1,721,013 research outputs found
A study of maternal reports of childhood injuries that result in hospital attendance or admission: do they match National Health Index database records?
No full textBackground: Childhood injury is one of the leading causes of morbidity and mortality worldwide and concern is increasingly expressed at the lack of adequate data to inform policies and injury prevention strategies. Objective: The aim of this thesis was to examine the reliability and validity of the use of maternal recall of childhood injuries in a birth cohort study of Pacific mothers residing in New Zealand. Maternal reports of child injuries and medical attendance events reported were matched to listings held within the National New Zealand Health Information Service (NZHIS), computer database of public hospital events, the National Medical Discharge Summary (NMDS) database. Methods: The 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 at the 6-year measurement waves. Mothers identified injury events by proxy report, in face to face interviews with ethnic specific interviewers. Information was gained on the type of injuries sustained, their frequency and medical attendance events associated with these injuries. The Statistical Classification of Diseases and Related Health Problems Code 10th Revision (ICD-10-AM) was used to ascertain injury and non injury status for the NMDS medical attendance listings. Results: Kappa statistics demonstrated a modest level of agreement between the NHI database listings and the mothers reporting of childhood injuries between the 0-6-year old children. However McNemar's test of symmetry revealed no systemic under-reporting on behalf of the mothers, suggesting that the use of maternal proxy reporting of childhood injuries is indeed a valid measure. Conclusion: While maternal proxy reporting of 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. Further investigation exploring the reliability of maternal recall over time and development of an internationally recognised and standardized questionnaire for capturing parent reports of childhood injury is advocated. The responsible use of de-identified data in child health studies is believed to have a pivotal role to play in reliability and validity studies in the future
A Study of Maternal Reports of Childhood Injuries That Result in Hospital Attendance or Admission: Do They Match National Health Index Database Records?
No full textBackground: Childhood injury is one of the leading causes of morbidity and mortality worldwide and concern is increasingly expressed at the lack of adequate data to inform policies and injury prevention strategies. Objective: The aim of this thesis was to examine the reliability and validity of the use of maternal recall of childhood injuries in a birth cohort study of Pacific mothers residing in New Zealand. Maternal reports of child injuries and medical attendance events reported were matched to listings held within the National New Zealand Health Information Service (NZHIS), computer database of public hospital events, the National Medical Discharge Summary (NMDS) database. Methods: The 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 at the 6-year measurement waves. Mothers identified injury events by proxy report, in face to face interviews with ethnic specific interviewers. Information was gained on the type of injuries sustained, their frequency and medical attendance events associated with these injuries. The Statistical Classification of Diseases and Related Health Problems Code 10th Revision (ICD-10-AM) was used to ascertain injury and non injury status for the NMDS medical attendance listings. Results: Kappa statistics demonstrated a modest level of agreement between the NHI database listings and the mothers reporting of childhood injuries between the 0-6-year old children. However McNemar's test of symmetry revealed no systemic under-reporting on behalf of the mothers, suggesting that the use of maternal proxy reporting of childhood injuries is indeed a valid measure. Conclusion: While maternal proxy reporting of 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. Further investigation exploring the reliability of maternal recall over time and development of an internationally recognised and standardized questionnaire for capturing parent reports of childhood injury is advocated. The responsible use of de-identified data in child health studies is believed to have a pivotal role to play in reliability and validity studies in the future
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Associations of home environment, food and growth among Pacific children in Auckland, New Zealand
No full textPacific adults and children in New Zealand have the highest prevalence of obesity and overweight compared with any other group. The relationships of home environments with food consumption and rapid growth among Pacific children residing in South Auckland, New Zealand are not well understood. These factors were examined in the Pacific Islands Families (PIF) birth cohort study, which started in the year 2000 with the last wave of physical measurements in 2014.
