Social network media exposure and adolescent eating pathology in Fiji.

BACKGROUND: Mass media exposure has been associated with an increased risk of eating pathology. It is unknown whether indirect media exposure--such as the proliferation of media exposure in an individual's social network--is also associated with eating disorders. AIMS: To test hypotheses that both individual (direct) and social network (indirect) mass media exposures were associated with eating pathology in Fiji. METHOD: We assessed several kinds of mass media exposure, media influence, cultural orientation and eating pathology by self-report among adolescent female ethnic Fijians (n=523). We fitted a series of multiple regression models of eating pathology, assessed by the Eating Disorder Examination Questionnaire (EDE-Q), in which mass media exposures, sociodemographic characteristics and body mass index were entered as predictors. RESULTS: Both direct and indirect mass media exposures were associated with eating pathology in unadjusted analyses, whereas in adjusted analyses only social network media exposure was associated with eating pathology. This result was similar when eating pathology was operationalised as either a continuous or a categorical dependent variable (e.g. odds ratio OR=1.60, 95% CI 1.15-2.23 relating social network media exposure to upper-quartile EDE-Q scores). Subsequent analyses pointed to individual media influence as an important explanatory variable in this association. CONCLUSIONS: Social network media exposure was associated with eating pathology in this Fijian study sample, independent of direct media exposure and other cultural exposures. Findings warrant further investigation of its health impact in other populations.

Taxing soft drinks in the Pacific: implementation lessons for improving health.

A tax on soft drinks is often proposed as a health promotion strategy for reducing their consumption and improving health outcomes. However, little is known about the processes and politics of implementing such taxes. We analysed four different soft drink taxes in Pacific countries and documented the lessons learnt regarding the process of policy agenda-setting and implementation. While local social and political context is critically important in determining policy uptake, these case studies suggest strategies for health promotion practitioners that can help to improve policy uptake and implementation. The case studies reveal interaction between the Ministries of Health, Finance and Revenue at every stage of the policy making process. In regard to agenda-setting, relevance to government fiscal priorities was important in gaining support for soft drink taxes. The active involvement of health policy makers was also important in initiating the policies, and the use of existing taxation mechanisms enabled successful policy implementation. While the earmarking of taxes for health has been widely recommended, the revenue may be redirected as government priorities change. Health promotion practitioners must strategically plan for agenda-setting, development and implementation of intersectoral health-promoting policies by engaging with stakeholders in finance at an early stage to identify priorities and synergies, developing cross-sectoral advocacy coalitions, and basing proposals on existing legislative mechanisms where possible.

Breakfast skipping as a risk correlate of overweight and obesity in school-going ethnic Fijian adolescent girls.

The prevalence of overweight and obesity has increased globally, and population data suggest that it is also increasing among ethnic Fijian youth. Among numerous behavioural changes contributing to overweight in youth residing in nations undergoing rapid economic and social change, meal skipping has not been examined as a potential risk factor. The study objectives were to assess the prevalence of overweight, obesity, and breakfast skipping and examine their cross-sectional association in a community sample of school-going ethnic Fijian adolescent girls (N=523). We measured height and weight, and assessed dietary patterns, eating pathology, dimensions of acculturation, and other socio-demographic and cultural data by self-report. We observed a high prevalence of both overweight (41%, including 15% who were obese) and breakfast skipping (68%). In addition, in multivariable analyses unadjusted for eating pathology, we found that more frequent breakfast skipping was associated with greater odds of overweight (odds ratio (OR)=1.15, confidence interval (CI)=1.06, 1.26, p<0.01) and obesity (OR=1.18, CI=1.05, 1.33, p<0.01). Regression models adjusting for eating pathology attenuated this relation so that it was non-significant, but demonstrated that greater eating pathology was associated with greater odds of both overweight and obesity. Future research is necessary to clarify the relation among breakfast skipping, eating pathology, and overweight in ethnic Fijian girls, and to identify whether breakfast skipping may be a modifiable risk factor for overweight in this population.

Serum 25-hydroxyvitamin D concentration of Indigenous-Fijian and Fijian-Indian women.

