Pacific Islands Families Study: Household Food Security during Pregnancy and Secondary School Educational Achievement.

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.

Understanding suicidality in Pacific adolescents in New Zealand using network analysis.

INTRODUCTION: Pacific adolescents in New Zealand (NZ) are three to four times more likely than NZ European adolescents to report suicide attempts and have higher rates of suicidal plans. Suicidal thoughts, plans, and attempts, termed suicidality in this study, result from a complex dynamic interplay of factors, which emerging methodologies like network analysis aim to capture. METHODS: This study used cross-sectional network analysis to model the relationships between suicidality, self-harm, and individual depression symptoms, whilst conditioning on a multi-dimensional set of variables relevant to suicidality. A series of network models were fitted to data from a community sample of New Zealand-born Pacific adolescents (n = 550; 51% male; Mean age (SD) = 17 (0.35)). RESULTS: Self-harm and the depression symptom measuring pessimism had the strongest associations with suicidality, followed by symptoms related to having a negative 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 contribution to suicidality, highlighting the valuable information gained from analysing depression at the symptom-item level. Reducing the sources of pessimism and building self-esteem presented as potential targets for alleviating suicidality amongst Pacific adolescents in New Zealand. Suicide prevention strategies need to include risk factors for self-harm.

Relationship between perceived and measured body size among Pacific 14-year-olds in Aotearoa|New Zealand: Findings from the Pacific Islands Families Study.

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.

The relationship between sleep duration and health among Pacific adolescents within New Zealand: Findings from the Pacific Islands families study.

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.

Ethical publishing in 'Indigenous' contexts.

Ethical publishing practices are vital to tobacco control research practice, particularly research involving Indigenous (Indigenous peoples: For the purposes of this Special Communication, we use the term Indigenous people(s) to include self-identified individuals and communities who frequently have historical continuity with precolonial/presettler societies; are strongly linked to the land on which they or their societies reside; and often maintain their own distinct language(s), belief and social-political systems, economies and sciences. The authors humbly acknowledge, respect and value that Indigenous peoples are diverse and constitute many nations, cultures and language groups. Many Indigenous peoples also exist as governments in treaty relations with settler-colonial societies, and all Indigenous peoples have inherent rights under international law. The language and terminology used should reflect the local context(s) and could include, but are not limited to, terms such as Aboriginal, Bagumani, Cherokee, First Peoples, First Nations, Inuit, Iwaidja, Kungarakan, Lakota, Maori, Mѐtis, American Indian, Navajo, Wagadagam, Wiradjuri, Yurok, etc) people. These practices can minimise, correct and address biases that tend to privilege Euro-Western perspectives. Ethical publishing practices can minimise and address harms, such as appropriation and misuse of knowledges; strengthen mechanisms of accountability to Indigenous peoples and communities; ensure that tobacco control research is beneficial and meaningful to Indigenous peoples and communities; and support Indigenous agency, sovereignty and self-determination. To ensure ethical practice in tobacco control, the research methodology and methods must incorporate tangible mechanisms to include and engage those Indigenous peoples that the research concerns, affects and impacts.Tobacco Control is currently missing an ethical research and evaluation publishing protocol to help uphold ethical practice. The supporters of this Special Communication call on Tobacco Control to adopt publication practice that explicitly upholds ethical research and evaluation practices, particularly in Indigenous contexts. We encourage researchers, editors, peer reviewers, funding bodies and those publishing in Tobacco Control to reflect on their conduct and decision-making when working, developing and undertaking research and evaluation of relevance to Indigenous peoples.Tobacco Control and other publishers, funding bodies, institutions and research teams have a fundamental role in ensuring that the right peoples are doing the right work in the right way. We call for Tobacco Control to recognise, value and support ethical principles, processes and practices that underpin high-quality, culturally safe and priority-driven research, evaluation and science that will move us to a future that is commercial tobacco and nicotine free.

Sore and tired. A qualitative study exploring the symptom experience of youth with bronchiectasis.

This qualitative study was conducted to explore the experiences of youth living with bronchiectasis in New Zealand (NZ). Semi-structured interviews were conducted with youth with bronchiectasis. Key themes were identified using an inductive approach through constant comparative analysis and guided by Thorne's interpretive description (ID). Fifteen young people of mixed ethnicity (nine females and six males) aged between 13 and 23 years participated. Three key themes 'sore and tired', 'life interrupted and 'looking after self' were identified. This paper will focus on 'sore and tired' and its three subthemes which describe the participants symptom experience. While there was variability in physical symptom patterns, cough, soreness and fatigue were prominent features impacting physical, emotional and social aspects of day-to-day life. All identified pervasive and profound fatigue as significant. The identification of prodromal symptoms provides opportunity for greater appreciation of the varied and personal symptom experience of young people with bronchiectasis. Early identification of these symptoms and inclusion within management plans for escalating treatment has the potential to improve outcomes, reducing delays in seeking additional medical management and preventing further exacerbation.

Depression, anxiety and worry in young Pacific adults in New Zealand during the COVID-19 pandemic.

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.

Barriers to older Pacific peoples’ participation in the health-care system in Aotearoa New Zealand.