At recruitment, participant families (n=1376) were representative of the Pacific population in South Auckland, an area where 37% of Pacific people in New Zealand reside. As well as birth weight, anthropometric measurements were recorded for PIF children followed up at 4, 6, 9, 11 and 14 years (y). Examination of growth trajectory to age 14 y confirmed that the child cohort continued to grow at an accelerated rate compared to the World Health Organisation (WHO) child growth reference. The increase in mean BMI among PIF boys and girls from 11 to 14y was 77% and 108% higher than the WHO references. The prevalence of overweight including obesity was 78.1% for boys and 71.8% for girls at mean age 14.5 years using the International Obesity Task Force reference.
Analysis of food frequency patterns at ages 4 and 6 y highlighted 12 most frequently eaten foods accounting for 25% of all food consumed on a daily basis. Average frequency of consumption of these 12 foods remained relatively stable over this period of transition to school (r2 = 0.53). Three carbohydrate foods, bread, breakfast cereal and rice, were the most frequently eaten, followed by milk and fruit (apples and pears, oranges and mandarins, and bananas). Snack foods, including powdered fruit drinks, crisps, noodles, and food drinks (e.g. Milo™) constituted a third of the most frequently eaten foods and chicken was the only protein in the most frequently eaten foods.
At age 9 years for 972 children, small positive associations of household size and daily intake of bread (rho=0.138, p<0.001) and weekly intake of soft drink (rho=0.088, p<0.05), and a negative association of household size and BMI Z among girls (rho=-0.099, p<0.05) were found. Two-parent status was positively associated with BMI Z (rho=0.084, p<0.05) and maternal education was positively associated with fast food intake (rho=0.106, p<0.05) and negatively with BMI Z (rho=-0.086, p<0.05). Maternal deprivation was positively associated with higher consumption of bread (rho=0.213, p<0.01), fast food (rho=0.108, p<0.05) and soft drink (rho=0.111, p<0.05) and negatively associated with fruit (rho=-0.094, p<0.01) and vegetables (rho=-0.094, p<0.001).
Two styles of parenting, authoritative and authoritarian, were found to have acceptable internal reliability (0.8 > α ≥ 0.7), allowing further examination against food habits and BMI Z. Described simply, authoritative parenting practices are highly controlled yet highly nurturing styles of parenting. Whereas authoritarian parenting practices encompass highly controlled but low nurturing styles of parenting. Authoritative parenting was significantly positively associated with daily consumption of fruit (rho=0.129, p<0.001) and vegetables (rho=0.082, p<0.05) among boys and girls, and with bread (rho=0.119, p<0.05) but only among girls. Authoritative parenting was also significantly negatively associated with consumption of fast food (rho=-0.186, p<0.001) and soft drink (rho=-0.094, p<0.01). Authoritative parenting was negatively associated with overall BMI Z. Alternatively, authoritarian parenting was significantly negatively associated with vegetable consumption (rho=-0.174, p<0.001) (boys and girls), and positively associated with consumption of fast food (rho=0.096, p<0.01) (girls) and soft drink (rho=0.114, p<0.001) particularly for boys. Authoritarian parenting was not associated with BMI Z.
This body of work has presented evidence that home environments play an important role in shaping Pacific children’s food consumption patterns especially in light of the need to address rapid growth and obesity. Analyses point to the continued influence of macro environmental socioeconomic pressures mediated through Pacific family homes such as in the positive relationship between household size and consumption of energy-dense foods, bread and soft drink; the two foods that were significantly related to BMI Z (at 9, 11 and 14 y). These observations were consistent and reinforced by the associations observed between indicators of maternal deprivation and all selected food habits at age 9 y. However, positive indications may be gleaned from characteristics in parenting styles that maintain high levels of control and responsiveness, moderating children’s food consumption and growth. As such, authoritative parenting practices were seen to have a positive effect on good eating habits and on cross-sectional and, importantly, longitudinal BMI Z among children.
