry assessments were used to establish the hearing level in 11-year-old Pacific children (n = 920). These children also completed multidisciplinary questionnaires, which included questions about involvement in delinquent behaviors, peer pressure, and self-perception. In the home setting, maternal reports were gathered on internalizing and externalizing problem behaviors in their offspring, their parenting style, and sociodemographic details. Results: A significant effect of hearing level was detected for the odds of reporting mild delinquency versus no delinquency (odds ratio: 1.02, 95% CI: 1.00 to 1.05), and odds of moderate delinquency versus no delinquency (odds ratio: 0.97, 95% CI: 0.94 to 1.00). No significant effect was detected for hearing level and severe delinquency or internalizing or externalizing behavioral problems in the clinical range. Middle ear disease (abnormal tympanogram in the worse ear) was not significantly associated with delinquency at any level or with internalizing behaviors in the clinical range. However, children with middle ear disease were significantly less likely than all other participants to exhibit disruptive externalizing behavior in the clinical range. Conclusions: Relatively young children with hearing loss reported engagement in moderate levels of delinquency that represent serious antisocial and potentially violent acts. This finding provides evidence of the significant effect that hearing loss has on child behavior. This association between hearing loss and moderate delinquency requires ethnic-specific interventions that are targeted for maximum benefit at appropriate times in childhood to mitigate potentially long-term health, educational, and behavioral risks.
120. Pacific and English Language Fluency and Mental Disorder Symptom Indications Among Pacific Mothers in New Zealand: Findings From the Pacific Islands Families Study. Schluter, P.J., Collet, O.A.M., Tautolo, E., Iusitini, L., Kokaua, J., Paterson, J. (2020). Asia Pacific Journal of Public Health. Published on 10 September 2020. https://doi.org/10.1177/1010539520956433
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Within New Zealand (NZ), Pacific people experience higher prevalence of mental disorder than non-Pacific people. Bilinguals are believed to have psychological advantages over monolinguals, although the empirical evidence base is equivocal. A prospective cohort of Pacific mothers was studied at 6 weeks (n = 1272), 1-year (n = 1135), and 2-year (n = 1059) postpartum. At 6 weeks, 343 (27.0%) mothers were fluent in both Pacific and English languages, 519 (40.8%) only fluent in Pacific language(s), and 410 (32.2%) only fluent in English. Over assessment waves, 16.0%, 12.5%, and 8.7% of mothers had mental disorder symptom indications. In adjusted generalized estimating equation analysis, mothers speaking English only had odds of mental disorder symptom indication 2.24 (95% confidence interval [CI] = 1.44-3.49) that of bilingual mothers, while those who spoke Pacific language(s) only had odds of 1.52 (95% CI = 0.95-2.42). Supporting Pacific and English languages within NZ may confer mental health benefits to new Pacific mothers and potentially others.
119. Perceptions of Pacific children’s academic performance at age 6 years: A multi-informant agreement study. Hyun Min Kim, H.M., McNeill, B., Everatt, J., Taleni, L.T., Tautolo, E., Gillon, G., Schluter, P.J. (2020). PLoS ONE. Published on 16 October 2020. https://doi.org/10.1371/journal.pone.0240901
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Purpose: In New Zealand, Pacific immigrants are among the fastest growing ethnic minorities but, as a group, they are also at most risk of not realising their literacy and educational aspirations critical for achieving their human potential and wellbeing. This may be due, in part, to a misalignment in the shared understanding of academic success between students, parents and their teachers within largely non-Pacific school environments. This study aims to report levels of agreement in child-mother, child-teacher, and mother-teacher perceptions of Pacific children’s academic performance at age 6 years. Method: A cohort of Pacific infants born during 2000 in Auckland, New Zealand, was followed as part of the Pacific Islands Families study. Maternal home interviews were conducted at 6-weeks and 6-years postpartum, together with separate child and teacher elicitations at 6-years. Pairwise agreement of academic performance responses was assessed using Cohen’s weighted κ statistic, along with symmetry and marginal homogeneity tests. Results: At 6-years, information was available for 1,001 children and their mothers, and teachers’ evaluations for 549 children. Negligible to slight agreements and significant asymmetry were found between the child-mother (κ = 0.03, 95% CI: -0.03, 0.09), child-teacher (κ = 0.04, 95% CI: 0.01, 0.08), and mother-teacher (κ = 0.07, 95% CI: 0.03, 0.11) pairwise assessments–with children and mothers more likely to rate Pacific children’s academic performance higher than their teachers. Significantly higher concordances with teacher assessments were found among mothers with post-secondary education, proficiency in English, and stronger alignment with New Zealand culture and for children who performed strongly on a standardised measure of performance relative to their peers. Conclusion: Strategies are needed to align Pacific students’ and parental perceptions with documented educational achievement outcomes and to facilitate more effective and timely feedback on achievement results and home-school communication. The importance of removing language, cultural and socio-economic barriers to achieving shared understanding of academic performance between teachers and families is highlighted.
118. Pacific Islands Families Study: Patterns of Intimate Partner Violence Among Pacific Mothers. Paterson, J., Prah, P., Tautolo, E., Iusitini, L. (2020). Journal of Interpersonal Violence, https://doi.org/10.1177/0886260520938510
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Intimate partner violence (IPV) is a widespread social problem affecting all populations regardless of gender, race, and socioeconomic status. The aims of this study were to examine (a) patterns of IPV among Pacific women living in New Zealand and (b) the risk and protective factors associated with IPV perpetration and victimization. As part of the longitudinal Pacific Islands Families (PIF) Study, maternal interviews, which included reports about IPV, acculturation, and sociodemographic characteristics, were administered at phases 6 weeks, 2, 6, 11, and 14 years postpartum. Age had a significant effect on perpetration of both minor and severe perpetration of IPV, and on being a victim of minor IPV. However, no significant effect was found for severe victimization. Cultural alignment also had a significant effect on perpetration of IPV with Pacific mothers who were strongly aligned to their traditional Pacific culture being significantly less likely to report minor or severe IPV perpetration compared with Pacific mothers who were closely aligned to western culture. Single mothers reported significantly more minor victimization, and those mothers who were more highly educated and were in a higher income bracket were significantly less likely to report severe physical IPV victimization. These findings can inform the timing and targeting of culturally appropriate violence prevention efforts in adolescence and young adulthood that focus on the development of healthy intimate partner relationships and effective methods of conflict resolution.
117. Exposure to Toenail Heavy Metals and Child Behavior Problems in Nine-Year-Old Children: A Cross-Sectional Study. Karatela, S., Coomarasamy, C., Paterson, J., & Ward, N. (2020). International Journal of Environmental Research and Public Health. 17(11), 4120; https://doi.org/10.3390/ijerph17114120
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Behavioral problems are multifactorial and includes perinatal, maternal, family, parenting, socio-economic and personal risk factors, but less is known about the association of postnatal heavy metals on children’s behavioral problems in Pacific Island children. Methods: A cohort of eligible nine-year-old children within a Pacific Island Families longitudinal study were recruited for a cross-sectional study. Child behavior problems were assessed using the child behavior checklist. Heavy metals (including Ni, Cu, Pb, Al, Cr and Cd) were determined in toenails, after acid digestion and analyzed using inductively coupled plasma mass spectrometry. Other factors such as lifestyle (smoking in pregnancy), health outcomes (obesity, health status), demographics (gender, ethnicity, parents’ marital status) and socioeconomic status (household income levels) were also collected. The statistical analysis included t-tests for independent sample and Mann–Whitney U-test, and chi-square or Fisher’s exact tests of independence for comparisons of the proportions. Regression models tested the hypothesized risk factors for behavior outcomes. Results: This observational study enrolled 278 eligible Pacific Island children living in Auckland, New Zealand. The prevalence of behavioral problems in the clinical range was high (22%) but there was no significant association between heavy metals in toenails and adverse behavioral outcomes. Conclusion: Regular monitoring and assessments of children for environmental risk factors, as well as social and lifestyle factors for behavior problems, continues. Alternative indicators of exposure to heavy metal should be evaluated.
116. Household Smoking Status and Heavy Metal Concentrations in Toenails of Children. Shamshad Karatela. Karatela, S., Coomarasamy, C., Paterson, J., & Ward, N. (2019). International Journal of Environmental Research and Public Health, 16(20), 3871. https://doi.org/10.3390/ijerph16203871
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There is limited evidence on the distribution of heavy metals and its association with secondhand smoking (SHS) within Pacific Island children living in New Zealand. Certain heavy metals such as cadmium (Cd), lead (Pb), and aluminum (Al) bioaccumulates in the body and can deteriorate health in both children and adults. Others, such as chromium (Cr) and nickel (Ni) in trace amounts are necessary but become toxic at high levels. Exposure routes of these elements include food, water, and air. The purpose of this study was to identify the distribution of toxic metal concentrations and its possible correlation with SHS within the Pacific Island children. A sub-sample of children within Pacific Island families longitudinal study, at the nine-year phase, who were living in the New Zealand city of Auckland were invited to participate, (n = 278). Toenails were used as a biomarker to determine Cr, Pb, Cd, Cu, Ni, and Al concentration using inductively coupled plasma mass spectrometry. Reliable and validated questionnaires were used for demographics, lifestyle, and health outcome variables. Significant differences between household smoking status and ethnicity, as well as parents’ marital status, were observed (p < 0.05). There was no statistical difference in heavy metal concentrations in smoking versus non-smoking households. However, Cr, Pb, Cd, Cu, and Ni concentrations were all higher than the required optimal health value in both groups. A high concentration of heavy metals was observed in these children that exceeded the value required for optimal health, although no significant difference in heavy metals with regards to secondhand smoking was observed. SHS was associated with children’s ethnicity and parental marital status, but not with household income levels or maternal education.
115. Mercury Exposure in Mother-Children Pairs in A Seafood Eating Population: Body Burden and Related Factors. Karatela,S., Wardand, N., Paterson, J. (2019). International Journal of Environmental Research and Public Health, 16(12), 2238. https://doi.org/10.3390/ijerph16122238
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Mercury is a neurotoxin that affects neurodevelopment in children; however, its association at the lowest concentration is not clear. The main objective of this study is to measure and evaluate mercury concentrations in mother–child pairs and its association demographics, lifestyle, and dietary factors within the Pacific Island Families living in Auckland, New Zealand. Methods: Mercury exposure was assessed in a sub-sample of mother–child pairs who were a part of the Pacific Island Families birth cohort, in Auckland, New Zealand at the 6-year phase. Hair samples were collected from both mothers and their children to determine mercury concentrations. Total mercury was measured using inductively coupled plasma mass spectrometry for hair samples. An interviewer-based reliable food frequency questionnaire (FFQ) examined the frequency of seafood by all the participants. Other variables such as sociodemographic (ethnicity and gender), lifestyle factors (income, education, and smoking status) and health outcomes (child behaviour and obesity) were also collected. Results: In this study, 41% of both mothers and their children had mercury concentrations above the US Environmental Protection Agency (EPA) recommended value of 1 µg/g. Most of the participants ate fish 3 or more times a week. A significant correlation was observed between mother and child hair mercury concentrations (Spearman Rho 0.79 (95% confidence interval (CI): 0.65, 0.88)). Conclusions: Mercury levels in children can be affected by their mothers’ levels due to similar eating patterns.
114: Integrating health, education and culture in predicting Pacific children’s English receptive vocabulary at 6 years: A classification tree approach. Kim, H., Schluter, P., McNeill, B., Everatt, J., Sisk, R., Iusitini, L., Taleni, L., Tautolo, E., Gillon, G. (2019). Journal of Paediatrics and Child Health, 55(10), 1251-1260. doi:10.1111/jpc.14397.
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Aim: Pacific children fare poorly on health and educational outcomes, including literacy. Early interventions are considered critical in reducing educational disparities. A prediction model was constructed to analyse the factors associated with Pacific children's English receptive vocabulary, an important component of English language development. Methods: A birth cohort study of Pacific children was used to construct a classification tree model and predict the proportions of Pacific children who performed strongly in a standardised test of English receptive vocabulary at 6 years of age (n = 1019). Classification trees were constructed using 10-fold cross-validation (CV) and pruned using the one-standard-error rule. Prediction errors were directly estimated using leave-one-out CV. Results: Analyses of misclassification errors from the pruned model gave false negative and positive rates of 19 and 19% from re-substitution and 54 and 21% from leave-one-out CV estimation, respectively. Of the predictors, maternal acculturation, small birthweight and performance in early developmental screening test at 4 years of age were found to have the highest goodness of split. Conclusions: The cultural environment to which Pacific children were exposed in early childhood, indicated by the maternal acculturation, was more crucial in distinguishing children with strong English-receptive vocabulary skills than socio-economic or prenatal conditions. This highlights the importance of integrating the cultural environment into designing measures for facilitating Pacific children's language development. Keywords: Pacific people; acculturation; decision trees; forecasting; vocabulary.
113: Pacific Islands Families Study: Physical growth to age 14 and metabolic risk. Plank, L. D., Obolonkin, V., Smith, M. B., Savila, F., Jalili‐Moghaddam, S., Tautolo, E., & Rush, E. C. (2019). Pediatric Obesity, 14(5), e12497.
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Background:The relationships between the trajectories of weight gain from early childhood to adolescence and risk for metabolic disease are not well understood. Objective:The objective of the study is to examine the relationships between weight gain from 2 to 14 years and metabolic risk factors at age 14 years in Pacific Island children. Methods: z scores for weight were calculated at each of the ages 2.5, 4, 6, 9, 11, and 13.5 years in 1053 children. Growth trajectories were determined by estimating the linear trend of z scores with age for each child. In a subgroup of 204 children, biomarkers of metabolic risk were measured and related to linear trend intercepts and slopes. Results: More rapid growth (greater slope of z score trajectory) was associated with higher concentrations of insulin, leptin (boys), urate, and markers of liver function, insulin resistance and inflammation. Children with higher weights in early life (greater intercept) showed fewer associations with metabolic markers, but considered together, intercept and slope were independently associated with a range of metabolic risk factors. Conclusions: Both rapid weight gain and a higher body weight in early childhood were associated with higher risk for metabolic disease. Monitoring growth trajectories may help target interventions to optimize nutrition, physical activity, and growth.
112: Vegetables: New Zealand Children Are Not Eating Enough. Rush, E., Savila, F, Jalili-Moghaddam, S., & Amoah, I. (2019). Frontiers in Nutrition, published online 8 January 2019. https://doi.org/10.3389/fnut.2018.00134
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We know that eating a variety of vegetables every day is associated with favorable health across the lifecourse. Internationally, food-based dietary guidelines encourage the consumption of a variety of vegetables and fruit but globally,people are not eating enough vegetables to meet the three-or-more-a-day guideline. Vegetables are good sources of vitamins and minerals, fiber, and many bioactive compounds that promote health and provide energy. They also help reduce hidden hunger (micronutrient deficiencies) and support the healthy growth and development of children. New Zealand is a world leader in the production of diverse nutrients and foods yet poverty and other environmental barriers mean only one in two children eats three-or-more servings of vegetables a day. Price and availability are limiting factors. The proliferation of community, school and home vegetable gardens and vegetable cooperatives may improve access. On a macro level, upstream policies such as a “living wage,” affordable housing, and land-use planning are required. International dietary solutions include an agricultural shift to intensified horticulture with a focus on vegetables. The consumption of more plant-based foods including vegetables would reduce green-house gases, reduce land clearing, and help prevent diet-related disease if consumed daily across the lifecourse.
111: Hearing and ear status of Pacific children aged 11 years living in New Zealand: the Pacific Islands families hearing study. Purdy, S. C., Taylor, S., Schluter, P. J., Tautolo, E., Iusitini, L., Ahmad, Z., Sundborn, G., & Paterson, J. (2018). International Journal of Audiology, 58(2), 77-86.
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Objective: This study aimed to determine the prevalence of hearing loss and ear problems in Pacific children, and investigate current and past demographic, health and social factors potentially associated with hearing and ear problems. Design: A cross-sectional observational study design nested within a birth cohort was employed. Study sample: Nine-hundred-twenty Pacific children aged 11 years were audiologically assessed. Using average hearing thresholds at 500, 1k and 2k Hz, 162 (18%) right and 197 (21%) left ears had ≥20 dB hearing loss. Hearing loss was mild (20–39 dB) in most cases; 2% of ears had moderate to moderate-severe (40–69 dB) hearing loss. However, only 101 (11%) children had normal peripheral hearing defined by passing hearing threshold, tympanogram and distortion product otoacoustic emission assessments. Those with confirmed middle ear disease at age 2 years had significantly increased odds of a non-Type A tympanogram (adjusted odds ratio: 2.00; 95% confidence interval: 1.56, 2.50) when re-assessed at age 11 years. Conclusions: Hearing loss, abnormal tympanograms, and auditory processing difficulties were present in many Pacific children. Interventions are also urgently needed to mitigate the effect of the longstanding ear disease likely to be present for many Pacific children.
110: Cultural, individual, and familial risk and protective factors associated with depressive symptoms in Pacific youth living in New Zealand. Paterson, J., Tautolo, E., Iusitini, L., & Sisk, R. (2018). Social Work in Mental Health, 16(6), 725-742.
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This article examines cultural, individual, and familial risk and protective factors associated with depressive symptoms in Pacific youth living in New Zealand. At ages 11 (n = 950) and 14 (n = 931), Pacific youth participated in multidisciplinary interviews that included the Children’s Depression Inventory. Across time points, factors significantly associated with higher depressive symptoms were involvement in bullying and gang activities. Positive parenting was significantly associated with lower depressive symptoms, and Tongan youth were significantly less likely to report depressive symptoms than Samoan youth. Time-varying factors were gender, problem behaviour syndromes, and maternal education. Gaining more knowledge about modifiable risk and protective factors that contribute to depression in Pacific youth is an important tool to support new approaches that promote adaptive psychological adjustment during adolescence.
109: Health literacy of Pacific mothers in New Zealand is associated with sociodemographic factors and non-communicable disease risk factors: surveys, focus groups and interviews. Sa’ulilo, L., Tautolo, E., Egli, V., & Smith, M. (2018). Pacific Health Dialog, 21(2), 67-70.
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Introduction: Pacific people living in New Zealand, suffer from inequitably high rates of noncommunicable diseases and their associated risk factors. This disease burden may be compounded by low health literacy levels. The objectives of this research were: (1) measure relationships between health literacy, socio-demographic factors and non-communicable disease risk factors in a large sample of Pacific mothers living in New Zealand and (2) gain in-depth understanding of social and cultural factors contributing to these relationships. Methods: Logistic regression was employed to investigate health literacy and: acculturation, socioeconomic status, physical activity, education, smoking status, health status, and alcohol consumption. Semi-structured focus groups were conducted with Pacific mothers and interviews with Pacific health professionals adopting the culturally appropriate talanoa, and kakala methods, within the Fonofale framework. Findings: Associations between low health literacy and age, ethnicity, acculturation, employment, education, smoking status, and alcohol status were shown. Novel findings from the focus groups were: the use and comprehension of health information and what constitutes preferred information and health service delivery modes. Conclusions: Findings suggest current health related information is not being used to its fullest extent by Pacific mothers. This may be due to underlying socio-demographic factors. This is the first study to examine the factors related to health literacy among Pacific mothers in NZ. Findings should be used to inform future interventions and delivery of public health nutrition messages.
108: Cohort profile: Pacific Islands Families (PIF) growth study, Auckland, New Zealand.Rush, E., Oliver, M., Plank, L. D., Taylor, S., Iusitini, L., Jalili-Moghaddam, S., Savila, F., Paterson, J., Tautolo, E. (2016). BMJ Open, 6(11), e013407. doi:10.1136/bmjopen-2016-013407
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Purpose: This article profiles a birth cohort of Pacific children participating in an observational prospective study and describes the study protocol used at ages 14–15 years to investigate how food and activity patterns, metabolic risk and family and built environment are related to rates of physical growth of Pacific children. Participants: From 2000 to 2015, the Pacific Islands Families Study has followed, from birth, the growth and development of over 1000 Pacific children born in Auckland, New Zealand. In 2014, 931 (66%) of the original cohort had field measures of body composition, blood pressure and glycated haemoglobin. A nested subsample (n=204) was drawn by randomly selecting 10 males and 10 females from each decile of body weight. These participants had measurement of body composition by dual-energy X-ray absorptiometry, food frequency, 6 min walk test and accelerometer-determined physical activity and sedentary behaviours, and blood biomarkers for metabolic disease such as diabetes. Built environment variables were generated from individual addresses.\ Findings to date: Compared to the Centres for Disease Control and Prevention (CDC) reference population with mean SD scores (SDS) of 0, this cohort of 931 14-year-olds was taller, weighed more and had a higher body mass index (BMI) (mean SDS height >0.6, weight >1.6 and BMI >1.4). 7 of 10 youth were overweight or obese. The nested-sampling frame achieved an even distribution by body weight. Future plans: Cross-sectional relationships between body size, fatness and growth rate, food patterns, activity patterns, pubertal development, risks for diabetes and hypertension and the family and wider environment will be examined. In addition, analyses will investigate relationships with data collected earlier in the life course and measures of the cohort in the future. Understanding past and present influences on child growth and health will inform timely interventions to optimise future health and reduce inequalities for Pacific people.