BACKGROUND: Serum 25-hydroxyvitamin D (25OHD) concentrations are lower in Pacific people compared to Caucasians living in New Zealand. However, there are no data on the 25OHD concentrations of Pacific people living in the Pacific Islands. AIM: To assess the vitamin D status of indigenous and Indian Fijian women living in Fiji by measuring 25OHD concentrations. METHODS: 25OHD concentrations in a national sample of 511 Fijian women (15-44 y). RESULTS: The mean 25OHD concentration of Fijian women was 76 nmol/L (95% CI: 73, 78). 25OHD was lower in Fijian Indian [70 (66, 74) nmol/L; n=205] women compared to indigenous Fijians [80 (76, 84) nmol/L; n=306] (p<0.0001). The mean 25OHD was higher in rural [77 (74, 80) nmol/L; n=392] than urban [70 (65, 76) nmol/L; n=119] women (p<0.0001). Body mass index (BMI) and age were not predictors of 25OHD concentrations. Of Fijian females, 3%, 11%, and 56% had 25OHD concentrations indicative of 25OHD insufficiency using cut-offs of < or =37.5, < or =50 and < or =80 nmol/L, respectively. CONCLUSION: Mean 25OHD in Fijian women was generally adequate and exceed concentrations reported in Pacific females living in New Zealand.

Feasibility of a School-based Study of Health Risk Behaviors in Ethnic Fijian Female Adolescents in Fiji: The HEALTHY Fiji Study.

OBJECTIVE: Behavioral risk assessment is critical to developing intervention strategies to promote adolescent health, but also presents logistical, ethical, and scientific challenges. This paper reports on feasibility of a school-based study of health-risk behaviors in ethnic Fijian adolescent girls. METHODS: We assessed feasibility of school-based participation and implementation of assessment in the local vernacular language by examining observational data and by calculating response rates and as well as language selection and item completion rates. RESULTS: All invited study area schools participated (n=12). Response rates were >70% for study participation among eligible study participants in the overall sample as well as the peri-urban and rural sub-samples. The majority of respondents (71.9%) selected the local Fijian vernacular language version rather than the English version (28.1%). Although 43.6% of respondents completed a questionnaire in a language not spoken as the primary language at home, only ten respondents (1.9%) were assessed as having difficulty with the language of the self-report questionnaire. Item completion rates for the primary outcomes were >90% for both study phases and in both language versions. Study participant response rate for further assessment of concerning symptoms was also very high and teachers were successfully recruited for participation in training and accepting referrals to support these students at each participating school. CONCLUSION: School-based behavioral risk data collection in the vernacular language was feasible. Evaluation and referral of individual study participants with concerning symptoms to educators for further assistance and support also appeared feasible. We suggest that close collaboration among Fiji-based and specialty consultants to address scientific, linguistic, logistical, and ethical challenges were contributing factors to study feasibility.

Prevalence and Socio-demographic Correlates of Cigarette Smoking, Alcohol Use, and Unsafe Sexual Behavior among Ethnic Fijian Secondary Schoolgirls.

INTRODUCTION: The HEALTHY Fiji Study examines the impact of social transition on health risk behaviors among school-going ethnic Fijian adolescent girls. The primary aim of the present study was to assess prevalence and socio-demographic correlates of three risk behaviors, alcohol use, cigarette smoking, and unsafe sexual behavior in the study population. METHODS: We used an adapted version of the Global School-based Health Survey (GSHS) to assess health risk behaviors in a school-based sample of ethnic Fijian girls (n=523) in June and July 2007. We calculated prevalence of risk behaviors and then examined their relation to socio-demographic variables in logistic regression models. RESULTS: Prevalence estimates for any current alcohol use and cigarette smoking (20.1% and 17.6%) and lifetime history of sexual intercourse (20.8%) indicate that substantial percentage of this study sample has engaged in one of these health risk behaviors. Alcohol use was associated with two other risk behaviors, recurrent cigarette smoking and lifetime history of sexual intercourse. Although prevalence of alcohol use was lower than in several other Pacific populations, it was higher than previously reported among Fijian girls. CONCLUSIONS: The prevalence of alcohol use, cigarette smoking, and unsafe sexual behaviors in this study population warrants concern. Comparison with estimates from previous health behavior surveys in Fiji suggest that mode of assessment may impact prevalence estimates for health risk behaviors.