In order to counter poor nutrition, rapid growth and increased body size, a variety of macro- and micro-environmental measures must be addressed. At the macro level, policies must address increasing levels of poverty and the undersupply of housing in New Zealand, which are key environmental determinants of health. Improved social services to support families experiencing socioeconomic deprivation is recommended to improve food security particularly for children and pregnant mothers. In community settings, food retail environments that support heathier choices could also be a helpful strategy for improving child nutrition. At the micro-level, benefits may be gained in health and nutrition literacy for parents and support strategies to improve food environments in the home. Improved nutrition for Pacific children will have positive flow-on effects in other areas of health apart from body size, improvement of overall quality of life, a more productive workforce, improved health of the next generation and reduction in the cost of non-communicable diseases on the national health budget
Pacific Island Families Study: parental perceptions of overweight obesity and future concern for child’s weight status
No full textAcross the life course, social and cultural determinants of overweight and obesity need better understanding. Two out of three New Zealand (NZ) born Pacific children are either overweight or obese but little is known about the perception of overweight, expressed as a level of concern, of Pacific parents. The aim of this study was to analyse data collected at birth, four and six years in the Pacific Island Families (PIF) study to provide longitudinal information about the relationship of parental perceptions of child weight status and actual weight status. The influence of the context of the socio economic and cultural environment at the birth of the child could also be explored. 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?” Possible answers ranged from “unconcerned” through increasing levels of concern to “very concerned”. At four and six years weight, height and percentage body fat were measured and body mass index (BMI) derived. Weight status and levels of adiposity were referenced to international standards. Mothers’ BMI (n=140) was calculated using height and weight measured when their child was six years old. The majority of parents were unconcerned at four and six years (62% and 69.1%) about the future overweight status of their child. Between four and six years 15.6% of parents maintained a level of concern and 47.1% remained unconcerned, 15.3% became more concerned and 22.0% went from any level of concern to unconcerned. Using the international Cole cut-offs, at four years 40.1 % of the children were classified as normal, 34.1%, as overweight and 25.8% obese. At six years the proportions were similar; normal 41.3%, overweight 31.1% and obese 27.6%. Compared with the Centre for Disease Control (CDC) children centiles 2000, at four years the mean BMI standard deviation score (SD) was 1.62 ±1.08 (±SD) and six years 1.38 ±0.88. At four and six years the proportion of parents who were concerned 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). The factors associated with parental perception were examined in a multivariate model using logistic regression. Factors examined included the sex of the child, acculturation, ethnicity, education, smoking, marital status, mothers age, household income, parity and household size. Ethnicity and parity were found to have statistical significance (p<0.0001) in relation to parental perception. 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. Using an obesity cut-off of 30kg/m2 for maternal BMI, 92.1% of mothers were obese. There was no association of maternal BMI with child body size. This study is unique because it was able to examine, in a contemporary Pacific cohort, the association of actual child overweight and obesity with parental concern for future overweight status of their child. While the level of concern was low and the prevalence of overweight and obesity high, the context of the socio economic and demographic environment 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. Interventions firstly should address the socio economic demographic environment of a Pacific family. Then emphasis should be placed on the life course concept, highlighting firstly the socio cultural exposures from conception that are associated with childhood overweight and obesity and secondly the increasing inability/difficulty in reversing health projections established during childhood, which may motivate parents to provide and adapt the child’s environment. Careful consideration should be made when disseminating information about perception to the parents of overweight and obese children, as not to unnecessarily raise concern if appropriate and timely interventions are not intended. Support (socio, economic and cultural) should be made available to parents in conjunction with information. Whole family focussed interventions may be effective, targeting aspects both in the child’s immediate and intermediate environment. This study adds much needed ethnic-specific information, offering Pacific cultural insight of parental perception of childhood weight status. The study can be used to identify the opportunities for intervention within both the micro and macro scale of the environment of Pacific families. There are a number of stressors identified in socio economic environment that these Pacific families exist in and take precedence over concern for child weight status. Pacific parents have more pressing matters to worry about. Policies need to address the issue of easing these identified environmental stressors. (i.e. GST on fruit and vegetables to increase the recommended intake). Communal interventions with multi level benefits and socially culturally significance may also be warranted