107: Accelerometer data treatment for adolescents: Fitting a piece of the puzzle.Oliver, M., Taylor, S., Iusitini, L., Stewart, T., Savila, F., Tautolo, E., Plank, L., Jalili-Moghaddam, S., Paterson, J., & Rush, E. (2017). Preventive Medicine Reports, 5, 228-231. https://doi.org/10.1016/j.pmedr.2016.12.010
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This study aimed to assess the differences in participant retention and associations between physical activity and key variables when a range of accelerometer data inclusion criteria are employed. Data were drawn from 204 adolescents of Pacific Island heritage (survey, body composition, 7-day accelerometry) and their parents (date of birth, socioeconomic status) between October 2014 and February 2016 in Auckland, New Zealand. Data wear time criteria for inclusion were as follows: A) > = 10 h/weekday or > = 8 h weekend day, > = 5 days (at least one weekend day); B) > = 10 h/weekday or > = 8 h weekend day, > = 4 days; C) > = 7 h/day, > = 3 days; D) > = 10 h/day, > = 1 day. Overall, 49%, 62%, 88%, and 96% of participants met the criteria, respectively. Adjusted odds of meeting each criterion were examined using a multivariable logistic regression model. Almost 50% of participants were excluded by the most stringent inclusion criteria. Increased body fat percentage and proportion of time in moderate-to-vigorous activity were associated with decreased odds of meeting Criterions A and B. This research contributes to a growing understanding of the impact of differing accelerometer reduction approaches to sample retention and bias in adolescent physical activity research.
106: Pacific Islands Families (PIF) Study: Housing and psychological distress among Pacific mothers. Paterson, J., Iusitini, L., Tautolo, E., Taylor, S., & Clougherty, J. (2018). Australian & New Zealand Journal of Public Health, 42(2), 140-144.
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OBJECTIVE: In a sample of Pacific mothers living in New Zealand, we examined: 1) maternal reports about seven specific major housing problems (too small, difficult to get to from the street, in poor condition, damp, cold, presence of pests, too expensive); and 2) associations between these housing problems and maternal psychological distress, adjusting for some maternal sociodemographic characteristics. METHODS: The Pacific Islands Families longitudinal study follows a cohort of Pacific children born in Auckland, New Zealand, in 2000 and their parents. At the 14-year phase, mothers (n=844) were asked about housing conditions and psychological distress. RESULTS: Mothers who reported having any major housing problem, particularly the presence of pests and poor housing conditions, were significantly more likely to report psychological distress after adjusting for sociodemographic confounders. CONCLUSIONS: The impact of housing on mental health is complex and may be influenced by social, health and sociodemographic characteristics of Pacific mothers. Implications for public health: The finding that housing problems are significantly associated with psychological distress among Pacific mothers in New Zealand is an important finding. However, more in-depth qualitative research is needed to provide a clearer understanding of the way housing problems affect mental health and to guide strategies that minimise this outcome for Pacific mothers.
105: Distinguishing transient versus stable aspects of depression in New Zealand Pacific Island children using Generalizability Theory. Paterson, J., Medvedev, O., Sumich, A., Tautolo, E., Krageloh, C., McNamara, R., Berk, M., Narayanan, A., Siegert, R. (2017). Journal of Affective Disorders, 227, 698-704.
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BACKGROUND: The distinction between temporary versus enduring or state/trait aspects of depression is important. More precise distinction would improve understanding of the aetiology of depression and those aspects most amenable to intervention thus identifying more homogeneous, dynamic targets for clinical trials. Generalizability Theory has been proposed as useful for disentangling state and trait components of psychopathology. METHODS: We applied Generalizability Theory to determine the relative contributions of temporary and enduring aspects of depression in a widely used screening measure of depression the - 10-item Children's Depression Inventory (CDI-10; Kovacs, 1985). Participants were children of Pacific Island descent living in New Zealand (n = 668). Data were collected at ages - 9, 11, and 14 years. RESULTS: The CDI-10 demonstrated acceptable generalizability across occasions (G = 0.79) with about one third of variance in total scores attributed to temporary and two thirds to more enduring aspects of depression. There were no other significant sources of error variance. Two items were identified as more sensitive than the remaining eight to more dynamic symptoms. LIMITATIONS: Studies with briefer test-retest intervals are warranted. Use of this Pacific Island cohort limits generalizability of findings to other cultures and ethnicities. No data were collected on whether participants had received intervention for depression. CONCLUSIONS: While the CDI-10 reliably measures both stable and transient aspects of depression in children, the scale does not permit clear distinction between them. We advocate application of Generalizability Theory for developing state/trait depression measures and determining which existing measures are most suitable for capturing modifiable features of depression.
104: Motivations for Smoking Cessation and the Impact of Regulatory Tax Increases Amongst Fathers within the Pacific Islands Families Study.Tautolo, E.-S., Iusitini, L., Taylor, S. M., & Paterson, J. (2017). Journal of Smoking Cessation, 12(1), 32–37.
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Aims: To examine the prevalence of smoking, motivations for cessation, and impact of tobacco excise tax increases amongst a cohort of Pacific fathers at 11 years after the birth of their child. Methods: Within the context of broader interviews, 723 Pacific fathers participating in the Pacific Islands Families (PIF) Study were surveyed about their smoking at the 11-year measurement point. Prevalence of smoking was calculated, alongside motivations to quit, and the impact of increases to the excise tax on tobacco. Results: Smoking prevalence amongst Pacific fathers remains high (38%) at 11 years postpartum, although 81% of smokers disclosed interest in quitting smoking. The strongest motivation to quit smoking was their ‘own health’ (n = 185, 82%), followed by ‘the cost’ (n = 148, 66%), and the impact on ‘their child's health’ (n = 113, 50%). Among smokers, 12% (n = 31) had never attempted to quit, whereas 63% (n = 159) had made multiple attempts. Approximately 70% (n = 191) of smokers indicated the New Zealand Government-initiated tobacco excise tax increases caused them to reduce their tobacco consumption. Conclusions: High smoking prevalence amongst this cohort raises serious concerns about the risks Pacific families and communities face from smoking. Maintaining a sustained series of tobacco excise tax increases, alongside the utilisation of information on key motivators for Pacific fathers to quit smoking, may prove more effective in supporting Pacific communities to achieve the New Zealand Government's Smokefree 2025 goal.
103: Healthy Pacific grandparents: a participatory action research project exploring ageing well among Pacific people in New Zealand. Tautolo, E., Wrapson, W., Paterson, J., Wright-St Clair, V., Neville, S., Dewes, O., & Iusitini, L. (2017). Self & Society, 45(2), 134-148.
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The New Zealand older adult population (aged 65+?years) is growing at a faster rate than the younger population, with many of those in the later years living much longer. The proportion of older Pacific people is forecast to reach 4.1% of the country’s total population within the next two decades, highlighting the importance of research focused on ageing Pacific populations. This article sets out the research protocol and methods for the Pacific Islands Families: Healthy Pacific Grandparents’ Study, which aims to investigate older Pacific people’s viewpoints on ageing to identify specific cultural values, perspectives and understandings as the Pacific population in New Zealand ages. The study will recruit and utilize participants from a grandparent cohort that is nested within the families of the longitudinal Pacific Islands Families Study. This study uses a Participatory Action Research approach to position the participants in a leadership role where they are co-researchers involved in both the research and the implementation of recommendations. Utilizing a transformative research process will bring older Pacific people together to define for themselves their needs and their experiences, identify any areas of shortcoming, and support the implementation of solutions through strategic and informed actions.
102: Status and interrelationship of toenail elements in Pacific children. Karatela, S., Ward, N., Zeng, I., Paterson, J. (2017). Journal of Trace Elements in Medicine and Biology, 46, 10-16.
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Elemental deficiencies or in excess effects growth and development. Pacific population are at a disadvantage due to food insecurity as compared to New Zealand European households. This study aims to evaluate the status and interrelationship of elements (essential, non-essential and toxic) in nine-year-old Pacific children who were part of the Pacific Island Families Study living in New Zealand.
101: Acculturation and its impact on the oral health status of Pacific children in New Zealand: findings from the Pacific Islands Families study. Schluter, P.J., Kanagaratnam, S., Taylor, S., Tautolo, E. (2017). Journal of Public Health Dentistry, 77 (3), 225-233.
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Immigration and acculturation are increasingly recognized as important explanatory factors for health disparities, although their impact on oral health is less well understood. This study investigates the relationship between Pacific children's cultural orientation and oral health, after adjusting for potentially moderating and confounding variables.
100. Domain specific effects of postnatal toenail methylmercury exposure on child behaviour. Karatela,S., Paterson, J., Ward, N. (2017). Journal of Trace Elements in Medicine and Biology, 41, 10-15.
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Very little is known about the relationship between postnatal methylmercury concentrations (via toenails as bioindicator) and behavioural characteristics of Pacific Island children living in New Zealand. The aim of this study was to explore the association between total mercury exposure and different domains of behavioural problems in Pacific children.
099. Maternal Cultural Orientation and Child Growth in New Zealand Pacific Families. Tseng, M., Taylor, S., Tautolo, E., Savila, F., Paterson, J. and Rush, E. (2015). Childhood Obesity, 11(4), 430-438.
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Background: In New Zealand (NZ), children of Pacific heritage are generally born heavier and gain weight more quickly than non-Pacific children. Immigrants' health is commonly expected to converge with the host population through acculturation. The aim of this analysis was to examine whether mothers' acculturation is associated with less-rapid weight gain in NZ Pacific children, and whether this differs by mothers' nativity. Methods: In a birth cohort of 1249 children followed 2000–2011, birth weight and weight and standing height, measured at years 2, 4, 6, 9, and 11, were quantified as sex- and age-specific weight (weight-for-age; WFA) and BMI z-scores. Maternal acculturation (range, 11–54) was assessed at baseline and years 4, 6, and 11. Results: In adjusted models using generalized estimating equations to account for repeated measures, maternal acculturation was not significantly associated with children's WFA or BMI z-scores overall. In stratified analyses, change in maternal acculturation score was inversely associated with WFA z-score change among children of NZ-born, but not immigrant, mothers (beta=−0.021; 95% confidence interval, −0.036 to −0.007; p=0.006; interaction, p=0.005). Conclusions: Our study provides the first evidence in a longitudinal sample that changes in maternal acculturation can influence children's growth, suggesting the importance of lifestyle or behavioral factors related to a mother's cultural orientation. Given the high risk of obesity and its related conditions in the NZ Pacific population, critical next steps are to identify mediating factors, as well as to understand the processes influencing growth among children of immigrant mothers.
098. Pacific Islands Families Study: Signs of puberty are associated with physical growth at ages 9 and 11 years. Rush, E., Tautolo, E., Paterson, J., Obolonkin, V. (2015). The New Zealand Medical Journal, 128(1425), 24-33.
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Aim To prospectively observe, at ages 9 and 11, the relationship of parental report of pubertal signs with height, weight, body mass index and birth weight in children of the Pacific Islands Families cohort born in the year 2000. Method At ages 9 and 11 years a parental questionnaire assessed five gender-specific pubertal signs for 619 children and height and weight were objectively measured. At 9 years, body fatness was derived from frequency bioimpedance analysis. Birth weight was obtained from hospital records. Anthropometric measures of children with and without pubertal signs at each age were compared. Results At both 9 and 11 years, more than 80% of both boys’ and girls’ parents reported the presence of a growth spurt. The growth trajectory between 9 and 11 years was steep compared to the Centers for Disease Control reference child. At age 11, girls showing pubertal signs had substantially greater height, weight and body mass indexes than girls who did not. Girls with a growth spurt at age 9 years (91%) had a heavier birth weight than those without; a difference of 250 g (95% CI 50, 450 g). Conclusion The relationships between birth weight, rapid growth in childhood and early pubertal signs are complex. In addition to biological factors, food security and socioeconomic factors need to be addressed to ensure that the children of these children are exposed to an environment that is supportive of healthy rates of growth and development.
097. Tracking obesogenic food consumption patterns of children in The Pacific Islands Families Study 2004–2006. Savila, F., Obolonkin, V., & Rush, E. (2012). Obesity Research & Clinical Practice, Vol. 6 (1), 58
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Aim: A dietary pattern that includes energy-dense, nutrient-poor foods is one of the possible underlying causes of rapid growth in childhood. The Pacific Islands Family study, a longitudinal study of 1398 Pacific children born in the year 2000, has shown rapid growth and high prevalence of overweight and obesity (60%) at age 6 years. We aimed to measure both for the population and for the individual differences if any in the frequency of consumption of the most popular foods at ages 4 and 6 years: before and after starting school. Method: At both ages 4 and 6 a 117 item food-frequency questionnaire was answered by parents for 636 children. At each time point foods were ranked by frequency of consumption and frequency compared by scatter plots. Results: Cross-sectionally and longitudinally at age 4 and 6 the 11 foods ‘‘most frequently consumed’’ were the same. At both ages the reported frequency of the most popular foods (portions) , bread (>85% white), breakfast cereal and rice were 1.2, 0.8 and 0.5 times-a-day respectively but the frequency of consumption of apples, bananas and oranges and milk halved (0.8—0.3 times-a-day). Other ‘‘most frequently consumed’’ foods were milky drinks, powdered fruit drink, chicken, noodles and potato crisps. When all foods that have added sugar were grouped, reported consumption was 7.3 times-a-day at age 4 and 5.4 times-a-day at age 6 years. Conclusion: Dietary pattern has not changed greatly from age 4 to 6 years but the frequency of fruits and milk was reduced.
096. Tracking food consumption frequency of children from age 4 to 6 years: the Pacific Islands Families study. Savila, F., Obolonkin, V., & Rush, E. (2015). New Zealand Medical Journal, 128 (1420), 16-24.
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AIM: To report longitudinal food frequency consumption and evaluate tracking of food frequency among a cohort of New Zealand-born Pacific children. OBJECTIVE: Identify the most commonly consumed foods and estimate tracking among Pacific children aged 4 and 6 years. METHOD: A qualitative food frequency questionnaire was administered to n>1,000 caregivers of children aged 4 and 6 years. Consumption scores were developed from averaged frequency of daily food. Foods and food groups were examined for tracking. RESULTS: Caregivers completed questionnaires for 646 children at both ages. Twelve most frequently consumed foods were identified, accounting for up to 25% of all food consumed daily. Across ages 4 and 6, the association for frequency of the most frequently consumed foods was moderate (r2 =0.53). Food groups: breads and cereals; meat and alternates; and vegetables and fruit constituted approximately 72% of all foods consumed daily. The association of frequency of consumption within food groups across the two measurement periods was strong (r2 =0.96). CONCLUSIONS: Pacific children consume similar foods that track from age 4 through age 6 years.
095. Pacific Father Involvement and Early Child Behaviour Outcomes: Findings from the Pacific Islands Families Study. Tautolo, E-S., Schluter, P.J., Paterson, J. (2015). Journal of Child and Family Studies, 24, 3497-3505.
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This paper examines the relationship between father involvement and their child’s behaviour outcomes amongst a birth cohort of Pacific children and fathers in New Zealand. A birth cohort was established in 2000 from births at Middlemore Hospital in South Auckland where at least one parent was identified as being of Pacific ethnicity and a New Zealand permanent resident. This included 1,376 mothers, 825 fathers, and 1,398 children at baseline. At the 6-years measurement wave, father involvement was measured using the Inventory of Father Involvement, and child behaviour measured using the Child Behaviour Check-list. Internalising and externalising behaviour was related to father involvement in crude and adjusted logistic regression and generalised estimating equation models. 571 Pacific fathers participated at the 6-years measurement wave; most of Samoan (42.9 %) or Tongan (33.5 %) ethnic identification. Overall, 190 (32.1 %) children exhibited clinical or border-line internalising and externalising behaviour. Self-reported father involvement was generally high, but lower involvement was significantly related to increased odds of internalising [adjusted odds ratio (aOR) approximately 1.9, p < 0.001] and externalising (aOR approximately 4.0, p < 0.001) behaviour. Father involvement was significantly associated with child behaviour in Pacific families within New Zealand. Strategies that promote and enable increased father involvement may reduce negative child outcomes amongst Pacific families.
094. Gambling behaviours and associated familial influences among 9-year old Pacific children in New Zealand. Bellringer, M., Taylor,S., Savila, F. & Abbott, M. (2014). International Gambling Studies, 14(3), 457-471.
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There is a paucity of research investigating child gambling, particularly studies that do not use retrospective designs. The presented findings provide cross-sectional data of the gambling behaviours of 874 9-year old Pacific children from a birth cohort study (recruited from one hospital) investigating health, developmental and social outcomes for Pacific children and their families in New Zealand. Structured interviews were administered to participants (mothers and children), face to face, in their homes (mothers) or school (children). Child gambling behaviours and associations with some maternal behaviours were investigated; five gambling participation questions were included in the child interview. Almost all child respondents (96%) reported having played card games with family or friends and 60% reported participation in housie (bingo), although only 27% reported having bet with money. Associations were noted between child gambling and household deprivation, and effectiveness of parental monitoring. There was no association between children's gambling and mothers' gambling. This is the first research to examine gambling in Pacific children at 9 years of age within a familial context. It will allow exploration of links between parental gambling and child development of gambling behaviours, as well as risk and protective factors for problem gambling at future data collection phases of the study.
093. Will New Zealand be smokefree by 2025? Smoking prevalence amongst a cohort of Pacific adults. Tautolo, E.-S., Iusitini, L., Taylor, S., & Paterson, J. (2014). The New Zealand Medical Journal, 127(1393), 99-106.
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Aim: To examine the prevalence of smoking amongst a cohort of Pacific fathers and mothers from birth up to 11 years after the birth of their child. Methods: Within the context of broader interviews, 1073 Pacific fathers and 1434 Pacific mothers participating in the longitudinal Pacific Islands Families (PIF) Study were surveyed about their smoking at multiple time-points of the study from 2000 until 2012. Prevalence rates of any and heavy smoking were calculated and analysed. Results: Maternal prevalence rates showed a sharp decline during pregnancy and immediately postpartum, yet rates then increased gradually to pre-birth levels within one to four years. Prevalence rates for mothers showed little change between 4 and 11 years postpartum, maintaining a steady 32% for mothers. While prevalence rates for fathers show a decline from initial levels (40.3%), they still remain extremely high (37.5%) at 11 years postpartum. Conclusion: The minimal decline in smoking prevalence amongst this cohort is of alarming concern for Pacific families and their communities. Given the New Zealand Government’s Aotearoa Smokefree 2025 goal, innovative approaches must be implemented to discover effective solutions to help Pacific communities reduce their smoking.
092. Children of the outer Cook Islands have lower BMI compared to their urban peers. Stewart, D., Reed, P., & Rush, E. C. (2014). New Zealand Medical Journal, 127(1388), 96-98.
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091. Pacific Islands Families Study: depressive symptoms in 9-year-old Pacific children living in New Zealand. Paterson, J., Iusitini, L., & Taylor, S. (2014). The New Zealand Medical Journal, 127(1390), 13-22.