Introduction Participation in the health-care system is a key component of healthy ageing strategies. The number of Pacific people aged ≥65 years in Aotearoa New Zealand will increase significantly over the next decade. Addressing the considerable health inequities and unmet need for care Pacific Island people experience when compared to other ethnicities in Aotearoa New Zealand should be a priority. Aim To identify barriers to older Pacific people's participation in the health-care system in Aotearoa New Zealand. Methods A participatory action research design was utilised. In total, 104 Pacific co-researchers contributed to focus groups using Talanoa , a traditional method of conversational dialogue deeply rooted in Pacific Island culture. Data were collected in Pacific Island languages from storytelling and conversations shared within the focus groups. Data were translated into English and analysed using a collaborative approach. Results Three main themes captured older Pacific peoples' barriers to participation in the health-care system: accessing health care; relationships with health-care providers; and understanding the health-care system. Discussion Older Pacific people have the capacity to influence locally driven programmes to be more responsive to their needs and aspirations. Improving older Pacific peoples' participation in health care will require a commitment to partnership and inter-sectoral collaboration identified in recent ageing strategies. The findings will inform local communities, and policy and practice aimed at improving the health and wellbeing of Pacific peoples who are ageing in Aotearoa New Zealand.

Risk factors for depression in Pacific adolescents in New Zealand: A network analysis.

BACKGROUND: Network analysis provides opportunities to gain a greater understanding of the complex interplay of risk factors for depression and heterogeneous symptom presentations. This study used network analysis to discover risk factors associated with both depression severity and depression symptoms amongst Pacific adolescents in New Zealand. METHODS: Mixed graphical models with regularization were fitted to data from a community sample of New Zealand born, Pacific adolescents, (n = 561; 51% male; Mean age (SD) = 17 (0.35)) and associations between a wide range of potentially explanatory variables and depression severity and depression symptoms investigated. The associations identified were then tested for reliability, using resampling techniques and sensitivity analysis. RESULTS: In the networks, the explanatory variables associated with both depression severity and depression symptoms were those related to quality of the relationships with mother or friends, school connectedness, and self-assessed weight, but the symptoms they were associated with varied substantially. In the depression severity networks, impulsivity appeared to be a bridging node connecting depression severity with delinquency and negative peer influence. LIMITATIONS: The data were analysed cross-sectionally, so causal inferences about the directions of relationships could not be inferred and most of the data were self-reported. CONCLUSIONS: The results illustrate the varied way that adolescent depression can manifest itself in terms of symptoms and suggest specific items on the depression inventory that might be suitable targets for prevention strategies and interventions, based on the risk factor - depression symptom profiles of individuals or groups.

Getting there together: highlights, challenges and opportunities for tobacco control in the Oceania region.

BACKGROUND: The paper focuses on the geographical region of Oceania. We highlight the tobacco control leadership demonstrated in this region and describe the challenges and opportunities to achieving country-specific smoke-free goals. RESULTS: Significant achievements include smoke-free nation goals, world-leading initiatives such as plain packaging, and a bold plan by New Zealand to reduce the retail availability of smoked tobacco products and remove virtually all the nicotine from cigarettes and rolling tobacco. There are significant challenges and opportunities before reaching smoke-free status including implementation pathways requiring strong governance and leadership and compliance monitoring and enforcement. CONCLUSIONS: We conclude that achieving a smoke-free Oceania is possible through already existing bold country and regional smoke-free goals, excellent tobacco control leadership, experience and resources, and an understanding of how to work collectively. However, a commitment to focus tobacco control efforts regionally is required to achieve a smoke-free Oceania together.

Parental education related to their children's health in late childhood and early adolescence for Pacific families within New Zealand.

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.

Relationships between physical function, body composition and metabolic health in Pacific Island youth.

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.

Pacific Islands Families Study: Patterns of Intimate Partner Violence Among Pacific Mothers.

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.

A "pretty normal" life: a qualitative study exploring young people's experience of life with bronchiectasis.

PURPOSE: Bronchiectasis is a chronic respiratory disease that impacts significantly on quality of life for those who have it. There is a paucity of literature exploring the perspectives of children and young people. The aim of this study was to examine the day-to-day life experience of a group of young people with bronchiectasis. METHOD: A qualitative study using semi-structured interviews explored fifteen young people's perspectives of life with bronchiectasis. Key themes were identified using an inductive iterative approach through constant comparative analysis guided by Thorne's interpretive description. RESULTS: Life with bronchiectasis was conceptualized by participants as "Pretty Normal". This consisted of two co-existing life views which represented how young people balanced the ups and downs of adolescence while learning to accommodate the demands of living with bronchiectasis. Three key thematic elements "sore and tired", 'life interrupted and "looking after self", influenced and challenged these two views of life. CONCLUSIONS: Young people with bronchiectasis portray life as being the same as their peers. Despite this, they recognized that the symptoms, interruptions, and self-management responsibilities led them to find ways of coping and integrating their experience into a new and modified view of normal.

Pacific Islands Families Study: adverse impact of food insecurity on child body composition.

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.

Visual impairment and its correction among Pacific youth in Aotearoa: findings from the Pacific Islands Families Study.

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.