Pacific Island Families Study: Parental Perceptions of Overweight Obesity and Future Concern for Child’s Weight Status
No full textAcross the life course, social and cultural determinants of overweight and obesity need better understanding. Two out of three New Zealand (NZ) born Pacific children are either overweight or obese but little is known about the perception of overweight, expressed as a level of concern, of Pacific parents. The aim of this study was to analyse data collected at birth, four and six years in the Pacific Island Families (PIF) study to provide longitudinal information about the relationship of parental perceptions of child weight status and actual weight status. The influence of the context of the socio economic and cultural environment at the birth of the child could also be explored. 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?” Possible answers ranged from “unconcerned” through increasing levels of concern to “very concerned”. At four and six years weight, height and percentage body fat were measured and body mass index (BMI) derived. Weight status and levels of adiposity were referenced to international standards. Mothers’ BMI (n=140) was calculated using height and weight measured when their child was six years old. The majority of parents were unconcerned at four and six years (62% and 69.1%) about the future overweight status of their child. Between four and six years 15.6% of parents maintained a level of concern and 47.1% remained unconcerned, 15.3% became more concerned and 22.0% went from any level of concern to unconcerned. Using the international Cole cut-offs, at four years 40.1 % of the children were classified as normal, 34.1%, as overweight and 25.8% obese. At six years the proportions were similar; normal 41.3%, overweight 31.1% and obese 27.6%. Compared with the Centre for Disease Control (CDC) children centiles 2000, at four years the mean BMI standard deviation score (SD) was 1.62 ±1.08 (±SD) and six years 1.38 ±0.88. At four and six years the proportion of parents who were concerned 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). The factors associated with parental perception were examined in a multivariate model using logistic regression. Factors examined included the sex of the child, acculturation, ethnicity, education, smoking, marital status, mothers age, household income, parity and household size. Ethnicity and parity were found to have statistical significance (p<0.0001) in relation to parental perception. 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. Using an obesity cut-off of 30kg/m2 for maternal BMI, 92.1% of mothers were obese. There was no association of maternal BMI with child body size. This study is unique because it was able to examine, in a contemporary Pacific cohort, the association of actual child overweight and obesity with parental concern for future overweight status of their child. While the level of concern was low and the prevalence of overweight and obesity high, the context of the socio economic and demographic environment 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. Interventions firstly should address the socio economic demographic environment of a Pacific family. Then emphasis should be placed on the life course concept, highlighting firstly the socio cultural exposures from conception that are associated with childhood overweight and obesity and secondly the increasing inability/difficulty in reversing health projections established during childhood, which may motivate parents to provide and adapt the child’s environment. Careful consideration should be made when disseminating information about perception to the parents of overweight and obese children, as not to unnecessarily raise concern if appropriate and timely interventions are not intended. Support (socio, economic and cultural) should be made available to parents in conjunction with information. Whole family focussed interventions may be effective, targeting aspects both in the child’s immediate and intermediate environment. This study adds much needed ethnic-specific information, offering Pacific cultural insight of parental perception of childhood weight status. The study can be used to identify the opportunities for intervention within both the micro and macro scale of the environment of Pacific families. There are a number of stressors identified in socio economic environment that these Pacific families exist in and take precedence over concern for child weight status. Pacific parents have more pressing matters to worry about. Policies need to address the issue of easing these identified environmental stressors. (i.e. GST on fruit and vegetables to increase the recommended intake). Communal interventions with multi level benefits and socially culturally significance may also be warranted