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Summary This study investigated associations between individual, maternal, cultural and socio-demographic variables with symptoms of child depression in 9-year-old Pacific children living in New Zealand. At approximately 9 years of age, child self-reports (n=858) of depressive symptoms were gathered. We found that being a victim or perpetrator of bullying, previous internalising behaviour problems and low maternal education were significantly associated with high child depression scores. Low depression scores were associated with children’s positive perception of self, physical abilities, parental and peer relationships, high verbal intelligence, and high performance at school. These findings indicate that building up child self-esteem and supportive relationships around the child are likely to reduce the risk of depression and these strengths may mitigate against bullying involvement Abstract Aim: This study investigated associations between individual, maternal, cultural and socio-demographic variables with symptoms of child depression in 9-year-old Pacific children living in New Zealand. Method: The longitudinal Pacific Islands Families (PIF) Study is following a cohort of Pacific children born in Auckland, New Zealand, in 2000. At approximately 9 years postpartum, child self-reports (n=858) of depressive symptoms were gathered. Results: Being a victim or perpetrator of bullying, previous internalising behaviour problems and low maternal education were significantly associated with high child depression scores. Low depression scores were associated with children’s positive perception of self, physical abilities, parental and peer relationships, high verbal intelligence, and high performance at school. Conclusion: These findings indicate that building up child self-esteem and supportive relationships around the child are likely to reduce the risk of depression and these strengths may mitigate against bullying involvement.
090. Alcohol consumption by parents of Pacific families residing in New Zealand: Findings from the Pacific Islands Families Study. Schluter, P. J., E.-S. Tautolo, et al. (2013). Alcohol 47(3): 241-248.
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Harmful alcohol consumption amongst Pacific people (those of Polynesian descent) is recognized as a public health priority in New Zealand, yet little epidemiological information exists on this pattern of drinking. Using a large birth cohort study, which includes the mother, father and child triad, this study aims to determine the prevalence and change in any harmful drinking levels prenatally, antenatally and in the postpartum period for mothers and fathers, and to measure the concordance of both partners' reports of that drinking in an ethnically representative sample of Pacific families within New Zealand. Participants were selected from births where at least one parent was identified as being of Pacific ethnicity and a New Zealand permanent resident (1376 mothers and 825 fathers at baseline); many of whom are young to middle aged adults. These participants have been prospectively followed-up multiple times since. The Alcohol Use Disorders Identification Test consumption questions (AUDIT-C) were used over successive measurement waves to define any and harmful drinking levels. Recommended screening thresholds were employed. Longitudinal analyses on complete cases and imputed data, accounting for differential attrition, were undertaken and reported. Clear temporal patterns of alcohol consumption emerged for both mothers and fathers, together with significant and important ethnic differences. Moreover, there was considerable movement in alcohol consumption categories between consecutive measurement waves for both mothers and fathers. Among couples, there was significant asymmetry in drinking patterns and poor statistical agreement. However, 9.1% (14.1% in imputed analyses) of Pacific children aged 2 years had both parents indicated for harmful drinking. The significant important heterogeneity and ethnic differences suggest that both ethnic-specific and pan-Pacific interventions and prevention strategies are likely needed for successful interventions. More emphasis should be placed on targeting and addressing parents' alcohol misuse, particularly in the antenatal or postnatal period.
089. Exploration of the Impact of Gambling and Problem Gambling on Pacific Families and Communities in New Zealand. Taylor, S., Coombes, R., Poon, Z., & Abbott, M. (2013). Auckland, Gambling and Addictions Research Centre, Auckland University of Technology.
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088. Growth centiles of Pacific children living in Auckland, New Zealand.Rush, E. C., Obolonkin,V. V., Savila, F. (2013). Annals of Human Biology 40(5): 406-412.
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Background: Since 2000, the longitudinal Pacific Island Families study has measured the weight, height and body mass index (BMI) of 582 girls and 643 boys at 2, 4, 6 and 9 year data collection phases. Aim: To extend and record the age-related distribution of weight, height and BMI measures in Pacific children aged 2–10 years and to compare the distribution to population and clinical growth charts. Methods: Gender-specific age-related centile curves were derived using the LMS method for weight, height and BMI. The 50th centiles from the World Health Organisation growth reference for 2–5 year olds and the Centres for Disease Control (CDC) for 5–10 year olds were compared. Overweight and obesity were defined by the CDC BMI 85th and 95th centiles. Results: The proportion of children whose weight and height were above the reference 50th centile increased with age. At age 10, using CDC criteria, more than 50% of the children were classified as obese and 70% were overweight. Conclusions: These charts support the need to prioritize interventions for Pacific families to address childhood obesity. These centile curves could help assess the relative growth of Pacific children and identify children for further assessment and treatment.
087. Associations Between Breaks in Sedentary Time and Body Size in Pacific Mothers and Their Children: Findings From the Pacific Islands Families Study. Oliver, M., Schluter, P.J., Healy, G.N.,Tautolo, E.,Schofield, G.M. & Rush, E. (2013).Journal of Physical Activity and Health 10(8): 1166-1174.
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Background: Breaks in sedentary behavior are associated with reduced body size in general populations. This study is the first to consider the relationship between objectively assessed sedentary breaks and body size in Pacific children and their mothers. Method: Pacific children aged 6 years (n = 393) and their mothers (n =386) residing in New Zealand were invited to participate in 2006. Sedentary time was assessed via accelerometry. Average frequency, duration, and intensity of breaks in sedentary time per hour were calculated. Waist circumference was assessed and demographic factors collected via questionnaire. Relationships between waist circumference and potential associated factors for participants were assessed using linear regression analyses. Results: Accelerometer data were obtained from 126 children (52 boys) and 108 mothers. Mean (standard deviation) waist circumference values for mothers and children were 114 cm (20.1 cm) and 59.4 cm (7.8 cm), respectively. For mothers, time spent sedentary and being an ex/nonsmoker were positively related to waist circumference. For children, watching television every day and having a mother with a high waist circumference was associated with a greater waist circumference. Conclusion: Strategies that focus on reducing sedentary time in Pacific mothers and on encouraging television free days in young Pacific children are recommended Keywords: physical activity; child health; accelerometry; obesity.
086. Pacific Islands Families Study 2009: Mother and child gambling. Bellringer, M., S., Taylor, Poon, Z., Abbott, M., & Paterson, J. (2012). Auckland, Gambling and Addictions Research Centre, Auckland University of Technology.
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The Pacific Islands Families (PIF) study is a longitudinal study following a cohort of Pacific children born in the year 2000. The study aims to determine the pathways which lead to optimal health, development and social outcomes for Pacific children and their families. Mothers, fathers and children are assessed at various data collection waves as the study progresses.AimThe aim of the gambling element of the PIF study 2009 data collection and analysis was to:• Assess for possible predictors and protective factors for gambling• Investigate associations between child gambling behaviours and other variablesMethodA range of gambling-related questions was incorporated into the interview questionnaire protocols for mothers and children at the Year 9 data collection phase. The majority of participants were visited in their homes by the interviewers to complete the structured assessments. Where applicable, Year 9 data for mothers were compared with Year 6 data.Summary of key findingsGambling data were collected from 957 mothers and 874 children.Participation - mothersFrequency of gambling for mothers who reported gambling in the past 12 months was likely to be weekly for lottery products (Lotto, Instant Kiwi), keno and Housie, and monthly or less for electronic gaming machines. A small minority (3.7%) of the mothers who had gambled reported playing Keno daily.Participation - childrenAlmost all the children reported participating in either card games or Housie, though the majority did not play for money (73%). Boys were more likely to play for money than girls who were more likely to prefer Housie than boys. When playing Housie for money, a greater percentage of boys and girls played more with family than when playing Housie not for money. Conversely, a substantially lower percentage played with friends when playing for money than when not playing for money.Almost one-fifth (17%) of children had received scratch cards as a gift and seven percent reported buying Lotto/Big Wednesday/keno tickets.Trends - mothersThere was an increase in gambling prevalence and incidence amongst mothers from Year 6 to Year 9. In Year 6, 36% had gambled in the previous 12 months; in Year 9, 50% reported past-year gambling. This included 199 mothers gambling in Year 9 who had not done so in Year 6 and 90 mothers who stopped gambling from Year 6 to Year 9.The majority of mothers in Year 6 and Year 9 who had gambled in the past year were classified (using PGSI) as current non-problem gamblers (84% and 90% respectively), with 12%/5% classified as low risk gamblers, three percent in both years classified as moderate risk gamblers, and one percent in both years classified as problem gamblers. Changes in non- gambling and gambling status, and PGSI risk levels, of individual mothers from Year 6 to Year 9 occurred in both directions indicating that problematic gambling exists on a continuum with some people moving into and out of problem gambling over time. All movement along the continuum for mothers who had been classified as low risk/moderate risk/problem gambler in Year 6 was towards reduced risk or problems in Year 9. Note that sample sizes were small so this finding must be treated with caution.Forms of gambling participation have remained similar across both time points with Lotto being the most popular, and other forms at a substantially lower level.Expenditure patterns in Year 9 indicated support for a bimodal distribution of gambling, as had been shown previously in Year 6. The bimodal distribution was indicated by a positive skew to data where there was a relatively high median expenditure correlated with low participation forms of gambling, and vice versa.Fewer mothers reported having problems with someone else’s gambling in Year 9 (n=25) compared with Year 6 (n=41). The majority of relationships were with close, immediate family members (e.g. spouse/partner, sibling or parent). Key negative impacts included worrying about the other person’s gambling, financial concerns and safety concerns.Trends - childrenNo trends for children were identifiable as the current study was the first time gambling- related data have been collected.Potential risk factors - mothersGambling in Year 6 was associated with higher odds (4.4 times) for gambling in Year 9 and could indicate that participation in gambling is a risk factor for continued gambling participation. It appeared likely that any gambling is a risk factor (up to 4.5 times greater odds) for subsequent gambling on continuous forms (any form of gambling other than Lotto/keno), which are known to have a higher risk for problem gambling development.Worsening of financial situation (total household income decreased) from Year 6 to Year 9 was associated with gambling in Year 9 (twice as great odds).A mild level of socio-economic deprivation was associated with gambling on continuous forms (1.7 times greater odds) in Year 9.Being a smoker was associated with gambling (2.75 greater odds) in Year 9.Experiencing at least one significant life event in the previous 12 months was strongly associated (up to 5 times greater odds) with gambling expenditure in the upper quartile (≥$40/month); however, this finding needs to be treated with caution due to small sample size of mothers experiencing no life events and in the upper quartile of gambling expenditure.Potential risk factors - childrenBeing involved in a gang was associated with higher odds (2.55 times) of gambling participation.Lower parental monitoring was associated with higher odds (1.5 times) of gambling participation.Potential protective factors - mothersChange in marital status from partnered to separated from Year 6 to Year 9 was associated with lower odds (0.43 times) for gambling.Potential protective factors - childrenThere was an indication that increased cognitive ability (similarities test) was associated with slightly lower odds (0.95 times) of participating in gambling.There was no indication of any relationship between gambling and other health issues for mothers or children.LimitationsAll findings refer to the study population and not the New Zealand Pacific population as a whole as the data have not been weighted. The data refer only to associations and not causal relationships.
085. Body Composition in a Multiethnic Community in New Zealand. Rush, E. C. (2012). In V. R. Preedy (Ed.), Handbook of Anthropometry: Physical Measures of Human Form in Health and Disease (pp. 2581-2592.). London, Springer.
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084. Pacific Islands Families (PIF) Study: Behavioural Problems During Childhood. Paterson, J., Taylor, S., Schluter, P., & Iusitini, L. (2012). Journal of Child and Family Studies, DOI: 10.1007/s10826-012-9572-6
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Pacific peoples represent one of the fastest growing population subgroups in New Zealand and suffer disproportionately from diabetes, obesity, and other diseases. There is little research on the predictors of behavioral problems in Pacific children or the role that cultural variables play in shaping the unique environments in which child development occurs This study aims to examine the: (1) prevalence of behavior problems at 2, 4, and 6 years-of-age among Pacific children, and (2) relationships between maternal, cultural, and socio-demographic factors and behavioral problems. Data were gathered from the Pacific Islands Families Study. Maternal reports of child behavior were obtained using the Child Behavior Checklist for over 1000 Pacific children. The prevalence of clinical internalizing problems at ages 2, 4, and 6 years was 16.8, 22 and 8.5%, and clinical externalizing was 6.7, 10.7, and 14.6% respectively. Significant risk factors associated with clinical internalizing were maternal depression, maternal smoking, intimate partner violence, and having a single mother. Significant risk factors for clinical externalizing were harsh parenting, maternal depression, having a New Zealand born mother, and low household income. Across dimensions, a protective factor was found for children with mothers who described themselves as strongly aligned with Pacific traditions. These findings contribute to the limited longitudinal data specific to children from different ethnic groups and demonstrate the importance of cultural factors in developmental outcomes. Keywords: Child behaviour; Pacific children; Longitudinal; Child Behavior Checklist; Acculturation.
083. The Future of the Pacific Islands Families Study: a future with unlimited potential.Sundborn, G., Paterson, J., Iusitini, L., Tautolo, E., Taylor, S., Oliver, M., Jhagroo, U., Hirao, A.,& Savila, F. (2011).Pacific Health Dialog, 17(2), 198-202.
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082. Ten Years of Research for the Pacific Islands Families Study: A Comparative Review of publications. Savila, F., Sundborn, G., Hirao, A., & Paterson, J. (2011).Pacific Health Dialog, 17 (2), 188-196.
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In 2000, the Pacific Islands Families Study (PIFS) initiated research into developmental pathways of health outcomes for Pacific children and families. Not only was the study premised on addressing the gap in longitudinal research of Pacific peoples, it also aimed to increase Pacific-researcher capacity. After ten years of operation, this paper reviews the journal publications and Pacific authorship from the PIFS. The PIFS team published 55 journal articles in 29 peer reviewed journals. Forty-four (80.0%) of these articles had a Pacific author, including seven (12.7%) where the first-author was Pacific. Most articles used cross-sectional data (n = 38, 69.1%) and a quarter used longitudinal data (n = 15, 27.3%). Eighteen (62.1%) of the 29 journals that PIFS articles were published in were registered on the Journal Citations Report database, with 2009 5-year journal impact factors ranging from 1.064 to 6.504. The PIFS achieved a similar number of publications compared with the Dunedin Multidisciplinary Health and Development Study (DMHDS, n = 48) and Christchurch Health and Development Study (CHDS, n = 67). Further analysis, showed that the PIFS (27.3%) had the lowest proportion of publications using longitudinal data compared to the DMHDS (n = 37.5%) and CHDS (65.7%). This review provides a stocktake of publications in the first decade of the PIFS and shows that although the development of Pacific-researcher capacity has been promising, greater attention must be given to increasing first-authorship of academic writing and to utilising longitudinal data to better understand the origins of health status of Pacific peoples.
081. An exploration of physical activity, nutrition, and body size in Pacific children. Oliver, M., Rush, E., Schluter, P.J., Sundborn, G., Iusitini, L., Tautolo, E., Paterson, J., & Heimuli, J. (2011).Pacific Health Dialog, 17(2), 176-187.
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080. Reliability and validity of maternal recall of injuries in Pacific children: findings from the Pacific Islands Families Study. Robertson, H., Schluter, P.J., & Sundborn, G. (2011).Pacific Health Dialog, 17(2), 164-174.
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Background: Childhood injury is one of the leading causes of morbidity and mortality worldwide. Many epidemiological studies use self-report injury data to understand the pattern of injury, and to identify risk factors and potential injury countermeasures, but the veracity of these data is not without question. Aims: To investigate the reliability and validity of the use of maternal recall of childhood injuries in a birthcohort study of Pacific mothers residing in New Zealand. Methods: As part of the Pacific Islands Families Study (PIFS), this study included 1,354 Pacific children born in Auckland in 2000 whose mothers completed a questionnaire at 6-weeks, 1-year, 2-years, 4-years, and 6-years postpartum. Maternal reports of child injuries and medical attendance events reported were matched to listings held within the National New Zealand Health Information Service’s National Medical Discharge Summary (NMDS) database. Results: Overall, 120 child injury events were listed in the NMDS database and 139 in the PIFS questionnaires. Kappa statistics demonstrated a modest level of agreement between the NMDS database listings and the mothers reporting of childhood injuries over the six years postpartum. However, McNemar’s test of symmetry revealed no systemic under-reporting by the mothers, suggesting that the use of maternal proxy reporting of childhood injuries is a valid measure in this population. Discussion: While maternal proxy reporting of Pacific childhood injuries was found to be a valid measure, some evidence of misinterpretation of questions was found; suggesting continued vigilance and development of maternal completed childhood injury questionnaires is warranted.
079. Experience of physical abuse in childhood and perpetration of physical punishment and violence in adulthood amongst fathers: findings from the Pacific Islands Families Study. Schluter, P.J., Tautolo, E., & Paterson, J. (2011).Pacific Health Dialog, 17(2), 148-162.
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Background: Family violence is a serious and increasingly significant public health issue, both in New Zealand and internationally. While Pacific families in New Zealand experience disproportionately higher rates of violence compared to their Palagi counterparts, little epidemiological information exists about the effect of childhood abuse on Pacific fathers and whether it increases their proclivity on perpetrating violence. Aims: To determine the prevalence of physical discipline administered to young Pacific children by their fathers and physical intimate partner violence (IPV) perpetrated against their partners; and to relate this to fathers’ recalled levels of paternal and maternal childhood physical abuse. Methods: A cohort of Pacific infants born during 2000 in Auckland, New Zealand, was followed. At 6-weeks and 2-years postpartum, home interviews conducted for mothers and experience of IPV within the last 12 months was measured using the Conflict Tactics Scale. At 1-year and 2-years postpartum, home interviews conducted for fathers and acts of physical discipline were elicited. At the 1-year phase, childhood history of physical abuse was also elicited using the Exposure to Abusive and Supportive Environments Parenting Inventory. Crude and adjusted generalised estimating equation models were employed for statistical analyses. Results: The sample included 786 partnered fathers who were living with their child at the 1-year measurement wave and 579 fathers at the 2-years measurement wave. Smacking children was common (25.0% at 1-year, 81.7% at 2-years) and hitting children with an object was not infrequent (1.4% at 1-year, 14.2% at 2-years). Physical IPV perpetrated by the father ranged from 23.1% to 27.5% while severe IPV was reported by 10.1% to 14.3% of partners. Fathers subjected to higher levels of paternal physical abuse in childhood were significantly more likely to physically discipline their child with smacking than those with lower levels of paternal physical abuse, after adjusting for confounding factors; as were fathers subjected to higher levels of maternal physical abuse. While not statistically significant, fathers subjected to higher levels of paternal or maternal physical abuse in childhood had estimated odds ratios greater than unity for all other physical violence measures captured compared to fathers with lower levels of paternal or maternal physical abuse.
078. Prevalence and concordance of smoking among mothers and fathers within the Pacific Island Family Study.Tautolo, E., Schluter, P.J., & Taylor, S. (2011).Pacific Health Dialog, 17(2), 136-146.
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Cigarette smoking continues to contribute to the adverse mortality and morbidity rates for Pacific people in New Zealand. Using a large cohort study of Pacific families, this paper investigates the prevalence of smoking amongst Pacific mothers and fathers over three time-points, up to six years after the arrival of their child, to determine the concordance of both partners’ reports of that smoking. Moreover, the patterns of smoking between partners were investigated over the three major Pacific ethnicities that reside in New Zealand (Samoan, Tongan and Cook Island Māori). Maternal self-report prevalence of smoking estimates ranged from 29.8% (1-year) to 33.6% (6-years). Paternal self-reported prevalence of smoking estimates were higher, and ranged from 37.9% (2-years) to 45.2% (6-years). The prevalence estimates for smoking in both mothers and fathers over all three measurement waves were higher than the 26.9% reported for Pacific people in the 2006/07 New Zealand Health Survey. No significant change in fathers’ smoking prevalence over time was observed (p=0.37); however a significant increase in mothers’ smoking prevalence over time was noted (p=0.002). Significantly, for about 25% of Pacific children both their parents were current smokers. Reducing infant exposure to tobacco smoke, by encouraging parents to quit smoking or banning smoking in the home and local environment (such as vehicles), is likely to bring about improved health outcomes for many Pacific children. Findings suggest that the interaction between parents should be considered rather than focusing on mothers’ or fathers’ smoking behaviour in isolation.
077. A Comparison of Parenting Practices between Samoan Parents Living in New Zealand and Samoa.Iusitini, L., Taylor, S., Cowley-Malcolm, E., Kerslake, M., & Paterson, J. (2011).Pacific Health Dialog, 17(2), 120-133.
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This study compares the nurturing and disciplinary practices of Samoan parents living in New Zealand with those of Samoan parents living in Samoa. Mothers and fathers with two-year-old children resident in each country completed a modified version of the Parent Behavior Checklist. Multivariable logistic regression revealed that fathers in NZ were less nurturing and more disciplinarian than fathers in Samoa and mothers in NZ. Older parents were less nurturing but used less harsh discipline than younger parents, more educated parents were more nurturing, and parents on lower incomes were harsher disciplinarians.
