Assessing youth empowerment and co-design to advance Pasifika health: a qualitative research study in New Zealand.

OBJECTIVES: The Pasifika Prediabetes Youth Empowerment Programme (PPYEP) was a community-based research project that aimed to investigate empowerment and co-design modules to build the capacity of Pasifika youth to develop community interventions for preventing prediabetes. METHODS: This paper reports findings from a formative evaluation process of the programme using thematic analysis. It emphasises the adoption, perceptions and application of empowerment and co-design based on the youth and community providers' experiences. RESULTS: We found that the programme fostered a safe space, increased youth's knowledge about health and healthy lifestyles, developed their leadership and social change capacities, and provided a tool to develop and refine culturally centred prediabetes-prevention programmes. These themes emerged non-linearly and synergistically throughout the programme. CONCLUSIONS: Our research emphasises that empowerment and co-design are complementary in building youth capacity in community-based partnerships in health promotion. Implications for public health: Empowerment and co-design are effective tools to develop and implement culturally tailored health promotion programmes for Pasifika peoples. Future research is needed to explore the programme within different Pasifika contexts, health issues and Indigenous groups.

Pasifika Prediabetes Youth Empowerment Programme: learnings from a youth-led community-based intervention study.

AIM: Using a co-design approach, we describe exploratory findings of a community-based intervention to mobilise Pasifika communities into action, with the intent of reducing the risk factors of prediabetes. METHOD: A group of 25 Pasifika youth aged 15-24 years from two distinctive Pasifika communities in New Zealand were trained to lead a small-scale, community-based intervention programme (among 29 participants) over the course of eight weeks. The intervention, which targeted adults aged 25-44 years who were overweight or obese, employed both an empowerment-based programme and a co-design approach to motivate community members to participate in a physical-activity-based intervention programme. RESULTS: Findings show significant reductions in total body weight and waist circumference, as well as improved physical activity. CONCLUSIONS: The strength of this intervention was evident in the innovative approach of utilising Pasifika-youth-led and co-designed approaches to motivate communities into healthier lifestyles. The approaches used in this project could be utilised in a primary healthcare setting as a community-wide strategy to reduce diabetes risk, particularly among Pasifika peoples.

Salt intake and iodine status of women in Samoa.

The objective of this study was to determine iodine nutrition status and whether iodine status differs across salt intake levels among a sample of women aged 18-45 years living in Samoa. A cross-sectional survey was completed and 24-hr urine samples were collected and assessed for iodine (n=152) and salt excretion (n=119). The median urinary iodine concentration (UIC) among the women was 88 µg/L (Interquartile range (IQR)=54-121 µg/L). 62% of the women had a UIC <100 µg/L. The crude estimated mean 24-hr urinary salt excretion was 6.6 (standard deviation 3.2) g/day. More than two-thirds (66%) of the women exceeded the World Health Organization recommended maximum level of 5 g/day. No association was found between median UIC and salt excretion (81 µg/L iodine where urinary salt excretion >=5 g/day versus 76 µg/L where urinary salt excretion <5 g/day; p=0.4). Iodine nutrition appears to be insufficient in this population and may be indicative of iodine deficiency disorders in Samoan women. A collaborative approach in monitoring iodine status and salt intake will strengthen both programs and greatly inform the level of iodine fortification required to ensure optimal iodine intake as population salt reduction programs take effect.

Salt Intakes, Knowledge, and Behavior in Samoa: Monitoring Salt-Consumption Patterns Through the World Health Organization's Surveillance of Noncommunicable Disease Risk Factors (STEPS).

This project measured population salt intake in Samoa by integrating urinary sodium analysis into the World Health Organization's (WHO's) STEPwise approach to surveillance of noncommunicable disease risk factors (STEPS). A subsample of the Samoan Ministry of Health's 2013 STEPS Survey collected 24-hour and spot urine samples and completed questions on salt-related behaviors. Complete urine samples were available for 293 participants. Overall, weighted mean population 24-hour urine excretion of salt was 7.09 g (standard error 0.19) to 7.63 g (standard error 0.27) for men and 6.39 g (standard error 0.14) for women (P=.0014). Salt intake increased with body mass index (P=.0004), and people who added salt at the table had 1.5 g higher salt intakes than those who did not add salt (P=.0422). A total of 70% of the population had urinary excretion values above the 5 g/d cutoff recommended by the WHO. A reduction of 30% (2 g) would reduce average population salt intake to 5 g/d, in line with WHO recommendations. While challenging, integration of salt monitoring into STEPS provides clear logistical and cost benefits and the lessons communicated here can help inform future programs.

Low health-related quality of life in school-aged children in Tonga, a lower-middle income country in the South Pacific.