The Need for a Pacific-Specific Low Birth Weight Threshold: A Comparison Between Samoan Babies Born in Samoa With Samoan Babies Born in Aotearoa New Zealand
No full textThere are ethnic differences in mean birth weight, proportions of low birth weight, and infant mortality in the multiethnic society of Aotearoa New Zealand. Low birth weight in particular is strongly associated with infant mortality. Pacific babies born in Aotearoa New Zealand have a 40 percent greater risk of death than the average Aotearoa New Zealand baby. This is despite Pacific babies having a lower prevalence of pre-term and low birth weight deliveries compared to other Aotearoa New Zealanders. Therefore, it is important to consider the definition of low birth weight and whether an ethnic specific low birth weight threshold would better identify at risk Pacific infants. Study aims The aim of this project is to investigate whether the current standard measure used to determine low birth weight LBW < 2500 grams, as determined by the 10th percentile of full term births is appropriate for Pacific infants, or whether the suggested ethnic-specific low birth weight measure of < 3000 grams is more appropriate to identifying at risk Pacific infants. Design and Methods An international comparative cross-sectional study design was employed to examine birth weight such as LBW < 2500 grams and preterm births, relevant demographics such as age, parity and any other information available from birth records of the Samoan born population sample. The Samoan born sample consisted of 1,054 mothers and babies from birth registrations with the Samoan National Hospital – Tupua Tamasese Meaole TTM between the years January 2006–2007. The comparative sample of Aotearoa New Zealand born Samoans were sourced from the Pacific Island Families PIF birth cohort study and numbered 647 Samoan mothers and their babies. Results Samoan TTM babies were on average 3,319 grams whereas Samoan PIF babies were on average 3,553 grams, some 234 grams heavier p<0.001. Similarly, the 10th percentile for full term births measured at 2,840 grams for Samoan TTM babies and 3,065 grams for Samoan PIF babies, a difference of 225 grams. Significant predictor variables of mean birth weight for the two sample populations were country p<0.001; maternal age categories p<0.001; parity p<0.001 and infant sex p=0.02. Mothers’ smoking habits prior to conceiving were non-significant in predicting the mean birth weights of the two birth samples, although recall biases may have been responsible for this null finding. When all births were considered, Samoan PIF babies were more likely than those born in Samoa to be either preterm or low birth weight. Marital status as a main effect was the only significant predictor of either preterm or low birth weight outcomes, with PIF mothers in de facto relationships having higher odds of birthing either a preterm or low birth weight infant than TTM mothers Discussion There were significant differences in the birth weight distributions and profiles of Samoan TTM babies and Samoan PIF babies even after adjusting for the limited number of predictor variables available. However, both Samoan samples had a 10th percentile birth weight threshold that was significantly higher than the 2,500 grams threshold currently used to identify at risk births. The presence of other individual, cultural, societal and environmental factors, which were unavailable to the present study, may offer valid explanations for the results obtained. The significant differences observed between the proportions of either preterm or low birth weight within the two samples suggest other important factors excluding those which were available may be at play. Such factors may include differences in delivery procedures. For example, Aotearoa New Zealand may have a greater tendency to induce earlier labour once at risk infants are identified, and to conduct higher risk deliveries. Conclusions The mean birth weights and 10th percentile birth weights for the two Samoan sample populations were different; but both populations are significantly higher than the average Aotearoa New Zealand birth weights and 10th percentile birth weights. The results suggest an ethnic specific low birth weight threshold of < 3000 grams may be more appropriate to identify at risk Samoan infants
The need for a Pacific-specific low birth weight threshold: a comparison between Samoan babies born in Samoa with Samoan babies born in Aotearoa New Zealand