076. Utilisation of Traditional Pacific Healers by mothers and children of the Pacific Islands Families study. Sundborn, G., Taylor, S., Tautolo, E., Iusitini, L., & Finau, S. (2011).Pacific Health Dialog, 17(2), 105-118.
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Aim: This research explores data on the mother’s willingness to use, and children’s use of Traditional Pacific Healers (TPH) from the first five waves of the Pacific Islands Families study (PIFS). Specific aims were: to report the prevalence of, and describe factors associated with, (1) the willingness of Pacific mothers to use the health services of Traditional Pacific Healers, (2) the use of Traditional Pacific Healers to treat children within the cohort and (3) to assess whether the use of Traditional Pacific Healers was a substitute or a supplement for western medicine. Methods: Mothers were asked whether they would use a Traditional Pacific Healer if sick (willingness) and how often their child had seen a Traditional Pacific healer in the previous 12 months (use). These questions were asked at multiple measurement waves consisting of 6 week, 4 and 6 year for mothers, and 6 weeks, 1, 2, 4, and 6 year measurement waves for children. Results: at 6 weeks 48% of mothers were willing to use TPH and this decreased to 36% at year 4 and 24% at year 6. Pacific born mothers, Samoan and Tongan mothers, and religious mothers were significantly more willing to use a TPH. Varied patterns of use were observed by children based on ethnicity and measurement wave. Like mothers - use by children declined as they aged. At 6 weeks 18% of children saw a TPH whilst 8% saw a TPH at age 6 years. Mothers amenable to using traditional healers are using them as supplemental to western medicine, rather than as a substitute. Conclusions: There is a steady reduction observed in mother’s willingness and children’s use of TPH in the PIFS over time. This raises the question of the whether provision of TPH is sustainable in NZ. There are significant differences in use of TPH by ethnicity. Further research that assesses reasons for visits, treatments provided, and costs may help explain the observed variations shown in this study.
075. Impacts of inter-and intra-partnerships/relationships on traditional gift-giving in a cohort of Pacific mothers. Cowley-Malcolm, E., Gao, W., MacPherson, C., Perese, L., Erick, S., & Sundborn, G. (2011).Pacific Health Dialog, 17(2), 90-103.
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Traditional gift-giving (TGG) is an important element of familial obligations among Pacific families. Migration from Pacific homelands to New Zealand and other countries has had an impact on participation in TGG. Many anecdotal accounts have suggested that TGG diminishes when Pacific persons marry outside their ethnic groups. While TGG is an indicator of social cohesion TGG can have direct influence on disposable income. The practice of TGG impacts on health as Income and social cohesion are key determinants of health. Thus TGG Health and social cohesion are closely interrelated and interdependent. The data for this paper is taken from a longitudinal cohort study of 1,398 Pacific children and their families in South Auckland, New Zealand. The study sought participants’ responses to questions pertaining to the amounts gifted, the frequency of giving, recipients of the gifting and their reasons for participating and not participating in TGG. The assumption explored in this paper is that as Pacific peoples move outside their social sphere and become more acculturated with other ethnic groups, TGG was more likely to diminish rather than increase. This paper addresses the TGG participation rates among Pacific peoples in inter-ethnic relationships and intra-ethnic relationships. It argues that couples in an intra-ethnic intimate relationship are more likely to participate in traditional gift-giving than those who are in inter-ethnic intimate relationships. While this is true for most PI inter ethnic relationships the level of participation increases further with inter-ethnic intimate relationships among Tongans and Samoans who are also the largest participators of all ethnic groups in traditional gift–giving.
074. Traditional gift-giving and gambling amongst Pacific mothers living in New Zealand. Perese, L., Gao, W., Erick, S., MacPherson, C., Cowley-Malcolm, E., & Sundborn, G.(2011).Pacific Health Dialog, 17(2), 79-88.
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Cultural variables are implicated in gambling literature as playing an important role in the initiation and maintenance of gambling activity, however there remains a paucity of research that defines and investigates the association between cultural factors, gambling and problem gambling amongst different cultural groups. The first data collection point for a cohort of mothers within the longitudinal Pacific Islands Families study identified that the Pacific cultural practice of traditional gift-giving was associated with gambling activity and expenditure. In this paper, data about traditional gift-giving and gambling are presented from the third collection point within this study. The results support an association between gambling (rather than problem gambling) and traditional gift-giving. This paper contends the need to contextualise Pacific peoples gambling within Pacific cultures. Also a need is identified to examine and address the psycho-social and cultural impacts of gambling for Pacific peoples.
073. Agreement and discordance of parents' and teachers' reports of behavioural problems among Pacific children living in New Zealand. Gao, W., Paterson, J., Carter, S., Iusitini, L.,& Sundborn, G. (2011).Pacific Health Dialog, 17(2),65-77.
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Research suggests that ratings of child psychopathology by parents and teachers are generally not highly correlated. We examined the agreement and discordance between the child behaviour ratings of parents and teachers of a cohort of 6-year-old Pacific children living in New Zealand, based on scores from the Child Behaviour Checklist and the Teacher Report Form. Mother’s reports were obtained for 1019 children, of whom, 602 also had father’s reports and 559 had teacher’s reports. Rater agreement was low between all pairs of informants. Fathers and teachers had higher agreement than mothers and fathers, the latter in turn had higher agreement than mothers and teachers, and agreement was generally higher for Externalizing problems than Internalizing problems. In terms of discordance, mothers reported more aggressive behaviour than fathers, while fathers reported more Internalizing and Total problems than mothers. Mothers and fathers generally reported more behaviour problems than teachers. The higher agreement found between informants from different settings (fathers and teachers) than between informants from similar settings (mothers and fathers) is in contrast with some of the literature. Further research is needed to investigate how child, informant, and setting characteristics affect ratings of children’s behaviour.
072. Child developmental assessment at two-years of age: Data from the Pacific Islands Families (PIF) Study. Paterson, J., Iusitini, L., & Gao, W. (2011).Pacific Health Dialog, 17(2), 51-63.
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Aims: To describe the developmental profile of Pacific children living in New Zealand at two years of age in personal/social, language, cognitive, fine motor, and gross motor domains, and to examine how sociodemographic, maternal, and cultural factors influence children’s development. Methods: A cohort of Pacific infants born during 2000 in Auckland, New Zealand, was followed up at two- years postpartum. Maternal interviews were administered and the developmental status of the child was measured using the Australian Developmental Screening Test. Results: Maternal child development reports are presented for 1,018 two-year-old children. The majority of children were identified as having no developmental delay. The prevalence of no delay in any of these five domains was 64.8%. For those children (35%) who were identified with possible overall delay the significant risk factors were child ethnicity, low birth weight, being breastfed for less than six weeks, and single parenthood. Discussion: The powerful associations of these factors and developmental outcome suggest that interventions need to have the flexibility to address such issues within individual Pacific families and communities.
071. Parental perceptions of their child's weight and future concern: Pacific Islands Families Study. Heimuli, J., Sundborn, G., Rush, E., Oliver, M., & Savila, F. (2011).Pacific Health Dialog, 17(2), 33-49.
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Aim: Little is known about the perception of overweight, expressed as a level of concern, of Pacific parents and its relevance to children’s weight. The aim of this study was to analyse data collected at birth and four and six years in the Pacific Island Families Study (PIFS) to investigate the relationship between parental perceptions of child weight status and actual weight status. Method: A total of 569 parent child dyads (299 boys (52.5%), 270 girls (47.5%); 47.1% Samoan, 20.9% Tongan, 18.6 % Cook Island, 4.9% Niue, 8.4% other Pacific) were examined in this Parental Perception of Overweight Obesity Study (PPOS). At four and six years the question was asked of the parent “How concerned are you about your child becoming overweight?” A 5-point Likert scale was used, with possible answers ranging from “unconcerned” through increasing levels of concern to “very concerned”. At four and six years weight and height were also measured and body mass index (BMI) derived and classified using international standards. Potential factors associated with parental perception were examined in a multivariate model using logistic regression. Results: The majority of parents were unconcerned at four and six years (62% and 69.1%) about the future overweight status of their child. Using the international BMI classifications, at four years 40.1 % of the children were classified as normal weight, 34.1% as overweight, and 25.8% as obese. At six years the proportions were similar; i.e., normal 41.3%, overweight 31.1%, and obese 27.6%. At four and six years the proportion of parents who were concerned about their child’s future weight status was related to the child weight status e.g., at 6 years 20% of parents of normal children, 28% percent of parents of overweight and 51% of parents of obese children were concerned (p trend <0.0001). Ethnicity and parity were significantly related to parental perceptions (p<0.0001); identification with Tongan ethnicity was related to a higher proportion of concerned parents and an increased number of children in the family were related to a smaller proportion of concerned parents. Discussion: While the level of concern was low and the prevalence of overweight and obesity high, the context of the socio economic and demographic environments must be taken into account in the formulation of interventions. Overweight and obese Pacific children may benefit from interventions that target the awareness of parents, making them more conscious of the relationship of obesity with food and activity patterns and give practical support to change the environment. These findings raise the concern that there is a normalisation of overweight and obesity in Pacific parents and/or children. Interventions firstly should address the socio economic demographic environment of a Pacific family making healthier choices the easier choices.
070. What defines 'Low birth weight' in Pacific infants born in New Zealand? Sundborn, G., Schluter, P.J., Schmidt-Uili, M., & Paterson, J. (2011).Pacific Health Dialog, 17(2), 23-31.
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Aim: To report the combined and ethnic specific proportions of preterm and low birth weight (LBW) births, and average birth weights, for New Zealand’s four major Pacific ethnic groups (Samoan, Tongan, Cook Island Mäori, Niuean). Methods: Data were gathered from the Pacific Island Families Study (PIFS). Mothers of a cohort of 1398 Pacificinfants born in South Auckland New Zealand (NZ) during 2000 were interviewed when their infants were 6 weeks old. Birth outcome data were obtained from hospital records on receipt of full informed consent. Results: Of the Pacific ethnic groups preterm rates ranged from 5.3% to 8.3% (7.3% overall), LBW rates ranged from 3.4% to 5.7% (4.0% overall), and average birth weight of full term deliveries ranged from 3467 gm to 3751 gm (3664 gm overall). Cook Island and Niuean infants were significantly lighter than Samoan infants. Infants of Pacific born mothers were significantly heavier than infants born to NZ born Pacific mothers. There were no differences observed between infants of ‘ethnically homogenous’ parents compared ‘ethnically heterogeneous’ parents. The 10th percentile for all Pacific ethnic groups ranged from 2894 to 3065 grams. Conclusion: These data reaffirm that infants of various Pacific ethnic groups are larger than other New Zealand infants. Furthermore, analyses of the PIFS cohort suggest that a LBW threshold for NZ born Pacific infants of 3000 grams may be more appropriate.
069. Cohort profile: A decade on and strong - The Pacific Islands Families Study. Sundborn, G., Paterson, J., Jhagroo, U., Taylor, S., Iusitini, L., Tautolo, E., Savila, F., Hirao, A., & Oliver, M. (2011).Pacific Health Dialog, 17(2), 9-21.
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068. Growth and childhood obesity: perspective of Pacific Island children in New Zealand. Rush, E., & Bristow, S.(2012). In V. R. Preddy (Ed.), The Handbook of Growth and Growth Monitoring in Health and Disease (pp. 1621-1624). New York: Springer
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067. Acculturation status has a modest effect on smoking prevalence among cohort of Pacific fathers in New Zealand. Tautolo, E.-S., Schluter, P., Paterson, J., & McRobbie, H.(2011). Australian and New Zealand Journal of Public Health, 35 (6), 509-516
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Objective: This article explores the relationship between smoking prevalence and acculturation among a cohort of Pacific Island fathers resident in New Zealand. Methods: Overall, 766 Pacific fathers were included in the analysis. Self-reported smoking status was assessed and compared with data from a robust epidemiological measure of acculturation status specifically designed for use amongst the Pacific population. Additional variables describing socio-demographic and other circumstances of the participating fathers were also incorporated in the analysis because of their known association with smoking behaviour. Results: Overall, 40.3% of Pacific fathers were current smokers. Multivariable logistic regression showed that acculturation status was associated with smoking crude (p<0.001) and multivariable logistic regression models, when adjusting to socio-demographic variables (p=0.008). Conclusion: Smoking rates for Pacific fathers in New Zealand are high. There appears to be a modest effect of acculturation on smoking prevalence, where those fathers with higher Pacific cultural identity have the lowest smoking rates. It is opined that the strength of identification and a holistic view of health enhances the motivations of Pacific fathers to be smoke-free in New Zealand. Implications: Strategies which maintain, enhance, and incorporate fathers’ Pacific cultural identity may be a useful addition to comprehensive tobacco control strategies to reduce the prevalence of smoking in Pacific people living in New Zealand. Keywords: Pacific; tobacco; fathers; acculturation; New Zealand.
066. Acculturation of Pacific mothers in New Zealand over time: findings from the Pacific Islands Families study. Schluter, P., Tautolo, E.-S., & Paterson, J. (2011). BMC Public Health, 11(1), 307
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Background: The epidemiological investigation of acculturation has often been hampered by inconsistent definitions and measurement, and methodological short-comings. Adopting a bi-directional model, with good theoretical and psychometric properties, this study aimed to describe the temporal, ethnic and socio-demographic influences of acculturation for a group of Pacific mothers residing in New Zealand. Methods: Pacific mothers of a cohort of Pacific infants born at a large tertiary hospital in South Auckland in 2000 were interviewed at 6-weeks, 4-years and 6-years postpartum. At each measurement wave a home interview lasting approximately 90 minutes was conducted with each mother. Adapting the General Ethnicity Questionnaire, two scales of acculturation were elicited: one measuring New Zealand cultural orientation (NZAccult) and one measuring Pacific Islands cultural orientation (PIAccult). Acculturation scores were standardised and analysed using random intercept polynomial and piecewise mixed-effects regression models, accounting for the longitudinal nature of the repeated measured data. Mothers who immigrated to New Zealand and those who lived their lives in New Zealand were investigated separately. Results: Overall, 1276 Pacific mothers provided 3104 NZAccult and 3107 PIAccult responses over the three measurement waves. Important and significant differences were observed in both bi-directional acculturation measures between the two maternal groups studied. New Zealand cultural orientation increased, on average, linearly with years lived in New Zealand both for immigrant mothers (0.013 per year, 95% CI: 0.012, 0.014), after adjusting for maternal age, and for mothers who lived their lives in New Zealand (0.008 per year, 95% CI: 0.06, 0.010). Immigrant mothers maintained their Pacific cultural orientation for, on average, 12 years before it began to linearly decrease with each year lived in New Zealand thereafter (-0.009 per year, 95% CI: -0.010, -0.008), after adjusting for maternal age. Mothers who lived their lives in New Zealand had a Pacific orientation that was, on average, unchanged regardless of the number of years lived in New Zealand. Significant ethnic and socio-demographic variations were noted. Conclusions: Understanding the patterns and trajectories of acculturation over time, and its key determinants, is necessary for the development of appropriate targeted health policy and care in typically vulnerable and marginalised immigrant populations.
065. Factors Related to Accelerometer-Derived Physical Activity in Pacific Children Aged 6 Years. Oliver, M., Schluter, P. J., Schofield, G. M., & Paterson, J.(2011). Asia-Pacific Journal of Public Health 23(1), 44-56
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The objective of this study was to investigate potential factors related to Pacific children’s moderate-to-vigorous physical activity (MVPA). A total of 393 Pacific children aged 6 years and their mothers were invited to participate. Participants wore accelerometers over 8 days; height, weight, and waist circumference were measured, and mothers reported on individual, social, and perceived environmental factors. Generalized estimation equation models were used to identify associates of children’s daily MVPA. In all, 135 children and 91 mothers were included in analyses. Children spent 24% of time in MVPA; 99% of days had ≥60 minutes of MVPA. Higher maternal MVPA, male sex, longer sunlight hours, and rain-free days were associated with children’s MVPA. Approaches for improving activity in Pacific children may be most efficacious if strategies for inclement weather and the encouragement of activity in mothers and, in particular, their daughters are included. Also, 60 minutes of daily MVPA may be insufficient to protect Pacific children from increased body size. Keywords: child; family; physical activity; social environment; weather.
064. Perceived barriers and incentives to increased maternal physical activity: findings from the Pacific Islands Families Study. Schluter P. J., Oliver, M., & Paterson, J. (2011). Australian and New Zealand Journal of Public Health, 35 (2), 151-158
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Objective: To describe and compare Pacific and non-Pacific mothers’ perceived barriers and incentives to physical activity (PA) in New Zealand, and compare perceptions between Pacific mothers. Methods: Three samples were utilised: (i) mothers with children aged 5–15 years living at home from a nationally representative cross-sectional postal survey of adults conducted in 2003 (n=1,070 including 62 Pacific mothers); (ii) a cohort of Pacific mothers with children born in 2000, and interviewed 6-years postpartum (n=934); and (iii) a nested cross-sectional sub-study of (ii) conducted at the 6-years measurement wave (n=240). Participants in samples (i) and (ii) responded to identical questions on perceived barriers (23 items) and incentives (13 items) to PA. Body mass index (BMI) and accelerometer quantified PA was measured in (iii). Results: All barriers but one were significantly more influential for non-Pacific mothers than Pacific mothers and all incentives but one were significantly more likely to succeed for non-Pacific mothers. Pacific mothers’ perceptions of barriers and incentives to PA were similar between BMI and accelerometer quantified groupings. Conclusions and implications: Pacific mothers appear not to see PA as an issue of importance. Culturally appropriate approaches aimed at improving PA and health is needed to engage Pacific mothers in New Zealand. Keywords: Physical activity; inactivity; sedentary; Pacific; mothers.
063. Maternal self-report of oral health in six-year-old Pacific children from South Auckland, New Zealand. Paterson, J., Gao, W., Sundborn, G., & Cartwright, S. (2011). Community Dentistry and Oral Epidemiology, 39(1), 19-28
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Objective: To examine maternal and socio-demographic factors associated with oral health practices and experiences in six-year-old Pacific children. Methods: The longitudinal Pacific Islands Families (PIF) study is following a cohort of Pacific children born in Auckland, New Zealand in 2000. At approximately six years postpartum maternal reports (n = 1001) on child oral health practices and experiences of fillings and extractions were gathered. Results: Forty-five per cent of mothers reported that their child had experienced fillings or extractions. After adjusting for confounding factors, we found that Tongan children were almost twice as likely to have their teeth filled or extracted than Samoan children (OR, 1.93; 95%, 1.34-2.77). Differences between Samoan children and children of other ethnic groups were not significant. Children of mothers who had secondary qualifications were significantly less likely to have their teeth filled or extracted compared to children of mothers who had postsecondary qualifications (OR, 0.634; 95%, 0.44-0.90). Prolonged duration of breastfeeding was associated with an increased likelihood of filling or extraction experience. In terms of maternal oral hygiene, maternal tooth brushing frequency of less that once a day was significantly associated with increased odds of fillings and/or extractions in their children (OR, 1.35; 95% CI, 1.02-1.79). Children who were sometimes supervised for tooth brushing were significantly more likely to have fillings or extractions than children who were not provided supervision. Conclusions: These findings highlight the role of cultural factors and maternal hygiene in child oral health outcomes and suggest that health promotion efforts should encompass the whole family and embrace a culturally appropriate approach. Keywords: early childhood caries; mental health; oral health; Pacific children
062. Parenting Practices Among Fathers of a Cohort of Pacific Infants in New Zealand. Iusitini, L., Gao, W., Sundborn, G., & Paterson, J.(2011). Journal of Cross-Cultural Psychology, 42(1), 29-55
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This study examined the nurturing and harsh disciplinary parenting practices of fathers of a cohort of Pacific children born in New Zealand. At the 12-month measurement point, 823 fathers completed a modified version of the Parent Behavior Checklist comprising 15 items, 10 forming a Nurturing subscale and 5 forming a Harsh Discipline subscale. Findings revealed that a majority of Pacific fathers never or rarely used harsh discipline with their 12-month-old child, and hitting with an object was extremely rare. Levels of nurturance were more mixed, with playing and praise being common, but provision and reading of books being relatively uncommon. Multivariate logistic regression showed that relatively low Nurturance scores were associated with cultural separation, lower formal education, and nonpartnered marital status. Relatively high Harsh Discipline scores were associated with partnered marital status, gambling, and harmful alcohol consumption. Relatively low Harsh Discipline scores were associated with Tongan ethnicity and cultural maintenance. Keywords: pacific peoples; nurturing; discipline; fathers.