BACKGROUND: Ensuring a good life for all parts of the population, including children, is high on the public health agenda in most countries around the world. Information about children's perception of their health-related quality of life (HRQoL) and its socio-demographic distribution is, however, limited and almost exclusively reliant on data from Western higher income countries. OBJECTIVES: To investigate HRQoL in schoolchildren in Tonga, a lower income South Pacific Island country, and to compare this to HRQoL of children in other countries, including Tongan children living in New Zealand, a high-income country in the same region. DESIGN: A cross-sectional study from Tonga addressing all secondary schoolchildren (11-18 years old) on the outer island of Vava'u and in three districts of the main island of Tongatapu (2,164 participants). A comparison group drawn from the literature comprised children in 18 higher income and one lower income country (Fiji). A specific New Zealand comparison group involved all children of Tongan descendent at six South Auckland secondary schools (830 participants). HRQoL was assessed by the self-report Pediatric Quality of Life Inventory 4.0. RESULTS: HRQoL in Tonga was overall similar in girls and boys, but somewhat lower in children below 15 years of age. The children in Tonga experienced lower HRQoL than the children in all of the 19 comparison countries, with a large difference between children in Tonga and the higher income countries (Cohen's d 1.0) and a small difference between Tonga and the lower income country Fiji (Cohen's d 0.3). The children in Tonga also experienced lower HRQoL than Tongan children living in New Zealand (Cohen's d 0.6). CONCLUSION: The results reveal worrisome low HRQoL in children in Tonga and point towards a potential general pattern of low HRQoL in children living in lower income countries, or, alternatively, in the South Pacific Island countries.

Pacific parents' rationale for purchased school lunches and implications for obesity prevention.

Pacific children and adolescents are burdened with higher prevalences of obesity compared to other groups in New Zealand. Previous research shows Pacific young people purchase their lunch food items significantly more than other groups. The aim of this study is to describe school lunch food consumption patterns and the influences on these among low-income Pacific adolescents and their parents. Using mixed-methodology design; a self-completion questionnaire was administered to 4216 students who participated in the New Zealand arm of the Obesity Prevention In Communities (OPIC) project. Thirty Pacific households (33 adolescents and 35 parents) were interviewed in the qualitative phase of the study. Results found a greater proportion of Pacific students purchased school food items compared to other ethnic groups. Purchasing school food was related to having higher amounts of daily food money (>=NZD 6-15) and this was associated with increased quantities of soft drink consumption and after-school food purchasing of high-fat, high-sugar snack foods. There were no differences in school food purchasing behaviour by Pacific weight status (n=2485), with both Healthy weight (67.6%) and Obese students (66.9%) sourcing lunch from school canteens or shops outside of school rather than from home. Time-constrained parents confirmed convenience, poverty compensation and valuing students' independence as three reasons for choosing to make money available for students to purchase lunch food items. The social effects of poverty affect the health-promoting behaviours of Pacific communities in New Zealand. Social policies that decrease social inequities should be the intervention priority.

The role of sociocultural factors in obesity aetiology in Pacific adolescents and their parents: a mixed-methods study in Auckland, New Zealand.

AIM: To explore sociocultural factors that may promote or prevent obesity in Pacific communities in New Zealand. Specific objectives were to describe the behaviours, beliefs and values of Pacific adolescents and their parents, related to food consumption and physical activity and to examine the patterns among obese and non-obese Pacific adolescents and their parents. METHODS: A self-completion questionnaire was administered to 2495 Pacific students who participated in the New Zealand arm of the Obesity Prevention In Communities (OPIC) project, with quantitative comparisons between 782 obese and 814 healthy weight students. Sixty-eight people (33 adolescents and 35 parents) from 30 Pacific households were interviewed in the qualitative phase of the study. RESULTS: Healthy eating and higher levels of physical activity were related to parental presence at home, parental occupational type (non-shift) and better health education and experience. Obese adolescents held the same attitudes, beliefs and values about food and physical activity as their healthy-weight counterparts, but these factors were not protective for obesity-risk. CONCLUSION: This study indicates that social status and environmental factors related to poverty affect the health-promoting behaviours of Pacific communities in New Zealand. To address obesity in Pacific youth, specific macro-environmental changes are recommended including food pricing control policies to mitigate healthy food costs, revising sustained employment hour policies, making changes to school food and physical activity environments.

Body image and body change strategies among Tongan adolescents in Tonga and New Zealand.

AIM: The aim of this study was to evaluate the body image and body change strategies of adolescents from Tonga, and Tongans who are resident New Zealand. METHOD: In total, 598 Tongans from Tonga and 388 Tongans from New Zealand completed measures of body image, body change strategies and messages about their body. RESULTS: Tongans in Tonga were more likely to receive positive messages about a larger body from adults at school, church and the media, and losing weight from the media. They were also more likely to adopt strategies to lose weight, increase weight and increase muscles. CONCLUSION: The large body ideal appears to be still valued in Tonga, whereas Tongans also want to lose weight because of media messages to achieve a healthy body weight.