No full textThere are ethnic differences in mean birth weight, proportions of low birth weight, and infant mortality in the multiethnic society of Aotearoa New Zealand. Low birth weight in particular is strongly associated with infant mortality. Pacific babies born in Aotearoa New Zealand have a 40 percent greater risk of death than the average Aotearoa New Zealand baby. This is despite Pacific babies having a lower prevalence of pre-term and low birth weight deliveries compared to other Aotearoa New Zealanders. Therefore, it is important to consider the definition of low birth weight and whether an ethnic specific low birth weight threshold would better identify at risk Pacific infants. Study aims The aim of this project is to investigate whether the current standard measure used to determine low birth weight LBW < 2500 grams, as determined by the 10th percentile of full term births is appropriate for Pacific infants, or whether the suggested ethnic-specific low birth weight measure of < 3000 grams is more appropriate to identifying at risk Pacific infants. Design and Methods An international comparative cross-sectional study design was employed to examine birth weight such as LBW < 2500 grams and preterm births, relevant demographics such as age, parity and any other information available from birth records of the Samoan born population sample. The Samoan born sample consisted of 1,054 mothers and babies from birth registrations with the Samoan National Hospital – Tupua Tamasese Meaole TTM between the years January 2006–2007. The comparative sample of Aotearoa New Zealand born Samoans were sourced from the Pacific Island Families PIF birth cohort study and numbered 647 Samoan mothers and their babies. Results Samoan TTM babies were on average 3,319 grams whereas Samoan PIF babies were on average 3,553 grams, some 234 grams heavier p<0.001. Similarly, the 10th percentile for full term births measured at 2,840 grams for Samoan TTM babies and 3,065 grams for Samoan PIF babies, a difference of 225 grams. Significant predictor variables of mean birth weight for the two sample populations were country p<0.001; maternal age categories p<0.001; parity p<0.001 and infant sex p=0.02. Mothers’ smoking habits prior to conceiving were non-significant in predicting the mean birth weights of the two birth samples, although recall biases may have been responsible for this null finding. When all births were considered, Samoan PIF babies were more likely than those born in Samoa to be either preterm or low birth weight. Marital status as a main effect was the only significant predictor of either preterm or low birth weight outcomes, with PIF mothers in de facto relationships having higher odds of birthing either a preterm or low birth weight infant than TTM mothers Discussion There were significant differences in the birth weight distributions and profiles of Samoan TTM babies and Samoan PIF babies even after adjusting for the limited number of predictor variables available. However, both Samoan samples had a 10th percentile birth weight threshold that was significantly higher than the 2,500 grams threshold currently used to identify at risk births. The presence of other individual, cultural, societal and environmental factors, which were unavailable to the present study, may offer valid explanations for the results obtained. The significant differences observed between the proportions of either preterm or low birth weight within the two samples suggest other important factors excluding those which were available may be at play. Such factors may include differences in delivery procedures. For example, Aotearoa New Zealand may have a greater tendency to induce earlier labour once at risk infants are identified, and to conduct higher risk deliveries. Conclusions The mean birth weights and 10th percentile birth weights for the two Samoan sample populations were different; but both populations are significantly higher than the average Aotearoa New Zealand birth weights and 10th percentile birth weights. The results suggest an ethnic specific low birth weight threshold of < 3000 grams may be more appropriate to identify at risk Samoan infants
Associations of Home Environment, Food and Growth Among Pacific Children in Auckland, New Zealand
No full textPacific adults and children in New Zealand have the highest prevalence of obesity and overweight compared with any other group. The relationships of home environments with food consumption and rapid growth among Pacific children residing in South Auckland, New Zealand are not well understood. These factors were examined in the Pacific Islands Families (PIF) birth cohort study, which started in the year 2000 with the last wave of physical measurements in 2014.
At recruitment, participant families (n=1376) were representative of the Pacific population in South Auckland, an area where 37% of Pacific people in New Zealand reside. As well as birth weight, anthropometric measurements were recorded for PIF children followed up at 4, 6, 9, 11 and 14 years (y). Examination of growth trajectory to age 14 y confirmed that the child cohort continued to grow at an accelerated rate compared to the World Health Organisation (WHO) child growth reference. The increase in mean BMI among PIF boys and girls from 11 to 14y was 77% and 108% higher than the WHO references. The prevalence of overweight including obesity was 78.1% for boys and 71.8% for girls at mean age 14.5 years using the International Obesity Task Force reference.