061. Physical activity, sedentariness, and body fatness in a sample of 6 year old Pacific children. Oliver, M., Schluter, P.J., Rush E., Schofield, G., & Paterson, J. (2010). International Journal of Pediatric Obesity, 6(2-2), 565-73
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Objective: Pacific children living in New Zealand exhibit considerably higher rates of overweight and obesity than their non-Pacific peers. The study aim was to identify physical activity and sedentary behaviors related to increased body size in Pacific children, to inform future intervention development for improved activity profiles and body size outcomes in this population. Methods: Three hundred and ninety-three 6-year-old Pacific children and their mothers living in Auckland, New Zealand were invited to participate. Activity was assessed over 8 days using accelerometry and mothers reported on their child's sedentary behaviours. Children's height, weight, and body fatness was assessed and body mass index (BMI) and body fat z-scores calculated. Maternal height, weight, and waist circumference were assessed and BMI calculated. Associations between children's body fat z-scores and potential related factors were determined using regression analyses. Results: Of the 254 children who registered, 102 (27% overweight, 32% obese) were included in analyses. Almost all mothers were overweight or obese. On average, children's body fat z-scores were 1.75 standard deviations above the reference group (range -0.6, 3.14). After accounting for all other factors, watching television every day and having a mother with a high waist circumference were associated with increased body fat z-scores. Conclusions: Strategies for obesity reduction in Pacific children and their mothers living in New Zealand are urgently required. Multifaceted, family based interventions that include the promotion of healthy nutritional practices and television free days may be efficacious in improving activity profiles and body size outcomes for Pacific children. Keywords: Obesity; child; physical activity; accelerometer; television; sedentary; sitting.
060. Birth weight and growth trajectory to six years in Pacific children. Rush, E., W. Gao, et al. (2010). International Journal of Pediatric Obesity 5(2): 192-199. doi: 10.3109/17477160903268290. PMID: 19878093.
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Purpose: To identify the relationship of birth weight with increased body mass and fatness at age six in Pacific children. Methods: In the Pacific Islands Families Study, 722 New Zealand Pacific children who were full-term singleton births to mothers without known diabetes were enrolled at birth and were measured at six years. Birth weight was recorded and height and weight measured at two, four and six years of age; body mass index (BMI) was calculated and age-specific standard deviation (SD) scores determined from the CDC 2000 growth charts. At four and six years body fat percentage (%BF) was measured by bioelectrical impedance analysis. Results: Boys were born heavier and grew faster than girls. At six years the international obesity task force rates of overweight and obesity were 31.1% and 29.2%, respectively, for boys and 32.4% and 24.7%, respectively, for girls. Divided by sex and birth weight into quartiles children born heavy were the heaviest at six years but for children born small their weight SD score accelerated across the mean. Weight SD score increased faster than height SD score; at six years average SD scores for weight and height were 1.40 and 0.87. At six years SD scores for %BF were not different among birth weight quartiles but girls had a higher body fat than boys. At six years there was no measurable effect on body weight of not smoking during pregnancy or breastfeeding. Conclusions: The weight increase trajectory of these children is steep and tracks from birth. Obesity prevalence measured by BMI or %BF SD score is alarmingly high. Keywords: Children; Pacific; birthweight; growth; obesity; overweight.
059. Health of Pacific children: environmental and nutritional determinants. Karatela S., Paterson J. & Schluter P. (2010). Australasian Epidemiologist, 17(2), 109
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Background: Seafood is an important part of a healthy diet and is a major source of protein for many communities in New Zealand (NZ) especially Pacific people. According to the NZ National Children’s Nutrition survey (2002/03) 56% of Pacific children generally consume high fish diet. Along with the benefits of eating fish, seafood also contains environmental contaminants such as MeHg (a neurotoxin) which causes neurodevelopmental and impaired cognitive developments particularly prenatally and in children. Thus balancing the risks and benefits of eating fish is an important public health issue.
058. Vehicle child restraint usage for Pacific children aged 6 weeks to 4 years: Findings from the Pacific Islands Families Study. Schluter, P. J., & Paterson, J. (2010). Accident Analysis and Prevention, 42(6), 2075-2081 doi: 10.1016/j.aap.2010.06.020. PMID: 20728665.
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Child restraint systems (CRSs) for vehicles are designed to provide protection and prevent or reduce child mortality and morbidity in road traffic accidents. Overall, 90% of children under 5 years of age in New Zealand currently use CRSs. There is considerable regional variability in CRS usage, but little information exists on its ethnic variations or determinants. "Increasing the level of restraint use" is explicitly stated as one of the 13 priorities within the New Zealand Ministry of Transport's new road safety strategy. As such, understanding CRS prevalence, patterns and associates within different communities is essential in realising this priority. Utilising a large birth cohort of Pacific children (n=1376 mothers), this study aimed to report the prevalence of maternal self-reported car seat usage at the 6 weeks, 1-year, and 2 years postpartum measurement waves; car/booster seat usage at the 4 years postpartum measurement wave; and to identify important associates using generalised estimating equation (GEE) models. Car seats were not used by 161 (11.8%) Pacific children at the 6 weeks measurement wave, 71 (5.8%) at 1-year, and 44 (3.8%) at 2 years, while car/booster seats were not used by 139 (13.3%) at the 4 years wave. Multivariable GEE model results revealed that mothers with no formal education, high parity, who smoked tobacco, lower household income, who lacked English language proficiency, and had multiple births were all at higher odds of failing to use car seat/booster seats. Despite differential attrition being noted in mothers over time, a sensitivity analysis using multiple imputation methods yielded similar findings. Targeted initiatives and education programs focusing on these higher risk groups, in particular, is needed to increase uptake and use of CRS thereby decreasing Pacific children's exposure to injury risk. As New Zealand has a large and increasing proportion of Pacific, Maori and Asian people, there is a continuing need to understand cultural factors in traffic safety. Only when culturally appropriate initiatives and education programs have been developed and disseminated that meet the needs of New Zealand's different communities is the national priority likely to be realised. Keywords: Child restraint; Epidemiology; Risk factors; Cohort study; Pacific ethnicity.
057. Pacific Islands Families Study: The association of infant health risk indicators and the acculturation of Pacific island mothers living in New Zealand. Borrows, J., Williams, M., Schluter, P., Paterson, J., & Helu, S. (2010). Journal of Cross-Cultural Psychology, 42 (5), 699-724
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The Pacific Islands Families study follows a cohort of 1,398 Pacific infants born in Auckland, New Zealand. This article examines associations between maternal acculturation, measured by an abbreviated version of the General Ethnicity Questionnaire, and selected infant and maternal health risk indicators. Findings reveal that those with strong alignment to Pacific culture had significantly better infant and maternal risk factor outcomes than those with weak cultural alignment. In terms of Berry’s classical acculturation model, separators had the best infant and maternal outcomes; integrators had reasonable infant and maternal outcomes, while assimilators and marginalisors appeared to have the poorest infant and maternal outcomes. These findings suggest that retaining strong cultural links for Pacific immigrants is likely to have positive health benefits. Keywords: acculturation; infant health risk; Pacific health; culture and health.
056. Pacific Islands Families Study: Intimate Partner Violence and Postnatal Depression. Gao, W., Paterson, J., Abbott, M. W., Carter, S., & Iusitini, L. (2010). Journal of Immigrant and Minority Health, 12, 242-248
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Aim: The present study examined the association between maternal intimate partner violence (IPV) and postnatal depression (PND) 6 weeks after giving birth. Study Design: Data were gathered from the Pacific Islands Families Study. Mothers of a cohort of Pacific infants born in Auckland, New Zealand during 2000 were interviewed 6 weeks after giving birth. There were 1,085 mothers cohabiting in married or de-facto partnerships who completed measures of IPV and PND at the 6-week assessment point. Results: Women who were victims of physical violence were more likely to report postnatal depressive symptoms than those who were not (29.6% vs. 10.9%, OR: 3.44, 95% CI: 2.42, 4.97). The adjusted odds remained statistically significant (OR: 2.34, 95% CI: 1.52, 3.60). Conclusion: Findings suggest that being the victim of physical violence more than doubles the risk of PND. The results of the study may help to develop culturally appropriate social services and policies for Pacific women. Keywords: Intimate partner violence; Family violence; Maternal health; Postnatal depression; Postpartum depression.
055. Impact of current and past intimate partner violence on maternal mental health and behaviour at 2 years after childbirth: evidence from the Pacific Islands Families Study. Gao, W., Paterson, J., Abbott, M., Carter, S., Iusitini, L., & McDonald-Sundborn, G. (2010). Australian and New Zealand Journal of Psychiatry, 44(2), 174-182 doi: 10.3109/00048670903487126. PMID: 20113306.
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Objective: The present study examined the association between maternal intimate partner violence (IPV) at 6 weeks and 24 months postpartum and maternal health problems in a cohort of Pacific families with 2-year-old children in New Zealand. Methods: Data were gathered from the Pacific Islands Families Study. Mothers of a cohort of Pacific infants born in Auckland, New Zealand during 2000 were interviewed when the children were 6 weeks and 24 months of age. There were 828 mothers cohabiting in married or de facto partnerships who completed measures of IPV, mental health, and health-related behaviour such as smoking and high-risk alcohol use at both data points. The main statistical method used was logistic regression analysis. Results: Compared to mothers who did not experience physical violence at either data point, the odds of reporting psychological distress were 2.42 (95% confidence interval (CI) = 1.07-5.44) for those experiencing physical violence at 6 weeks only, 3.47 (95%CI = 1.75-6.86) for those experiencing physical violence at 24 months only, and 3.84 (95%CI = 1.78-8.30) for those experiencing physical violence at both data points after controlling for sociodemographic factors. Mothers experiencing verbal aggression or physical violence at both data points were more likely to report smoking or high-risk alcohol use at 24 months than those who did not, but the associations were no longer significant after controlling for sociodemographic factors. Conclusion: Being a victim of intimate partner physical violence at any time (past, recent and repeated) may contribute to an increase in maternal psychological distress. Health-related behaviours such as smoking and high-risk alcohol use at 24 months postpartum may to some degree be attributable to repeated victimization of physical violence and verbal aggression, but the relationships are not convincing and deserve further research in longitudinal studies. Keywords: behaviour; General Health Questionnaire; intimate partner violence; mental health; Pacific women.
054. Food Security for Pacific Peoples in New Zealand: A report for the Obesity Action Coalition. Rush, E. C. (2009). Wellington
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Executive summary This report provides a review and an overview of the 2008 situation for food security in New Zealand for Pacific peoples. During the writing of this report a “global financial crisis” occurred which compounds the global food security crisis. The purpose of this report was to identify key determinants of food security in New Zealand in the context of the lives of Pacific peoples by using evidence and key informant input from Pacific peoples throughout the country. The aim was to inform advocacy about how to support and celebrate the strengths of the Pacific community and improve their ability to consume the required quantities of healthy foods every day. Food insecurity is an escalating problem, particularly for households with children. In 1997, 60 in every 100 Pacific households reported that they could always afford to eat properly. In 2002, 46 in every 100 Pacific households with children reported that they could always afford to eat properly. Pacific peoples have picked up the challenge of food security and there is much good work and many intersectorial initiatives in place. If these continue to be supported they should have long-lasting effects within Pacific communities and future generations. Examples of initiatives include: • leadership training for Pacific health professionals • church-based interventions supported by district health boards • training of Pacific community health workers in how to deliver nutrition education within their communities. These actions will not be successful unless policy and the environmental infrastructure also offer support. Healthy food is more expensive than less healthy food, not as easy to access and not always as tasty. Food security will only be improved if bold, intersectorial and far-reaching actions are taken now. It is vital for public health that communities are protected from malnutrition. Central and local governments must make and enforce regulations for food supply and access that avert this crisis.
053. Pacific Islands Families: Child and Parental Physical Activity and Body Size—design and methodology. Oliver, M., Schluter, P. J., Paterson, J., Kolt, G. S., & Schofield, G. M. (2009). New Zealand Medical Journal, 122(1298) 48-58.
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Aim: To objectively assess physical activity (PA) and body size in 6-year-old children and their mothers participating in the Pacific Islands Families (PIF) cohort study, and to identify factors potentially related to PA and body size in Pacific children. Methods: The PIF cohort was drawn from live births at Middlemore Hospital (South Auckland, New Zealand) in 2000. Information has been collected at birth, 6 weeks, 12 and 24 months, and 4 and 6 years postpartum. At 6 years, the Child and Parental Physical Activity and Body Size (PIF:PAC) study was simultaneously conducted and measures of child and mother PA (8-day accelerometry), body size (waist circumference, body mass index), and PA supports and barriers (questionnaire) taken. Results: 254 mothers and their children took part in the PIF:PAC study. Usable accelerometer data were gathered for 173 mothers and 199 children over an average of 3–4 days. High levels of overweight and obesity were found in boys, girls, and mothers (62%, 58%, and 97% overweight or obese, respectively). Conclusion: Strategies for obesity reduction in Pacific populations are urgently required. Combined, the PIF and PIF:PAC studies will provide vital information for understanding and targeting the obesity epidemic in Pacific children
052. Two years on: Gambling amongst Pacific mothers living in New Zealand. Perese, L. M., Bellringer, M. E., Williams, M. M., & Abbott, M. W. (2009). Pacific Health Dialog. 15(1), 55-67.
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Research investigating the prevalence and correlates of Pacific peoples gambling within a New Zealand context is limited. This paper provides data about gambling activity from the two-year data collection point for a cohort of mothers within the longitudinal Pacific Islands Families study. The results indicate a number of consistencies and discrepancies between data collected at this time point and two years previously (six-week baseline data collection point). For example, at baseline, Samoans were the least likely to gamble and spent less money on gambling activities. Two years later, Samoans remained the least likely to gamble, but those who did gamble, were more likely to spend more money than other ethnicities. This article highlights the importance of this type of prospective study in examining the development of the risk and protective factors in relation to the development of problem gambling.
051. Relating intimate partner violence to health-care utilisation and injuries among Pacific children in Auckland: The Pacific Islands Families Study. Schluter, P. J., & Paterson, J. (2009). Journal of Paediatrics and Child Health, 45(9), 518-524
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Aim: Despite well-known emotional and behavioural sequela, few studies investigate health-care utilisation and injury impacts of children exposed to intimate partner violence (IPV). This study examines the association between mothers' IPV experience and general practitioner (GP) and hospital presentations by their children within the first 6 years of life. Methods: In 2000, a cohort of Pacific infants born in Auckland was established. At 6 weeks, 2 years and 6 years post-partum, maternal home interviews were conducted and IPV experience elicited using the Conflict Tactic Scale, together with reports of children's GP and hospital visitations. Results: At 6 weeks, 2 years and 6 years, 1098, 921 and 799 participating mothers were in intimate relationships. Severe physical IPV was reported by 22.1, 23.0 and 7.1% of mothers, respectively, and minor IPV was reported by another 18.7, 16.9 and 6.1%, respectively. Compared with children without maternal physical IPV exposure, children of mothers disclosing severe physical IPV were 1.19 (95% confidence interval (CI): 1.08–1.31) times as likely to visit GPs, and children of mothers disclosing minor physical IPV were 1.13 (95% CI: 1.02–1.25) times as likely to visit GPs, after adjusting for socio-demographic, maternal mental health and other confounding factors. No significant association was found between maternal IPV and children's hospital visits, or GP or hospital visits for injury. Conclusions: IPV is common for many mothers of Pacific children, and is associated with significantly more GP visits for exposed children. Identification of maternal IPV during mothers' and children's GP and hospital visits may help guide services to prevent future presentations to children. Keywords: children; domestic violence; epidemiology; health-care utilisation; injury
050. Food frequency information – relationships to body composition and apparent growth in the Pacific Island Family study at 4 years of age. Rush, E., Paterson, J., & Obolonkin, V.V. (2008). New Zealand Medical Journal, 121(1281), 63-71
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Aims: To record at the 4-year measurement point for the Pacific Island Family Study the most frequently eaten foods and to identify associations with growth and body composition. Methods: A food frequency questionnaire relating to consumption of 111 foods over a 4 week period was administered to the 739 children, to be completed by a parent. Body composition of the children was measured by anthropometry and body fatness by bioimpedance analysis. Patterns of association between body composition and food frequency were examined using correlation analyses. Results: The foods most frequently consumed were bread (1.32 times/day) and total milk (1.63), followed by breakfast cereal (0.83), and fruits (0.78-0.83). 77% of respondents consumed white bread only while 85% consumed standard milk and 7% consumed milk less than once a month or never. Recommended frequency of consumption for fruit was attained by 60%, while only 35% achieved the recommended level for vegetables. Traditional Pacific food consumption made up 5% of the dietary pattern. Protein consumption was positively associated with weight and BMI at 4 years, along with weight gain (0 to 4 years), while frequency of fat consumption was negatively correlated with these variables, in addition to body fat %. Dairy consumption showed a positive correlation with body fat % and BMI. Conclusions: This diet and body size analysis as part of a longitudinal study provides practical evidence to inform practical dietary advice and food policies. Further research is needed to explore association of growth with food patterns and quality.
049. Child Discipline and nurturing practices among a cohort of Pacific mothers living in New Zealand. Cowley,- Malcolm, E.T; Paterson J.E. Fairbairn-Dunlop, P., Gao, W., & Williams, M.(2009). Pacific Health Dialog, 15 (1), 36-46.
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The Pacific Islands Families (PIF) study is a longitudinal investigation of a cohort (N=1376) of Pacific infants born in New Zealand (NZ), and their mothers and fathers. Objectives: The PIF study aimed to determine: (1) the prevalence of disciplinary and nurturing parenting practices used with children at 12 months of age, and (2) the demographic, maternal and lifestyle factors associated with parenting practices. Methods: At the 12-month measurement point, mothers (N=1207) were interviewed about their parenting practices using a modified version of the Parent Behaviour Checklist. Results: High nurturance was significantly associated with Samoan ethnicity and post school qualifications, and low nurturance was significantly associated with post-natal depression, alcohol consumption and gambling. At the univariate level, high discipline scores were significantly associated with gambling, postnatal depression and lack of alignment to either Pacific or to European traditions. However the strongest association with discipline was the ethnicity variable with Tongan mothers reporting significantly higher disciplinary behaviours that all other ethnicities. Conclusions: It is clear that there are a number of common underlying lifestyle issues that need to be considered when dealing with parenting problems in families with young children. However, specific to Pacific families, is Tongan ethnicity accounting for a strong cultural effect on parenting style, in particular high discipline scores relative to other Pacific groups. This important finding may be used to guide social policy and prevention programmes that are focused on the wellbeing of Pacific mothers and their children.
048. Mental health well-being amongst fathers within the Pacific Island Families Study. (2009). Tautolo E., Schluter P., McDonald-Sundborn, G. Pacific Health Dialog, 15 (1), 69-78.
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This article investigates the prevalence of potential psychological disorder amongst a cohort of primarily Pacific fathers in New Zealand over their child's first 6-years of life. The analysis is based on data collected at 12-months, 2-years and 6-years postpartum during the Pacific Islands Families Study, and uses the 12-item General Health Questionnaire (GHQ12) to assess the prevalence of psychological distress amongst participant fathers at each measurement wave. Various sociodemographic and potentially confounding variables were also investigated to determine their effect on the risk of developing potential mental health disorder. The majority of fathers within the study reported good overall health and well-being and their prevalence of 'symptomatic' disorder was initially low at 12-months (3.90%) but increased significantly at 2-years (6.6%) and at 6-years (9.80%) in crude and adjusted analyses (both P-values < 0.001). In the adjusted analysis, the odds of symptomatic cases at 2-years was 1.7 (95% confidence interval: 1.1, 2.8) times that observed at 12-months postpartum and at 6-years the odds was 3.2 (95% confidence interval: 1.9, 5.2) times that observed at 12-months. Moreover in the adjusted analysis, smoking status, marital status, employment status, and ethnicity, were all significantly associated with the risk of developing symptomatic mental health disorder.
047. Do perceptions of neighbourhood problems contribute to maternal health?: Findings from the Pacific Islands Families Study. Carter,S., Williams,M., Paterson, J., Iusitini, L. (2009). Health & Place, 15 (2), 622-630. doi: 10.1016/j.healthplace.2008.10.005. Epub 2008 Nov 5. PMID: 19083257.
