Infant care practices in New Zealand: a cross-cultural qualitative study.

This paper describes and compares the infant care practices and beliefs of Maori, Tongan, Samoan, Cook Islands, Niuean and Pakeha (European) caregivers residing in Auckland, New Zealand. Focusing on four areas--sources of support and advice; infant feeding; infant sleeping arrangements; and traditional practices and beliefs--it explores inter-ethnic similarities and differences and intra-ethnic tensions. The international literature indicates that there can be significant cultural variation in infant care practices and in the meanings attributed to them. There is, however, little New Zealand literature on this topic, despite its importance for effective health service and health message delivery. Participants were primary caregivers of infants under 12 months. An average of six focus groups were conducted within each ethnic group, resulting in a total of 37 groups comprising 150 participants. We found similarities across all ethnic groups in the perceived importance of breastfeeding and the difficulties experienced in establishing and maintaining this practice. The spectrum of behaviours ranged widely with differences most pronounced between Pacific caregivers, especially those Island-raised, and Pakeha caregivers, especially those in nuclear families. Amongst the former, norms included: the family as central in providing support and advice; infant bedsharing; abdominal rubbing during pregnancy; baby massage; and the importance of adhering to traditional protocols to ensure infant well-being. Amongst the latter, norms included: strong reliance on professional advice; looser family support networks; the infant sleeping in a cot; and adherence to Western biomedical understandings of health and illness. Maori caregivers bridged the spectrum created by these groups and exhibited a diverse range of practices. Intra-cultural differences were present in all groups indicating the dynamic nature of cultural practices. They were most evident between Pacific-raised and New Zealand-raised Pacific caregivers, with the latter attempting to marry traditional with Western beliefs and practices.

Ethnic differences in perceptions of body size in middle-aged European, Maori and Pacific people living in New Zealand.

OBJECTIVES: The aim of this study was to compare perceptions of body size in European, Maori and Pacific Islands people with measured body mass index (BMI), waist-to-hip ratio and change in BMI since age 21 y. Socio-demographic factors that influenced perceptions of body size were also investigated. DESIGN: Cross-sectional survey. METHODS: Participants were 5554 workers, aged > or =40 y, recruited from companies in New Zealand during 1988-1990. RESULTS: Prevalences of BMI>25 kg/m2 were: Europeans, 64.7% men, 47.2% women; Maori, 93.2% men, 80.6% women; and Pacific Islanders, 94.1% men, 92.9% women. Similarly, prevalences of BMI >30 kg/m2 were: Europeans, 14.4% men, 14.6% women; Maori, 55.0% men, 41.9% women; and Pacific Islanders, 55.1% men, 71.7% women. At each perception of body size category, Maori and Pacific Islands men and women had a higher BMI than European men and women, respectively. BMI increased with increasing perception of body size in all gender and ethnic groups. Since age 21, increases in BMI were highest in Pacific Islands people and increased with increasing perceptions of body size category in all ethnic and gender groups. BMI adjusted odds (95% CI) of being in a lower perception category for body size were 1.70 (1.38-2.12) in Maori and 8.99 (7.30-11.09) in Pacific people compared to Europeans, 1.27 (1.13-1.42) times higher for people with no tertiary education, 1.41 (1.25-1.59) times higher in people with low socioeconomic status, and 0.94 (0.92- 0.95) for change in BMI since age 21. CONCLUSION: Nutritional programs aimed at reducing levels of obesity should be ethnic-specific, addressing food and health in the context of their culture, and also take into account the socioeconomic status of the group. On the population level, obesity reduction programs may be more beneficial if they are aimed at the maintenance of weight at age 21.

Maori infant care practices: implications for health messages, infant care services and SIDS prevention in Maori communities.

This paper uses findings from the Maori section of a multiethnic infant care practices (ICP) study undertaken in Auckland, New Zealand/Aotearoa, in 1998. It aims to increase understanding of present day Maori infant care practices in order, firstly, to inform infant health message and service delivery to Maori and, secondly, to understand the context of practices that comprise modifiable risk factors for SIDS. Publicity about modifiable SIDS risk factors since the early 1990s brought about a significant reduction in the national SIDS rate but the Maori rate reduced more slowly and in 1998 was still three times that of non-Maori. The ICP study was a qualitative study that, for the Maori section, involved seven focus groups and a one-on-one interview comprising 26 caregivers of under 12 month old infants. This paper focuses on five selected areas explored within the ICP study: sources of support, customary practices, infant feeding, infant sleeping arrangements and smoking. It discusses both valued infant care norms and factors that inhibit changes known to reduce SIDS risk. It argues that valued practices need recognition in order to make messages effective. It also challenges the emphasis on individual behaviour change as the primary means to reduce SIDS risk and argues that there is a need to extend prevention strategies beyond simple behaviour change messages to include structural change to reduce 'non modifiable' risk factors.