Analysis of food frequency patterns at ages 4 and 6 y highlighted 12 most frequently eaten foods accounting for 25% of all food consumed on a daily basis. Average frequency of consumption of these 12 foods remained relatively stable over this period of transition to school (r2 = 0.53). Three carbohydrate foods, bread, breakfast cereal and rice, were the most frequently eaten, followed by milk and fruit (apples and pears, oranges and mandarins, and bananas). Snack foods, including powdered fruit drinks, crisps, noodles, and food drinks (e.g. Milo™) constituted a third of the most frequently eaten foods and chicken was the only protein in the most frequently eaten foods.
At age 9 years for 972 children, small positive associations of household size and daily intake of bread (rho=0.138, p<0.001) and weekly intake of soft drink (rho=0.088, p<0.05), and a negative association of household size and BMI Z among girls (rho=-0.099, p<0.05) were found. Two-parent status was positively associated with BMI Z (rho=0.084, p<0.05) and maternal education was positively associated with fast food intake (rho=0.106, p<0.05) and negatively with BMI Z (rho=-0.086, p<0.05). Maternal deprivation was positively associated with higher consumption of bread (rho=0.213, p<0.01), fast food (rho=0.108, p<0.05) and soft drink (rho=0.111, p<0.05) and negatively associated with fruit (rho=-0.094, p<0.01) and vegetables (rho=-0.094, p<0.001).
Two styles of parenting, authoritative and authoritarian, were found to have acceptable internal reliability (0.8 > α ≥ 0.7), allowing further examination against food habits and BMI Z. Described simply, authoritative parenting practices are highly controlled yet highly nurturing styles of parenting. Whereas authoritarian parenting practices encompass highly controlled but low nurturing styles of parenting. Authoritative parenting was significantly positively associated with daily consumption of fruit (rho=0.129, p<0.001) and vegetables (rho=0.082, p<0.05) among boys and girls, and with bread (rho=0.119, p<0.05) but only among girls. Authoritative parenting was also significantly negatively associated with consumption of fast food (rho=-0.186, p<0.001) and soft drink (rho=-0.094, p<0.01). Authoritative parenting was negatively associated with overall BMI Z. Alternatively, authoritarian parenting was significantly negatively associated with vegetable consumption (rho=-0.174, p<0.001) (boys and girls), and positively associated with consumption of fast food (rho=0.096, p<0.01) (girls) and soft drink (rho=0.114, p<0.001) particularly for boys. Authoritarian parenting was not associated with BMI Z.
This body of work has presented evidence that home environments play an important role in shaping Pacific children’s food consumption patterns especially in light of the need to address rapid growth and obesity. Analyses point to the continued influence of macro environmental socioeconomic pressures mediated through Pacific family homes such as in the positive relationship between household size and consumption of energy-dense foods, bread and soft drink; the two foods that were significantly related to BMI Z (at 9, 11 and 14 y). These observations were consistent and reinforced by the associations observed between indicators of maternal deprivation and all selected food habits at age 9 y. However, positive indications may be gleaned from characteristics in parenting styles that maintain high levels of control and responsiveness, moderating children’s food consumption and growth. As such, authoritative parenting practices were seen to have a positive effect on good eating habits and on cross-sectional and, importantly, longitudinal BMI Z among children.
In order to counter poor nutrition, rapid growth and increased body size, a variety of macro- and micro-environmental measures must be addressed. At the macro level, policies must address increasing levels of poverty and the undersupply of housing in New Zealand, which are key environmental determinants of health. Improved social services to support families experiencing socioeconomic deprivation is recommended to improve food security particularly for children and pregnant mothers. In community settings, food retail environments that support heathier choices could also be a helpful strategy for improving child nutrition. At the micro-level, benefits may be gained in health and nutrition literacy for parents and support strategies to improve food environments in the home. Improved nutrition for Pacific children will have positive flow-on effects in other areas of health apart from body size, improvement of overall quality of life, a more productive workforce, improved health of the next generation and reduction in the cost of non-communicable diseases on the national health budget
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