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Research suggests that physical and social aspects of the neighbourhood have a bearing on our well-being. As part of the Pacific Islands Families Study, this study examined maternal perceptions and socio-demographic determinants of neighbourhood problems and their association with mental health. The main problems reported centred on noise, pollution and safety matters. Ethnicity, deprivation and alcohol consumption were the best predictors of greater perceived neighbourhood problems. Adjusted analyses showed that those reporting greater neighbourhood problems were almost twice as likely as those reporting fewer problems to have psychological morbidity. Mothers with high deprivation scores were 7.3 times more likely to have psychological morbidity. Findings suggest that neighbourhood quality and socio-economic position are important contributors to mental health. Negative effects on health are likely to derive from exposure to pollutants and from problem features in the neighbourhood acting as sources of psychosocial stress and barriers to health promoting activities. Improvements to services and regulations may contribute to health gains.
046. Maternal intimate partner violence and behavioural problems among Pacific children living in New Zealand. Paterson, J., Carter, S., Cowley-Malcolm, E., Gao, W., & Iustini, L. (2008). Journal of Child Psychology & Psychiatry 49 (4), 395-404.
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Aims: To examine (1) the association between maternal intimate partner violence (IPV) perpetration and victimisation and behavioural problems among two- and four-year-old Pacific children, and (2) the socio-demographic and parenting factors that may impact on this association. Design: Mothers of the Pacific Islands Families (PIF) cohort of Pacific infants born in New Zealand during 2000 were interviewed when the children were two and four years of age. This data set was based on mothers who were cohabiting in married or de-facto partnerships (N = 920) and who completed measures of IPV at the two-year assessment point and the Child Behaviour Checklist (CBCL) at the two-or four-year assessment points. Of these, 709 mothers completed the CBCL at both assessment points. Results: There were no significant associations between IPV and the prevalence rates of clinically relevant cases of behavioural problems in the two-year-old child cohort. However, the prevalence rates of clinically relevant internalising, externalising and total problem cases were significantly higher among four-year-old children of mothers who reported severe perpetration of IPV. The odds of being in clinical range of internalising were 2.16 times higher for children of mothers who were perpetrators of severe physical violence than for those children of mothers who were not, and for externalising and total problems they were 2.38 and 2.36 times higher respectively. Socio-demographic and parenting factors did not significantly influence the association between IPV and child behaviour problems. Conclusion: These findings contribute to the complex picture of the consequences that exposure to parental violence may have on the behaviour of young children. The effectiveness of preventative strategies may be maximised if implemented in these early years before such problems become entrenched and lead on to future behavioural problems and impaired family relationships. Keywords: Antisocial behaviour; behaviour problems; measures; Child Behaviour Check List; epidemiology; ethnicity.
045. Cohort profile: the Pacific Islands Families (PIF) Study. Paterson J., Percival T., Schluter P., Sundborn G., Abbott M., Carter S., Cowley-Malcolm E., Borrows J., Gao W. and the PIF Study Group. (2008). International Journal of Epidemiology, 37(2):273-279.
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How did the study come about? In New Zealand, the Pacific population (those resident with a Pacific Islands heritage) is one of the fastest growing population subgroups and on census night, 7 March 2006, numbered 265 974 usual residents or 6.6% of the total population.1 Auckland is the preferred region of domicile.2 Samoans constitute the largest group (50%), followed by Cook Island Maori (23%), Tongan (18%), Niuean (9%), Fijian (3%), Tokelauan (3%) and Tuvalu Islanders (1%).2 This ethnic diversity is manifest in differing cultures, languages, and differential access to and utilization of education, health and social services. Pacific people are over-represented in many adverse health and social statistics2–4 leading to higher rates of communicable and non-communicable disease,2,4,,5 hospitalization3,4,,6 and death.2 Yet, prior to this study, there was relatively little culturally specific information on which to base efficacious coordinated public health interventions for this ethnic group.7 The Pacific Islands Families (PIF) Study, a birth cohort study, was developed through a process of collaboration with Pacific communities, researchers, and relevant health and social agencies to provide this much needed information. At inception, the PIF study had two directors, Dr Janis Paterson and Dr Colin Tukuitonga, a number of Pacific and non-Pacific investigators, and a team of Pacific field staff. An independent Pacific People's Advisory Board, composed of community representatives, was established to guide the directors and the management team in the scientific and cultural directions of the research. The Plunket Society (a not-for-profit society with clinical staff and volunteer network, and the largest provider of services to support the health and development of children under five8) also worked closely with the PIF research team. Grants were awarded from the Foundation for Research, Science and Technology (FRST) in 1998 and the Health Research Council(HRC) in 1999 to undertake a pilot study that enabled instruments, recruitment and interview procedures to be tested and refined. The main study commenced in 2000 and has been principally funded from FRST, with supplementary studies funded by multiple national and regional agencies. To date, the study has received approximately NZD$4.42 million in funding.
044. Intimate partner violence and unplanned pregnancy in the Pacific Islands Families Study. Gao, W., Paterson, J., Carter, S., Iusitini, L. (2008). International Journal of Gynecology and Obstetrics. 100(2):109-115. doi: 10.1016/j.ijgo.2007.08.004.
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Objective: To examine the association between maternal intimate partner violence (IPV) victimization and unplanned pregnancy. Method: Mothers of the Pacific Islands Families (PIF) Study cohort of Pacific infants born in Auckland, New Zealand during 2000 were interviewed when the children were 6 weeks old. A total of 1088 mothers cohabiting in married or de-facto partnerships were questioned about IPV and whether their pregnancy had been planned. Results: Women identified as victims of physical violence were more likely to report an unplanned pregnancy than those who were not victims (68.7% vs 55.1%, odds ratio [OR] 1.78; 95% confidence interval [CI], 1.32–2.40). The adjusted odds remained statistically significant (OR 1.52; 95% CI, 1.01–2.26). Conclusion: The findings of this study suggest an association between IPV and unplanned pregnancy in the Pacific birth cohort. Keywords: Intimate partner violence; Unintended pregnancy; Domestic violence; Abuse during pregnancy; Reproductive health.
043. Maternal smoking during pregnancy and behaviour problems in a birth cohort of 2 year old Pacific children in New Zealand. Carter, S., Paterson, J., Gao, W., & Iustini, L. (2008). Early Human Development, 84(1),59-66. doi: 10.1016/j.earlhumdev.2007.03.009. Epub 2007 May 17. PMID: 17499944.
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Aim: The present study investigated associations between maternal smoking during pregnancy and child behaviour problems in a cohort of Pacific Islands two-year-old children in New Zealand. Study Design: Data were gathered as part of the Pacific Islands Families (PIF) Study. Mothers of a cohort of 1398 Pacific infants born in South Auckland, New Zealand were interviewed when their children were six-weeks, 12 and 24 months of age. Within the context of a wider interview, data regarding cigarette smoking during pregnancy was obtained from 1038 biological mothers at the six-week interview and reports of child behaviour using the Child Behaviour Checklist were gathered when the children were 24 months old. Results: The prevalence rates of clinically relevant cases were higher in children of smokers compared to non-smokers for internalising (22.6% versus 15.2%), externalising (9.6% versus 5.7%) and total problem scores (20% versus 12.4%). Following adjustment for potential confounding factors, smoking was associated with a moderately increased prevalence of total behaviour problems (OR=1.75, 95% CI=(1.12, 2.74); p=0.015). For internalising scores, the effects of smoking appeared to be raised for children of non-partnered mothers (OR=3.35, 95% CI=(1.29, 8.67); p=0.013). For externalising scores, smoking appeared to have a greater detrimental effect on girls (OR=2.37, 95% CI=(1.12, 5.04); p=0.024). Conclusions: Findings indicate there are significant effects of prenatal tobacco exposure on problem behaviour among young children. Smoking is a modifiable factor worthy of increased early preventive efforts.
042. Problem gambling related to intimate partner violence: findings from the Pacific Islands Families Study. Schluter P.J., Abbott M.W. and Bellringer M.E. (2008). International Gambling Studies, 8(1):49-61.
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Intimate partner violence (IPV) and problem gambling are becoming increasingly significant public health issues, especially amongst Pacific populations within New Zealand, yet no general population studies have explicitly investigated the association between these factors. This study aims to determine whether problem gambling is an independent risk factor for IPV victimization in 700 couples with a Pacific infant, after accounting for problem drinking. Victimization of any and severe physical IPV was indicated for 33% and 18% mothers, and 38% and 22% fathers, respectively. For mothers, 1% were classified as problem gamblers and 15% as problem drinkers; while for fathers, 2% were defined as problem gamblers and 26% as problem drinkers. In this first published study to simultaneously relate current problem gambling to IPV victimization in a general population, no association could be found.
041. Smacking - are we being too heavy-handed? Findings from the Pacific Islands Families Study. Schluter P.J., Sundborn G., Abbott M. and Paterson J. (2007). New Zealand Medical Journal, 120(1267), 47-55.
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Aims: To report the types, frequency, and concordance of physical punishments employed by parents on their Pacific children at ages 1, 2, and 4 years. Methods: A cohort of Pacific infants born during 2000 in South Auckland, New Zealand, was followed. Separate home interviews that included questions about child discipline were undertaken at 1-year, 2-years, and 4-years postpartum for mothers, and 1-year and 2-years postpartum for fathers. Results: Maternal interviews were completed from 1224, 1144, and 1048 mothers and 825 and 757 fathers respectively. Over these measurement waves, the prevalence of smacking was 21.5%, 52.0%, and 77.1% for mothers and 24.4% and 78.4% for fathers, while the prevalence of hitting with an object (such as a spoon or belt) was 0.2%, 6.6%, and 24.3% for mothers and 1.3% and 13.2% for fathers. There was poor statistical agreement in physical punishment administered between mothers and fathers, and significant asymmetry with fathers more likely to employ harsher punishment than mothers. Conclusions: Smacking is a widespread form of discipline administered to Pacific children, and hitting with objects is common. If the use of objects constitutes a consequential assault in the newly ratified Crimes (Substituted Section 59) Amendment Act 2007 then many parents within this cohort are in breach of this law. We believe that guidelines for corporal punishment which is legally acceptable needs to be made explicit to all, and widespread culturally sensitive efforts to teach parents positive parent management strategies is urgently required.
040. Application of the 2006 WHO growth standard from birth to 4 years to Pacific Island children. Rush, E., Paterson, J., Obolonkin, V., & Puniani, K. (2007). International Journal of Obesity, 32(3):567 – 572. doi: 10.1038/sj.ijo.0803751. Epub 2007 Oct 30. PMID: 17968380.
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Background: Pacific adults and children have very high rates of obesity. Objective: Body size at birth, 2- and 4 years for the whole cohort, compliant (not smoking and breastfed) and non-compliant children was compared to the 2006 World Health Organization (WHO) growth standard using z-scores. Design: Longitudinal data (n=659) from the 2000 Pacific Island family birth cohort study of weight at birth and weight and height at 2- and 4 years was analysed. Results: At birth the average child was 3.673±0.501 kg; z-score 0.605 units higher (P<0.000001) than the WHO standard. At 2- and 4 years, average z-scores for weight and body mass index (BMI) were significantly different from 0 (mean z-scores for weight +1.062 and +1.688, for BMI +1.701 and +1.969 respectively, P<0.000001). Mean height was significantly lower (P<0.000001) z-score=−0.232 at 2 years but higher (P<0.000001) at 4 years, z-score=+0.626. Over 4 years, the daily weight gain was 11.2 g day–1 compared with 8.9 g day–1 for the WHO child. Compliant (n=287) compared to non-compliant (n=372) weighed less and were slightly shorter at 2- and 4 years measurement points. Non-compliant children categorized as non-smoking (n=229) weighed more than smoking mothers' (n=143) children at birth, 2- and 4 years. Conclusion: Pacific children are born heavy, over 4 years increase in weight is faster and between 2- and 4 years increase in height is faster than the reference breastfed child, independent of pre- and postnatal factors. Smoking decreases the rate of weight gain and children who are not breastfed gain weight faster. Interventions to limit weight gain need to start with the family before conception. Keywords: early environment; Pacific children; growth standard; weight gain.
039. Maternal Mental Health and Child Behaviour Problems at 2 years findings from the Pacific Islands Families (PIF) Study. Gao, W., Paterson, J., Abbott, M., & Carter, S. & Iustini, L.(2007). Australia and New Zealand Journal of Psychiatry, 41(11): 885-95.
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Objective: The present study investigated associations between the timing and persistence of maternal psychological disorder and child behaviour problems in a cohort of Pacific 2-year-old children in New Zealand. Method: Mothers of a cohort of 1,398 Pacific infants born in South Auckland, New Zealand were interviewed when their children were 6 weeks, 12 and 24 months of age. Within the context of a wider interview, data regarding maternal mental health were obtained at these times and maternal reports of child behaviour were gathered when the children were 2 years old. Results: Prevalence rates for internalizing problems were significantly higher in children of mothers who had self-reported symptoms of psychological disorder (11.9% in no symptoms, 27.8% in early symptoms of postnatal depression, 21.1% in late symptoms of psychological disorder and 42.9% in persistent or recurrent symptoms). The adjusted odds ratio (OR) of a child having internalizing problems was 1.38 (95% confidence interval (CI): 0.79-2.43) in those of mothers reporting early symptoms of postnatal depression, 1.45 (95%CI: 0.85-2.49) in late symptoms of psychological disorder, and 2.93 (95%CI: 1.54-5.57) in persistent or recurrent symptoms relative to the no symptoms group. For externalizing problems, the effects of maternal psychological disorder were not significant. Conclusions: Maternal persistent or recurrent symptoms of psychological disorder may contribute to the behaviour problems of children as young as 2 years old. However, the timing of disorder, whether it is infant or toddler exposure, does not appear to be as crucial. Improved understanding of the associations between maternal psychological disorder and early child behaviour problems may help maternal and child health professionals design appropriate and effective screening and intervention programs to help Pacific mothers and children. Keywords: Child behaviour; Pacific children; maternal depression; mental health.
038. Food security, selection, and health eating in a Pacific community in Auckland, New Zealand. Rush, E., Puniani, N., Snowling, N., & Paterson, J. (2007). Asia Pacific Journal of Clinical Nutrition, 16, (3)448-454.
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When an infant is brought home to the family, it is often a time of emotional, economic and physical stress due to the extra demands placed on parents. Household food security means "access at all times to enough and nutritionally appropriate food to provide the energy and nutrients needed to maintain an active and healthy life". Questions about food security were asked of 1376 Pacific Island mothers (as part of the Pacific Island Family Study) approximately six weeks after the birth of their baby. Due to lack of money food sometimes ran out in 39.8% of households and in a further 3.8% food often ran out. Variety of foods was limited by lack of money in 39.3%. Foods that were still bought when money was limited included bread (97%), milk (95%), meat and chicken (91%), vegetables and fruit (83%), rice or pasta (82%), breakfast cereals (69%), fish or shellfish (50%) and biscuits or chips (44%). Alcohol (1%), soft drinks (11%), ice cream (12%) and fruit juice (21%) were the least often bought. Energy density (MJ/kg) and nutrient-density of typical foods limited by lack of money were analysed. Rice, bread and fatty meats provided the most calories per dollar and fruit and vegetables the least. The best protein-value for money was from minced beef, chicken and tinned tuna and the most fibre-rich foods included baked beans and mixed vegetables. Food security is a major problem for Pacific families. The environment of food availability, choice and cost requires attention to help close the health gap. Key Words: food security; obesity; Pacific; energy density; diet; costs.
037. Maternal childhood parental abuse history and current intimate partner violence: data from the Pacific Islands Families Study. Paterson, J., Fairbairn-Dunlop, P., Cowley-Malcolm, E., Schluter, P. (2007). Violence and Victims,22 (4) 474-488.
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Pacific peoples are a rapidly growing but socially disadvantaged segment of New Zealand society. Within this context, individuals may be particularly vulnerable to the experience of intimate partner violence (IPV). The aim of the study was to establish the association between the experience of maternal and/or paternal emotional or physical abuse and current severe physical partner violence perpetration or victimization among a cohort of Pacific women. Paternal physical abuse was the only statistically significant risk factor from childhood parenting history that was independently associated with severe physical perpetration and victimization within the mother's current intimate partner relationship (RR 2.6). These findings highlight the deleterious effect of paternal physical violence on subsequent IPV and contribute to the development of empirically based and considered ways to approach these complex phenomena. Keywords: Cohort study; emotional abuse; longitudinal; physical abuse.
036. Pacific Islands Families Study: Maternal factors associated with cigarette smoking amongst a cohort of Pacific mothers with infants. Erik- Peleti, S., Paterson, J., & Williams, M. (2007). New Zealand Medical Journal, Vol 120 (1256), 22-31.
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Aim: To describe the association between cigarette smoking and maternal factors amongst a cohort of Pacific mothers. Method: Mothers of a cohort of 1398 Pacific infants born in Middlemore Hospital, Auckland, New Zealand during 2000 were interviewed when their infants were 6 weeks old (n=1376) and followed up at 12 months (n=1219). This paper is based on all mothers who were interviewed at both data points. Mothers participated in a 1-hour interview that included questions about the number of cigarettes smoked yesterday, and the number of other people living in the same home who currently smoke cigarettes. Cross tabulations and logistic regression models were applied to investigate the association between maternal smoking and health, demographic, social, cultural, and educational factors. Results: At the 6 weeks data point, 24.5% of mothers reported smoking, and at the 12-month follow-up, 29.8% of mothers smoked. From the 6 weeks measurement point more mothers started smoking (9.6%) than stopped (4.4%). Variables associated with smoking at 12 months after birth were: age (less than 20 years), non-Tongan ethnicity, non-partnered or de facto marital status, New Zealand-born, low income, full-time parenting, English fluency, non-separationalism, living with other smokers, size of house is too small, and overcrowding. After controlling for confounding variables, English fluency and cultural alignment to mainstream New Zealand culture remained statistically significant. Formal education qualifications, parity, and type of house they lived in were not significantly associated with smoking. Conclusion: Many Pacific mothers in this cohort were smoking around the time of birth and continued to smoke a year after giving birth. These findings demonstrate the need to explore acculturation issues surrounding smoking behaviour and smoking cessation for Pacific women in New Zealand. A qualitative research design may assist in advancing a more effective response to cigarette smoking amongst Pacific mothers.
035. Pacific Islands Families Study: Risk factors associated with otitis media with effusion among two-year-old Pacific children. Paterson, J., Carter, S., Ahmed, Z., Wallace, J.,Garrett, N & Silva, P. (2007). International Journal of Pediatric Otorhinolaryngology, 71,(7) 1047-1054.
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Objective: This study examined the risk factors associated with middle ear disease in a cohort of Pacific 2-year-old children residing in New Zealand. Methods: The data were gathered as part of the Pacific Island Families: first 2 years of life (PIF) study in which 656 2-year-old were screened using tympanometry to identify children at risk for otitis media with effusion (OME) and other otological disorders. Results: Within this 2-year-old cohort of Pacific children, one set of factors significantly associated with OME was clustered around the respiratory and auditory health of the child over the past year. OME was more likely for children who were regularly suffering from fluid/pus discharge from ears (OR = 2.10, 95% CI: 1.01–4.35), children with five or more coughs/colds in the last year (OR = 1.90, 95% CI: 1.22–3.00), and children who frequently/constantly snored (OR = 2.60, 95% CI: 1.09–6.23) to have OME. Those children who were treated at home for breathing problems were more that two times more likely to have OME (OR = 2.61, 95% CI: 1.55–4.42). A second set of factors was clustered around environmental risks that exposed children to a large number of other children. Children who attended a day care centre for more than 20 h were five times more likely (OR = 5.21, 95% CI: 2.90–9.35) and those who regularly attended church (OR = 2.78, 95% CI: 1.05–7.40) were almost three times more likely to have OME. Conclusions: These findings portray a child compromised by persistent ear infections and general coughs and colds as being at increased risk of contracting OME. In line with international research these findings raise questions about the negative child health effects associated with the day care environment for young children. Keywords: Pacific children; Otitis media with effusion; Risk factors; Day care
034. Pacific Islands Families Study: Factors associated with living in extended families one year on from the birth of a child. Poland, M., Paterson, J., Carter, S., Gao, W., Perese, L., Stillman, S. (2007). Kōtuitui: New Zealand Journal of Social Sciences Online, 2:1, 17-28, DOI: 10.1080/1177083X.2007.9522421.