Ethnic differences in blood pressure: findings from the Fletcher Challenge-Auckland University Heart and Health Study.

AIMS: To investigate the determinants of ethnic differences in blood pressure, hypertension and the prevalence of additional risk factors for cardiovascular disease among a New Zealand population. METHODS: Baseline data from the Fletcher Challenge-University of Auckland Heart and Health Study were analysed for ethnic differences in blood pressure, and the likelihood of those with hypertension having other major cardiovascular disease risk factors was estimated. RESULTS: Maori and Pacific Islands participants had mean diastolic blood pressure up to 3 mmHg higher than Europeans, but Pacific Islands people had mean systolic blood pressure 3-4 mmHg lower than Europeans and Maori respectively. After adjustment for age and gender almost 20% of Maori, 16% of Pacific Islands and 11% of European people were classified as hypertensive. Adjustment for body mass index and alcohol consumption almost eliminated ethnic differences in blood pressure, and body mass index was found to be the single most important modifiable determinant of raised blood pressure. Greater proportions of Maori (15%) and Pacific Islands people (14%) with hypertension had multiple additional cardiovascular risk factors compared with Europeans (8%), but similar proportions were on antihypertensive drug treatment. CONCLUSIONS: Efforts to reduce obesity have the potential to significantly reduce raised blood pressure among Maori and Pacific Islands people. Overall cardiovascular risk is more likely to be higher in Maori and Pacific Islands people than in Europeans with hypertension, indicating that greater proportions of Maori and Pacific Islands people with high blood pressure should be receiving treatment.

Ethnic differences and recent trends in coronary heart disease incidence in New Zealand.

AIMS: This study compares recent coronary heart disease morbidity and mortality rates and ten year trends for Maori, Pacific Islands people and Europeans living in New Zealand. METHODS: Fatal coronary heart disease rates (mortality) and nonfatal hospitalisation rates for myocardial infarctions (morbidity) from 1983-92 were assessed and compared for males and females in each ethnic group, aged 35 to 64 years, using data from the Auckland Region Coronary or Stroke Study (ARCOS), a community-based coronary heart disease surveillance programme. RESULTS: The recent 1990-2 mean coronary heart disease mortality rate for Maori men (232/100 000) was almost double the rate for Pacific Islands men (135/100 000 p=0.008) and more than double the rate for European men (103/100 000 p=0.001). Maori women had a three-fold higher mean mortality rate (85/100 000) than European women (25/100 000 p=0.02). The morality rate for Pacific Islands women (42/100 000) was midway between the other ethnic groups. Over the decade 1983-92 coronary heart disease mortality rates have decreased significantly by approximately 5% per year for European men and women. Rates for Maori and Pacific Islands people also appear to have fallen although the precision of these estimates are low. Morbidity rates in 1990-2 were similar among men in all three ethnic groups. Among women, morbidity was approximately half the male rates and there were no clear differences between the ethnic groups. Between 1983 and 1992 morbidity rates declined significantly for European men (p=0.008) and women (p=0.02) by approximately 5% per year. Among Maori and Pacific Islands people the trends were variable. CONCLUSION: Maori men and women continue to experience more than double the coronary heart disease mortality rates than Europeans. Mortality rates for Pacific Islands people are intermediate between Maori and European. Both coronary heart disease mortality and morbidity rates are declining in Europeans; there appears to have been a decline in coronary heart disease mortality for Maori and Pacific Islands groups but not in morbidity rates which may have increased. Given the trend towards a decline in coronary heart disease mortality for Maori and Pacific Islands people, the most likely explanation for the apparent increase in morbidity is improved access to secondary health care services and greater awareness of coronary health disease symptoms.

Coronary heart disease mortality in Auckland Maori and Europeans.

This paper investigates the differential between Maori and European coronary heart disease mortality in Auckland by analysing data from an Auckland register of coronary heart disease. The age standardised coronary heart disease mortality rate for Maori men is 1.6 times higher than for European men, and the rate for Maori women is 4.2 times higher than that of European women. Maori mortality is disproportionately high for women, and for the younger age groups. Maori and European who died of definite myocardial infarction in Auckland between 1983-86 showed little difference in severity of coronary artery occlusion at post mortem, and the likelihood of cardiomyopathy contributing a major part to Maori heart disease mortality is small.