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Using data from the “Pacific Islands Families: the first two years of life” (PIF) study, this paper explores the factors associated with the living arrangements of mothers with a one-year-old Pacific child. Three living arrangements are considered: (1) those children who live with immediate family members only; (2) children who live with extended family members including at least one of their grandparents; and (3) children who live with extended family members but do not live with any of their grandparents. Findings of interest include: mothers who were born in New Zealand are much more likely to live in an extended family with the child’s grandparent(s) compared to those who came to New Zealand as an adult; and mothers with high New Zealand identity and low Pacific identity being more likely to live with extended family members other than the child’s grandparent(s) relative to those with low New Zealand and high Pacific identity.
033. Prevalence and concordance of interpersonal violence reports from intimate partners: findings from the Pacific Islands Families Study. Schluter, P. J., Paterson, J., & Feehan, M. Journal of Epidemiology and Community Health, 61(7), 625-630
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Background: Intimate partner violence (IPV) is an increasingly significant public health issue. Few studies investigate both partners' reports of such violence. Aim: To determine the prevalence of IPV perpetration and victimisation and the concordance of both partners' reports of that violence in a representative sample of Pacific couples using a standardised measure. Methods: A cohort of Pacific infants born during 2000 in Auckland, New Zealand, was followed. At 24-months postpartum, home interviews were conducted separately for mothers and fathers, and experience of IPV within the last 12 months was measured using the Conflict Tactic Scale. Concordance and symmetry between partner's reports was assessed using the kappa statistic and McNemar's test, respectively. Results: The sample included 915 partnered mothers and 698 partnered fathers of which 674 were couples. Over 85% of individuals perpetrated or were victims of verbal aggression. Perpetration and victimisation of physical IPV was reported by 37% and 28% of mothers and 11% and 8% of fathers, respectively. Fathers systematically under-reported IPV and significant differences emerged in the response distributions from couples with Tongan mothers compared with couples with Samoan or Cook Island Maori mothers. Discussion: IPV is common for many Pacific couples and consistent with that reported in other New Zealand groups. Mothers are as likely as fathers to perpetrate and be victims of this violence. However, patterns of reporting were different between mothers and fathers, and between Pacific ethnic groups, which has implications for the understanding and health promotion targeting of domestic violence.
032. Intimate Partner violence within a cohort of Pacific mothers living in New Zealand. Paterson, J.,Feehan, M., Butler, S., Williams, M., & Cowley, E. (2007). Journal of Interpersonal Violence, 22 (6), 698-721.
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Maternal reports of intimate partner violence (IPV) were obtained from a cohort of Pacific mothers living in New Zealand. The Conflict Tactics Scale was completed by 1,095 women who had given birth in the past 12 months, and who were married or living with a partner as married. The 12-month prevalence of “victimization” through verbal aggression was 77%, 21% for “minor” physical violence, and 11% for “severe” physical violence. The 12-month prevalence of “perpetration” of verbal aggression against a partner was 90%, 35% for “minor” physical violence, and 19% for “severe” violence towards their partner. The experience of social inequality and acculturation are associated with IPV, albeit differentially across the experience of victimization and perpetration. Factors significantly associated with victimization are ethnicity, maternal education, social marital status and household income. Factors significantly associated with perpetration are ethnicity, cultural alignment, maternal birthplace and alcohol consumption since the birth of the child
031. Maternal self-report of oral health in 4-year old Pacific children from South Auckland, New Zealand: findings from the Pacific Islands Families Study. Schluter P.J., Durward C., Cartwright S., and Paterson J. (2007). Journal of Public Health Dentistry, 67(2):69-77
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Objectives: To report on the oral health risk in a disadvantaged group of 4-year-old Pacific children and their mothers living in South Auckland, New Zealand. Methods: The Pacific Islands Families study follows a cohort of Pacific infants born in 2000. Maternal self-report of mother and child's oral health practices and child's filling and extraction experience was undertaken at interview approximately 4 years postpartum. Results: Overall, 1,048 mothers of children were interviewed. Children's reported oral health practices were generally poor, with 47 percent brushing < or =1/day, 47 percent having no adult assistance with brushing, 57 percent routinely snacking or drinking immediately prior to bed, and 26 percent yet to receive their first dental checkup. Maternal practices were also poor, with 34 percent brushing < or =1/day and 50 percent having never seen or last visiting a dentist over 5 years ago. Significant differences were seen in many practices between the major ethnic subgroups. Of children attending the school dental service, 22 percent were reported having at least one filling and/or extraction. In multivariable analyses, variables corresponding to mother's toothbrushing frequency, child snacking or drinking prior to bed, and duration of breastfeeding were significantly associated with reported filling and/or extraction experience; but no difference was seen between the three major maternal ethnic subgroups. Conclusions: Many mothers and their Pacific children have poor basic oral hygiene and dietary practices that increase the oral health risk in these children. Culturally appropriate and targeted strategies aimed at these modifiable practices need to be widely promoted so that the oral health burden carried by Pacific children can be reduced.
030. Infant care practices associated with sudden infant death syndrome: findings from the Pacific Islands Families study. Schluter, P., Paterson, J., & Percival, T. (2007). Journal of Paediatrics and Child Health, 43(5):388-393.
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Aim: To report infant care practice prevalence for known modifiable sudden infant death syndrome (SIDS) risk factors among a generally disadvantaged yet low-SIDS rate population of mothers with Pacific infants. Methods: The Pacific Islands Families study follows a cohort of Pacific infants born at a large tertiary hospital in South Auckland, between 15 March and 17 December 2000. Maternal self-report of infant care practices was undertaken at interview 6 weeks post-partum. Results: Overall, 1376 mothers self-reported upon their care practices for infants with median age of 7 weeks. Current maternal smoking was reported by 29%. Of infants: 50% were fully breastfed; 1% were placed prone to sleep; 50% usually bed-shared with their mother and 12% usually bed-shared with a mother who smoked; and 94% usually and 1% occasionally slept in the same room as their mother. Except for room sharing (P = 0.09), there were significant differences in these practices between the three major Pacific Island ethnic subgroups (all P < 0.001). Conclusion: Adoption of bed-sharing and room-sharing practices appears to be saving Pacific infants' lives, even though the New Zealand Cot Death Association has discouraged bed-sharing and not actively promoted room sharing. Mothers need to receive adequate information antenatally about the risks and benefits of room-sharing, bed-sharing and safe-sleeping practices and environments should they decide or have no option but to bed-share.
029. Pacific Islands families Study: Behavioural problems among Pacific children living in New Zealand. Paterson, J. Carter, S., & Gao, W. Perese, L. (2007). Journal of Child Psychology and Psychiatry, 48 (5), 514-522.514-522.
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028. Maternal gambling associated with families' food, shelter and safety needs: findings from the Pacific Islands Families Study. Schluter P., Bellringer M. and Abbott M. (2007). Journal of Gambling Issues, 19, 87-90.
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From a cohort study of Pacific families with children resident in Auckland (n = 983) we examine the association between maternal gambling over the previous 12 months and families' food, shelter, and safety needs. Overall, 666 (68%) mothers reported no gambling, 267 (27%) reported gambling but receiving no criticism, and 50 (5%) reported both gambling and receiving criticism. Compared to those with nongambling mothers, households with gambling mothers were more likely to have both food and housing issues related to a lack of money but no excess in physical intimate partner violence.
027. Risk factors for preterm and small for gestational age babies. A cohort from the Pacific Islands Families Study (PIF). Gao, W., Paterson, J., Carter, S., & Percival, T. (2006). Journal of Paediatrics & Child Health, 42, 785-792.
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Aim: To explore risk factors that are associated with preterm birth and full-term small-for-gestational-age (SGA) birth for a Pacific population. Methods: Data were gathered from the Pacific Islands Families Study. Mothers of a cohort of 1398 Pacific infants born in South Auckland, New Zealand during 2000 were interviewed when their infants were 6 weeks old. Mothers were questioned regarding maternal health, antenatal care and life-style behaviours. Data regarding birth outcomes were obtained from hospital records. Analyses focused on 1324 biological mothers who gave birth to a singleton and had valid data for birth outcomes. Results: Of 1324 singleton infants, the mean birthweight was 3.60 kg with standard deviation of 0.60 kg. Fifty-two (3.9%) had birthweight less than 2500 g. Ninety-four (7.1%) were born at less than 37 weeks of gestation. Most socio-demographic factors were not associated with poor birth outcomes. Primiparous birth, less frequent attendance of antenatal care and mother's history of high blood pressure were associated with preterm birth and SGA. Smoking during pregnancy increased the odds of having an SGA but not preterm birth. On the other hand, unplanned/unsure pregnancy and prior early pregnancy loss were associated with preterm birth but not SGA. Conclusion: Corroborating research conducted with other populations, most of the internationally and nationally recognised risk factors for preterm birth and SGA are also important for Pacific people. Smoking seems to explain more poor birth outcomes in Pacific Islands than in the New Zealand population as a whole
026. Indices and perception of crowding in Pacific households domicile within Auckland: findings from the Pacific Islands Families Study. Schluter P.J., Carter S. and Kokaua J. (2007). New Zealand Medical Journal, 120, (1248), 63-74.
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Aims: Pacific peoples (mostly of Samoan, Tongan, Niuean, or Cook Islands origin) have a higher proportion of reported household crowding than any other ethnic group in New Zealand. However, there are multiple ways crowding can be measured. This paper reports the prevalence and concordance of Pacific peoples’ own perception of household crowding together with three commonly employed indices, the American Crowding Index (ACI), Canadian National Occupancy Standard (CNOS), and Equivalised Crowding Index (ECI). Methods: A cohort of Pacific infants born during 2000 in Auckland was followed. Maternal home interviews were conducted at 6-weeks, 12-months, and 24-months postpartum. Household membership information was obtained from the 12-month interviews. Agreement was assessed using the k statistic. Results: In total, 1224 mothers completed the 12-month interview. Overall, 30% of mothers perceived crowding to be an issue for their households. Crowding was indicated by ACI for 37%, by CNOS for 32%, and by ECI for 59% of households. Agreement between measures ranged from poor (=0.36) to moderate (=0.61). In regression analyses, self-reported perception of crowding had better validity than ACI, CNOS, or ECI indices. Conclusion: Estimated household crowding prevalence depends on the index used. Self-reported perception of crowding appears the best measure and ECI the worst. Regardless of the index used, crowding remains an important problem for Pacific people despite recent initiatives within New Zealand.
025. Gambling among Pacific mothers living in NZ. Bellringer, M., Perese, L., Abbott, M., & Williams, M. (2006). International Gambling Studies, 6 (2), 217-235.
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There is a lack of research investigating Pacific peoples' gambling within a New Zealand context. In this paper, data about gambling activity (rather than problem gambling) are presented from the first data collection point for a cohort of mothers who are part of the longitudinal Pacific Islands Families study. The results indicate that gambling behaviour could be influenced by cultural differences. For example, Tongans are more likely to gamble than Samoans, and those who undertake traditional gift giving customs are likely to spend more money on gambling than those who do not. This paper identifies a need for research on Pacific peoples' gambling to acknowledge ethnic-specific cultural influences on gambling practices.
024. Exclusive and any breast-feeding rates of Pacific infants in Auckland: Data from the Pacific Islands Families First Two-Years of Life study. Schluter P.J., Carter S. and Percival T. (2006). Public Health Nutrition, 9(6):692-699
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Objectives: To present current breast-feeding rates for Pacific infants resident in New Zealand. Reasons for the introduction of complementary liquid foods were also explored. Design: A longitudinal study using hospital discharge summary records and maternal home interviews undertaken at 6 weeks, 12 and 24 months postpartum. Turnbull's non-parametric survival analysis was used to model exclusive breast-feeding rates. Setting: Auckland, New Zealand. Results: The cohort comprised 1376 infants at 6 weeks, 1223 infants at 12 months and 1142 infants at 24 months. Exclusive breast-feeding rates at hospital discharge, 6 weeks, 3 and 6 months postpartum were 84% (95% confidence interval (CI): 80–88%), 49% (95% CI: 43–55%), 37% (95% CI: 32–42%) and 9% (95% CI: 7–11%), respectively. Significant ethnic difference existed, with Samoan mothers having higher exclusive breast-feeding rates than Tongan mothers (P=0.002). The percentage of infants receiving any breast milk at hospital discharge, 6 weeks, 12 and 24 months was 96% (95% CI: 94–97%), 95% (95% CI: 94–96%), 31% (95% CI: 28–34%) and 15% (95% CI: 13–17%), respectively. Again ethnic differences emerged. Common reasons cited for discontinuation of exclusive breast-feeding included uncertainty of breast milk supply (56%), problems with breasts (30%) and difficulties breast-feeding in work or educational environments (26%). However, 691 (50%) mothers sought no advice about their breast-feeding concerns within the first six weeks of life. Conclusions: Exclusive breast-feeding rates for Pacific infants are ethnically heterogeneous, have declined since the 1990s and fall short of the World Health Organization recommendations. The principal reasons cited for exclusive breast-feeding discontinuation echo those reported over a decade ago. Keywords: Breast-feeding rates; Pacific infants; Epidemiology; Longitudinal study.
023. Postnatal depressive symptoms among Pacific mothers in Auckland: prevalence and risk factors. Abbott, M., & Williams, M. (2006). Australia and New Zealand Journal of Psychiatry,40 (3), 230-238.
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Objective: To assess the prevalence of and risk factors for postnatal depressive symptoms in a cohort of mothers of Pacific Island infants in Auckland, New Zealand. Method: The data were gathered as part of the Pacific Island Families Study, in which 1376 mothers were interviewed when their babies were 6 weeks old. The interview included the Edinburgh Postnatal Depression Scale (EPDS). Results: 16.4% of mothers were assessed as probably experiencing depression. Prevalence rates varied from 7.6% for Samoans to 30.9% for Tongans. In addition to ethnicity, risk factors identified by stepwise multiple logistic regression included low Pacific Island acculturation, first birth, stress due to insufficient food, household income less than dollar 40,000, difficulty with transport, dissatisfaction with pregnancy, birth experience, baby's sleep patterns, partner relationship and home. A large prevalence difference between Tongans and other groups remained when the effects of other risk factors were controlled statistically. Conclusions: The prevalence of depressive symptoms among Pacific mothers is at the upper end of the range typically reported. Focus on the overall rate, however, obscures substantial variation between groups. Risk factors are generally similar to those identified in previous research. Implications: The findings have implications for prevention and treatment and caution against assuming homogeneity within ethnic categories. Further research is required to explain differences in prevalence between Tongan and other Pacific Island groups. Keywords: ethnicity; migration; pacific island mothers; postnatal depression.
022. Pacific Islands Families Study: The prevalence of chronic middle ear disease in two-year-old Pacific children living in New Zealand. Paterson, J., Ahmed, Z., Carter, S., Wallace, J., & Garrett, N. Silva, P. (2006). International Journal of Pediatric Otorhinolaryngology, 70, 1771-1778
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Objective: The aim of this study was to determine the prevalence of chronic middle ear disease in 2-year-old Pacific children living in New Zealand. Methods: The data were gathered as part of the Pacific Islands Families: First Two Years of Life (PIF) Study in which 1001 two year olds were screened using tympanometry to identify children at risk for otitis media with effusion (OME) and other otological disorders. Those failing the screening tests were referred to Manukau Superclinic where they had a further tympanometry test, and if they failed this test, were followed up with a comprehensive otological examination by an otolaryngologist using otomicroscopy and pneumatic otoscopy. Results: Bilateral otitis media with effusion (OME) was the most common abnormality detected (N = 102) with further cases of unilateral OME (N = 8), and unilateral OME resolving (N = 2). Other cases of OME were associated with acute otitis media (AOM), impacted wax (N = 1), perforation (N = 1), and mild retraction (N = 2). Overall there were 118 children with unilateral or bilateral OME. AOM of any form was seen in nine cases. Retraction of the tympanic membrane was seen in 26 cases. The population prevalence among Pacific 2-year-old children was estimated as 25.4% for OME, 1.9% for AOM, and 26.9% for OME or AOM. Conclusions: These findings reveal that over 25% of Pacific Island 2-year-old were affected by OME and recommend the consideration of national screening for OME and other otological disorders at this earlier age. Keywords: Otitis media with effusion; Pacific children; Middle ear disease.
021. Maternal Smoking: Risks related to maternal asthma & reduced birth-weight in a Pacific birth cohort study Carter, S., Percival, T., Paterson, J., & Williams, M. (2006). New Zealand Medical Journal, 119 (1238), 19-30.
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Aims: This study investigated associations between smoking and maternal asthma and two indicators of pregnancy outcome: birth weight and preterm delivery. Methods: Data were gathered as part of the Pacific Islands Families (PIF) Study. Mothers of a cohort of 1398 Pacific infants born in South Auckland, New Zealand during 2000 were interviewed when their infants were 6 weeks old. Mothers were questioned regarding maternal health and lifestyle behaviours such as cigarette smoking. Additional data were obtained from hospital records. Analyses focused on 1368 biological mothers. Results: Approximately 20% of mothers reported smoking during their last trimester of pregnancy. Logistic regression analyses showed that smokers had over twice the risk of having maternal asthma as well as a low birth weight (LBW) or small for gestational age (SGA) infant than non-smokers. Smoking significantly reduced mean birth weight from between 149.2 grams (1–9 cigarettes) to 204.3 grams (10+ cigarettes). No significant association was found between smoking and preterm birth. Conclusions: Smoking is preventable, yet continues to have negative consequences for mothers and their offspring. Findings can inform public health policy and smoking cessation programmes for Pacific families.
020. Immunisation of a cohort of Pacific children living in New Zealand over the first 2 years of life. Paterson, J., Schluter, P., Percival, T., Carter, S. (2006).Vaccine, 24, 4883-4889
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Pacific children have had consistently evidenced low rates for routine childhood immunisations. Using the Pacific Islands Families: First 2 Years of Life cohort study, we investigated the immunisation rate of Pacific infants residing in New Zealand at 24-months postpartum. Full immunisation was reported for 89% of infants, substantially increased from the 53% found in the 1992 national survey and closer to the New Zealand Ministry of Health's target of 95%. Increased parity and maternal smoking were associated with incomplete child immunisation status. Initiatives to increase immunisation rates amongst Pacific children appear to be succeeding and warrant continuation. Keywords: Immunisation; Pacific infants; Cohort study.
019. Non-fatal injuries among Pacific infants in Auckland: data from the Pacific Island Families: First Two Years of Life Study. Schluter, P., Paterson, J., & Percival, T. (2006).Journal of Paediatrics and Child Health 42, 123-128.
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Aims: Child injury is the leading cause of mortality and morbidity in developed countries. While Pacific infant death rates are relatively high in New Zealand, little is known about non-fatal injury rates. We seek to describe maternally reported injury in Pacific infants aged between 0-24 months. Methods: A cohort of Pacific infants born during 2000 in Auckland, New Zealand, was followed. Maternal home interviews were conducted at 6 weeks, 12 months and 24 months postpartum and injury events were recalled. Marginal models using generalized estimating equations (GEEs) were used to analysis the longitudinal data. Results: The inception cohort included 1398 infants at 6 weeks, 1241 infants at 12 months and 1161 infants at 24 months. The age-specific injury incidence per 1000 person-years exposure was estimated at 48 (95% CI: 23, 88) injuries for infants aged 0-6 weeks, 106 (95% CI: 88, 127) injuries for infants aged 7 weeks-12 months and 174 (95% CI: 151, 199) injuries for infants aged 13-24 months. In the multivariable GEE model, older infants (P < 0.001), infants who were male (P = 0.01), born to Pacific Island fathers and non-Pacific Island mothers (P < 0.001), and in higher or unknown income groups (P = 0.01) were significantly more likely to suffer injury events. No significant two-factor interaction with infant age was identified. Conclusion: Among Pacific infants, non-fatal injury is common and injury incidence rates are considerably higher than national levels. Male infants and those born into ethnically mixed families, where the father was of Pacific Island ethnicity and the mother was non-Pacific, were at increased relative risk of injury and might benefit from specific injury prevention targeting. However, given the high injury incidence levels found, we advocate that investigation and targeting of culturally appropriate prevention strategies for all Pacific families with young children is required to reduce injury rates for Pacific infants in New Zealand.
018. Health problems among at six-week old Pacific infants living in New Zealand. Paterson, J., Carter, S., Tukuitonga, C., Williams, M. (2006). Medical Science Monitor 12 (2) CR51-4.
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Background: The purpose of this paper is to describe maternal reports of various health problems experienced by their Pacific infants in the first six weeks of their lives and to examine the infant, maternal and socio-demographic factors associated with infant health problems. Material/methods: The data were gathered as part of the Pacific Islands Families: First Two Years of Life (PIF) Study in which mothers in the cohort (n=1376) were interviewed about the health problems experienced by their infants (n=1398) in the first six weeks of life. Results: Fifty-five percent of mothers reported that their infant had experienced minor health problems, and 15.6% reported moderate to severe infant health problems. Most mothers (98%) reported that they had a regular family doctor or health clinic to go to if their infant had a health problem. We found no meaningful associations between infant, maternal, or socio-demograhic variables and general infant health problems, possibly because of the wide range of infant illnesses reported. Since 43% of the infant health problems reported were related to breathing difficulties we carried out univariate and multivariate analyses on this specific health problem. Factors significantly associated (p<0.05) with infant breathing problems were maternal cigarette smoking during the last trimester, cold housing, and residing in New Zealand for over 10 years. Conclusions: The high rate of infant health problems, in particular infant breathing problems, among Pacific infants in this cohort and the significant links with modifiable factors warrant priority action by housing and health agencies to minimise the consequences of these risk factors. Keywords: child health; Pacific families; longitudinal research.
017. Pacific Islands Families First Two Years of Life study: design and methodology. Paterson, J., Tukuitonga, C., Abbott, M., Feehan, M., Silva, P., Percival, T., Butler, S., Cowley-Malcolm. E., Borrows, J., Williams, M., & Schluter, P.(2006) New Zealand Medical Journal, 119, 1228), 63-80.
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Aims: Knowledge about the health, psychosocial, and behavioural characteristics of Pacific peoples with young children resident in New Zealand is limited. The Pacific Islands Families: First Two Years of Life (PIF) Study was designed to redress this knowledge gap. This paper describes the design and methodology of the PIF Study. Methods: Mothers of Pacific infants born at Middlemore Hospital between 15 March and 17 December 2000 were recruited. Maternal home interviews covering sociodemographic, cultural, environmental, child development, family and household dynamics, childcare, lifestyle, and health issues were undertaken at approximately 6-weeks, 12-months, and 24-months postpartum. Paternal home interviews and child development assessments were conducted at approximately 12-months and 24-months postpartum. Information from Middlemore’s Hospital Discharge Summary recordsvand Plunket’s 6-week and 6-month assessments was also captured. Results: 1708 mothers were identified, 1657 were invited to participate, 1590 (96%) consented to a home visit; and, of these, 1,477 (93%) were eligible for the PIF study. Of those eligible, 1,376 (93%) participated at 6-weeks, 1224 (83%) participated at 12-months, and 1144 (77%) participated at 24-months. No important differential attrition was observed. Paternal interviews and child assessments were conducted on 825 fathers and 1241 infants at 12-months and on 757 fathers and 1064 children at 24-months. Conclusions: The PIF study is a large, scientifically and culturally robust longitudinal study that has achieved respectable participation rates in a historically hard-to-reach population. We believe that results from this study will inform future policy development within New Zealand
016. Infant care practices among Pacific families living in New Zealand. Paterson, J., Butler, S., Percival, T. (2006). In J.E Low & P. Jose ( Eds.), In Lifespan Development: The New Zealand context. Auckland: Pearson.
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015. Pacific Islands Families: The First Two Years of Life: Gambling Amongst Pacific Mothers. Bellringer, M. E., Cowley-Malcolm, E. T., Abbott, M. W., & Williams, M. M. (2005). International Journal of Mental Health & Addiction, 3(1), 41-48.
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Pacific peoples in New Zealand are at high risk of developing gambling-related problems; estimated to be six times more likely than the risk for New Zealand Europeans. However, there is a paucity of research investigating Pacific people's gambling within a New Zealand context. This paper presents preliminary data, from the first data collection point, about gambling activity per se (as opposed to problem gambling) from a cohort of mothers who are part of the longitudinal Pacific Islands Families study. The data are analysed against various associated demographic and cultural variables. These early results indicate that cul-tural differences could play a part in gambling behaviour, for example, Tongans are more likely to gamble than Samoans, and those who partake in traditional gift giving customs are also more likely to gamble. Additionally, the data show an increased propensity for gam-bling amongst those with comorbid disorders such as alcohol misuse.
014. Housing Tenure: Pacific families in New Zealand. Carter, S., Paterson, J., & Williams, M. (2005). Urban Policy & Research, 23(4) 413-428.
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Home ownership has been associated with health, social and economic benefits. However, a decline in ownership has been observed over the past decade in New Zealand. Minority groups, including Pacific people, have been disadvantaged in the housing sector. This study investigated housing tenure and the relationship between tenure and health among mothers of a birth cohort of Pacific children in New Zealand. Findings showed that most families lived in state or private rental accommodation with few (15.4 per cent) owning their own homes. Homeowners were more likely to be older, partnered and have higher incomes. Better mental health was observed for homeowners compared to renters. Findings can inform housing and public health policy for Pacific families. Keywords: Home ownership; health; Pacific people; New Zealand
013. Maternal experiences of childhood: Pacific mothers in New Zealand. Fairburn-Dunlop, P., Paterson, J., Cowley, E. (2005). Pacific Studies, 28, (2), 291-309.
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The increase in reported acts of abuse within Pacific Island families in New Zealand raises the question of possible differences in Pacific child raising practices and expectations, including perceptions of what types of behaviour are abusive and what is disciplining. All too little research is available in this area. This study looks at parenting practices generally, focusing particularly on Pacific women’s perceptions of the way they were raised, in terms of the abusive and nurturing behaviours they experienced from male and female parents. The study group comprised more than 1200 mothers whose babies were born at Middlemore Hospital, Auckland, in 2000. Results suggest that abusive and supportive behaviours co-exist; physical abuse being recalled more strongly than emotional abuse, and mothers seeming both more abusive and more supportive than fathers. In terms of ethnicity, Tongan (and most other) mothers reported lower abuse rates and higher rates of supportiveness than Samoan mothers. Significantly, mothers born in New Zealand were more likely to report maternal and paternal abuse than those born in the Islands, though place of birth showed no significant effect on maternal and paternal love and support. Clearly, more research and discussion are necessary.
012. Factors associated with antenatal care by mothers of Pacific infants living in New Zealand. Low, P.,Paterson, J., Wouldes, T., Carter, S., Williams, M., & Percival, T. (2005). New Zealand Medical Journal Vol 118, 1216, (40-49)
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Aims: To describe antenatal care attendance by mothers of Pacific infants recently delivered at Middlemore Hospital, South Auckland and to examine the demographic and psychosocial factors associated with late initiation of care and inadequate attendance. Methods: The data were gathered as part of the Pacific Islands Families: First Two Years of Life (PIF) Study in which 1365 birth mothers in the cohort (n=1376) were interviewed when their infants were six weeks old about their antenatal care attendance. Results: Almost all (99.1%) mothers attended antenatal care at least once. Over a quarter (26.6%) initiated their antenatal care late, and 10.7% attended fewer than the recommended number of times. Maternal factors significantly associated with late initiation of antenatal care were high parity, first pregnancy, not being employed prior to pregnancy and Cook Island Maori ethnicity. Factors associated with inadequate attendance were reaction to the pregnancy and being employed prior to pregnancy. Conclusions: A significant proportion of mothers of Pacific infants reported initiating antenatal care later than the first trimester and attending fewer antenatal visits than recommended. These findings indicate that the importance of antenatal care needs to be promoted among Pacific communities.
011. Smoking among mothers of a Pacific islands birth cohort in New Zealand: associated factors. Butler, Williams, Paterson, Tukuitonga (2004). New Zealand Medical Journal 117, 1206,
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Aims: The present study investigated (among mothers of a Pacific Island birth cohort) the rates of smoking before, during, and after pregnancy as well as factors predictive of smoking during pregnancy. Methods Data were gathered as part of the Pacific Islands Families (PIF) Study. In this study, mothers of a cohort of 1398 Pacific infants born in Middlemore Hospital, Auckland during 2000 were interviewed when their infants were 6 weeks old. Mothers were questioned about their maternal health, and lifestyle behaviours such as cigarette smoking. Additional data were obtained from hospital records. Analyses focused on 1365 biological mothers. Results: Overall, 339 (approximately one-quarter) of the mothers reported smoking during pregnancy. 331 (76.1%) of the 435 smokers (before pregnancy) continued to smoke during pregnancy, and eight mothers commenced smoking once pregnant. Smoking rates for each trimester were 23.7% in the first, 21.0% in the second, and 20.4% in the third trimester of pregnancy, respectively. Multivariate analyses showed that smoking was significantly associated with several factors, including indicators of disadvantage and degree of westernisation. Conclusions: Greater efforts are needed to reduce smoking during pregnancy among Pacific women. Findings can be used to inform public health policy and smoking cessation programmes for Pacific families.
010.Technical Report 2. Pacific Islands Families: First Two Years of Life Study. Paterson, J., Tukuitonga, C., Abbott, M., Feehan, M.,Silva, P., Percival, T., Butler, S., Cowley, E., Borrows, J., & Williams, M. (2004). AUT Publication ISBN 1-877314-41-2
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This report will outline the methods and procedures used in the Pacific Islands Families (PIF): First Two Years of Life Study. The PIF was designed to advance scientific knowledge in a number of disciplines and provide public benefits through the provision of good information. This will inform the policy development and assist programme implementation for a variety of stakeholders working towards maximising the potential of Pacific families and communities within broader New Zealand society.
009. Maternal and Demographic factors associated with non-immunisation of Pacific infants living in New Zealand. Paterson, J., Percival, T., Butler, S., & Williams, M. (2004). NZ Medical Journal, 117 (1199).
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Aim: To identify the proportion of infants who had not received their first dose of the primary immunisation series at approximately 6 weeks of age, and to identify the maternal and demographic factors associated with non-immunisation. Method: The data were gathered as part of the Pacific Islands Families (PIF): First Two Years of Life Study in which 1376 mothers were interviewed about the immunisation status of their infant. Mothers responded to questions about whether their child had been immunised, who administered the vaccines, and how satisfied they were with the care and treatment of their child in that context. Results: Twenty-seven percent of the mothers reported that they had not had their infant immunised at approximately six-weeks of age. Factors significantly associated (p<0.05) with non-immunisation were ethnic group, maternal birth place, parity, difficulty with transport, and age of the baby at the time of the interview. Conclusions: These findings demonstrate the need for education about the importance of the primary immunisation series and the current schedules, together with community resources to support mothers in the context of this infant health care initiative. Improving immunisation uptake through education may not be sufficient with the more widespread issues of deprivation and social equity needing to be addressed.
008. Traditional Gift giving among Pacific families in New Zealand. Cowley, E., Paterson, J., & Williams, M. (2004). Journal of Family and Economic Issues, 25 (3), 431-444.
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The Pacific population in New Zealand is socially disadvantaged and over-represented in adverse social and health statistics. A cohort of 1,376 mothers of Pacific infants were asked about traditional gift commitments and the effect that these commitments had on the financial situation in their household. Sixty-two percent reported that they and/or their partner usually gave to their family or church, with 66.5% of this group giving to family in New Zealand, 58% to family in the Pacific Islands, and 75.9% to their church. Fifty-nine percent of these mothers reported that this gift commitment made their household financial situation more difficult. Factors significantly associated with gift giving are discussed, together with implications of these findings for Pacific families living New Zealand. Keywords: pacific families; traditional gift giving.
007. Factors associated with not breastfeeding exclusively among mothers of a cohort of Pacific infants in New Zealand. Butler S., Williams M., Tukuitonga C. & Paterson J. (2004) The New Zealand Medical Journal, 117, No. 1195.
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Aims: This study investigated the association between not breastfeeding exclusively (among mothers of a cohort of Pacific infants in New Zealand) and several maternal, sociodemographic, and infant care factors. Methods: The data were gathered as part of the Pacific Islands Families (PIF) Study. Infant feeding information was obtained through interviews with mothers (6 weeks post-birth) and from hospital records for 1247 of the 1365 biological mothers. Results: Factors significantly associated with not exclusively breastfeeding at hospital discharge included smoking, unemployment prior to pregnancy, years in New Zealand, not seeing a midwife during pregnancy, caesarean delivery, and twin birth status. Factors significantly associated with cessation (before 6 weeks post-birth) of exclusive breastfeeding (for mothers who initially breastfed exclusively) included smoking, employment prior to pregnancy, being in current employment, high parity, dummy use, not receiving a visit from Plunket, infant not discharged at the same time as the mother, infant not sharing the same room as the parent(s) at night, regular childcare, and having a home visit for the infant from a traditional healer. Conclusions: Aside from smoking, different factors were associated with initiation and maintenance of exclusive breastfeeding. Identification of risk factors should assist targeting women who are at heightened risk of not breastfeeding exclusively.
006. Pregnancy planning by mothers of Pacific infants recently delivered at Middlemore Hospital. Paterson J., Cowley E., Percival T & Williams M. (2004). The New Zealand Medical Journal, 117, (1188).
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Aim: To describe pregnancy planning by mothers of Pacific infants recently delivered at Middlemore Hospital. Methods: The data were gathered as part of the Pacific Islands Families: First Two Years of Life (PIF) Study in which 1365 birth mothers were interviewed six weeks after the birth about the planning of their pregnancy. Mothers were asked if the pregnancy was planned, if the pregnancy was unplanned, the form of contraception used, or, if not used, their main reasons for not using contraception. Results: Forty per cent of the mothers reported that they had planned their pregnancy. Of the 60% of mothers who had not planned their pregnancies, 70.8% were not using contraception when they conceived. The main reasons given by mothers for not using contraception were that they never thought about contraception (46.8%), did not like using contraception (42.5%), decided to take a chance (39.4%), did not want to risk the associated weight gain (30.4%), and did not think they could have a baby (17.3%). Factors significantly associated (p <0.05) with non-use of contraception by birth mothers who did not plan their pregnancy were lack of post-school qualifications and strong alignment with Pacific culture. Conclusions: The findings showed that many women in this cohort did not avail themselves of the various contraceptive services available to them. An investigation into the accessibility and acceptability of family planning services needs to be undertaken to ensure that services are delivered in a way that maximises choices regarding the use of contraceptives.
005. Problems with damp and cold housing among Pacific families in New Zealand. Butler S., Williams M., & Tukuitonga C. (2003). The New Zealand Medical Journal, 116, 494-502
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Aims: To describe reported problems with damp and cold housing among Pacific families in New Zealand and their associations with two facets of maternal health, namely postnatal depression and asthma. Methods: The data were gathered as part of the Pacific Islands Families: First Two Years of Life (PIF) Study in which 1376 mothers were interviewed when their infants were six weeks old. Mothers were questioned with regard to problems with dampness or mould and cold housing, facets of maternal health (assessed using the Edinburgh Postnatal Depression Scale), and asthma. Results: Over one third of the mothers (37%) reported that their homes had dampness/mould problems, and over half reported problems with cold housing (53.8%). Damp and cold housing were significantly associated with a number of variables including large household size, state rental housing, and financial difficulty with housing costs. Damp and cold housing were also both significantly related to maternal depression and incidence of asthma. Conclusions: Efforts to reduce problems with damp and cold housing are needed to improve maternal health. To this end, advice regarding the importance of home heating and ventilation may be beneficial.
004. Infant Bed Sharing among Pacific Families in New Zealand. Paterson J., Tukuitonga C., Butler S. & Williams M. (2002). The New Zealand Medical Journal, 115, 241-243.
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Aim: To describe infant bed-sharing among Pacific families in New Zealand. Methods: The data were gathered as part of the Pacific Island Families: First Two Years of Life (PIF) Study in which 1376 mothers were interviewed when their infants were six-weeks-old. Maternal reports of infant bed-sharing practices were assessed by questions about infant sleep location and the number of people who usually shared a mattress with the infant. Results: Over half of the mothers (54.9%) reported that their infants shared a mattress with other people, 44.2% sharing with one other person, the remainder sharing with two or more people. Of the bed-sharing infants, 4.7% slept on a mattress on top of the bed, and 4.7% only slept part of the night in the shared bed. Conclusions: Together with effective information delivery, the educational and housing issues that many Pacific families in New Zealand face need to be addressed so that parents can make informed decisions about infant care practices.
003. Infant feeding and feeding problems experienced by mothers in a birth cohort of Pacific infants in New Zealand. Butler S., Paterson J., Tukuitonga C. & Williams M. (2002). Pacific Health Dialog: Journal of Community Health and Clinical Medicine for the Pacific, 9(1), 34-39.
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Objectives: To describe the rates of exclusive breastfeeding, combination feeding, formula only feeding and infant feeding problems experienced by mothers of a birth cohort of Pacific infants in New Zealand. Methods: The data were gathered as part of the Pacific Islands Families Study, a prospective cohort study in which 1376 mothers of a cohort of 1398 Pacific infants born in Middlemore Hospital, South Auckland, New Zealand during 2000 were interviewed at home when their infants were six weeks old. Included in the interview were questions regarding method of infant feeding and any feeding problems experienced. Results: At the time of discharge from hospital, 85.5% of mothers were exclusively breastfeeding. However, six weeks later this dropped to 50%. The rates of exclusive breastfeeding (p = 0.003) and combination breast and formula feeding (p < 0.001) differed amongst the main ethnic groups. Samoan mothers had the highest exclusive rate (55.7%), and Tongan mothers had the lowest rate (42.2%). Several mothers reported experiencing common feeding problems. Reasons for combination breast and formula and formula-only feeding are discussed. Conclusions: Exclusive breastfeeding rates fell below national targets and those found in recent New Zealand studies. Most of the feeding problems reported are modifiable with education and support. Implications: It is suggested that the benefits of breastfeeding need promoting and increased postnatal support should be provided to increase the rates of exclusive breastfeeding amongst Pacific women. Supporting Tongan women should be a priority, given the lower exclusive breastfeeding rates observed among Tongan mothers.
002. Awareness of Sudden Infant Death risk factors among mothers of Pacific infants in New Zealand. Paterson J., Tukuitonga C., Butler S. & Williams M. (2002). The New Zealand Medical Journal, 114, No 1147, 33-35.
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Aim: To describe the awareness of Sudden Infant Death Syndrome (SIDS) risk factors among mothers of Pacific infants in New Zealand. Methods: The data were gathered as part of the Pacific Islands Families Study in which 1376 mothers were interviewed when their infants were six weeks old. Included in this interview were questions designed to examine the mothers’ awareness of SIDS risk factors. Results: Over one third (38.8%) of mothers were unable to accurately report a SIDS risk factor, 53.4% reported the risk associated with putting the baby to sleep in a prone position, 31.5% maternal smoking, and 19.5% correctly reported other SIDS risk factors. Lack of awareness of SIDS risk factors was significantly associated with Samoan and Cook Islands Maori ethnicity, being Pacific Islands born, having no post school qualifications, lower household income, not being fluent in English, having more than five children, and not attending antenatal classes. Conclusions: Despite SIDS prevention efforts, a considerable number of mothers in this cohort reported no awareness of SIDS risk factors. More effective methods are needed to provide consistent SIDS prevention information across Pacific ethnic groups.
001.PIF Technical Report 2002 Paterson J.,Tukuitonga C., Abbott M., Feehan M., Silva P., Percival T., Butler S., Cowley E., Borrows J., Williams M. & Giles L. (2002). Pacific Islands Families: First Two Years of Life Study. Technical Report 1. Auckland University of Technology. ISBN: 1-877314-00-5.
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BACKGROUND: Pacific people in New Zealand are characterised by high fertility, a high population growth rate and a youthful population (Cook, 1999). Pacific peoples tend to be disadvantaged in New Zealand society and are over-represented in adverse health and social statistics (Bathgate et al., 1994; Ministry of Health, 1998). Compared with national rates, Pacific children are at increased health risk with high rates of hospitalisation and high incidence of respiratory infections (Bathgate et al., 1994). These factors have implications for child health, development and wellbeing. Despite this, little epidemiological information on Pacific children's health and development is available to inform policy development. In response to this informational need, the Pacific Islands Families Study (PIF) was developed through a process of collaboration with Pacific communities, researchers, and relevant health and social agencies.