Pacific families in New Zealand experience high rates of type 2 diabetes and unequal access to health-supporting resources. Pacific communities draw on collectivism and social capital to mobilise social action. This study aimed to develop a Pacific Family Model (PFM) approach to address T2DM-related health inequities. This study involved an established empowerment programme aimed to build community knowledge and skillsets in health promotion strategies, and to co-design a diabetes-prevention programme led by the research team and community participants (n = 39). Measurements were taken at baseline and at six months from baseline, comparing young and old participant groups with T2DM. Mean scores were presented, and T-Test and Wilcoxon statistical tests were used to identify differences between the groups. Older participants demonstrated greater average changes in: weight loss (-6.58 kg), blood pressure (-2.33 mmHg), and BMI (-2.94 kg/m2), compared to the younger participants. The PFM approach successfully tailored a family health-promotion programme by leveraging Pacific values and family strengths, enabling collective learning and modest behaviour change. Participants reported higher health awareness and self-efficacy despite complex living realities. Further research should test scalability. Practically, culturally grounded, co-designed programmes should be paired with context-appropriate supports.

BackgroundDietary patterns are linked to obesity and metabolic health.AimTo explore associations between dietary patterns, adiposity, and metabolic syndrome risk in Pacific and New Zealand (NZ) European women.MethodsPacific (n = 126) and NZ European (n = 161) women aged 18-45 years from Auckland were recruited based on BMI (normal weight and obesity) with approximately half in each ethnic group. Body fat percentage (BF%) was assessed with DXA and used to stratify participants into low (<35%) or high (≥35%) BF% groups. Dietary intake was assessed using a 5-day food record and semi-quantitative food frequency questionnaire, analyzed with the National Cancer Institute method. Dietary patterns were derived using principal component analysis. Fasting blood was analyzed for insulin, glucose, and lipids. Metabolic syndrome was defined using harmonized criteria.ResultsFour dietary patterns were identified: Vegetarian, Processed, Prudent, and Keto. Regression analysis controlling for ethnicity, age, socioeconomic deprivation, energy intake, and physical activity showed that higher adherence to Vegetarian and Prudent patterns characterized by "core" foods was inversely associated with BF% and visceral fat% (p < 0.05). Higher adherence to Processed and Keto patterns (characterized by "discretionary," and less "core" foods, respectively) was positively associated with BMI, BF%, and visceral fat% for both ethnic groups. Every 1 unit increase in adherence to the Processed pattern was associated with 50% higher odds of metabolic syndrome (OR: 1.53 [95% CI: 1.02, 2.30], p = 0.042).ConclusionGreater adherence to "core" food patterns was associated with lower adiposity and metabolic disease risk, while patterns high in processed "discretionary" foods and less diversity of "core" foods were associated with higher metabolic risk.

BACKGROUND:Whānau-centredness is core to Māori wellbeing. Western models of health, in contrast, tend to be deficit-framed and individualistic, although a more collective model can be seen in the concept of syndemics: conditions that cluster in populations and are amplified by health inequities. Through the voices of whānau and key informants, we investigated how a whānau-ora approach can inform the management of syndemics of long-term conditions and infectious diseases within primary health care. METHODS:The study team was gifted the Māori name Pūriri [a medicinal tree] by a community leader, enabling the concept of syndemics to be considered in a Te Ao Māori context. We undertook a qualitative kaupapa Māori study, conducting focus groups and interviews with purposively selected participants. We utilised descriptive and inductive thematic analysis. RESULTS:We identified several themes to guide appropriate management of syndemic conditions in primary care. Participants stressed the importance of whakawhanaungatanga and strengths-based practices when working with whānau; culturally appropriate services that are grounded in Māori worldviews; whānau engagement in care; and whakawhanaungatanga, which is also vital at the Provider level. CONCLUSIONS:This paper reports findings from a Māori-led study, building on existing research focused on whānau-centred care and established approaches to Māori health. Building trusting, respectful connections through whakawhanaungatanga was seen as a central practice for engaging with Māori. Grounded in the symbolism of the Pūriri, these findings highlight pathways for primary health care to partner with whānau and communities in a whānau-ora approach to create enduring and equitable solutions to syndemics.

Unquestionably there is a need for more Indigenous and traditional knowledge to understand better the link between ‘culture and food systems, diet and traditional practices’ and ‘diet-related diseases’ (e.g. diabetes), particularly from a Pacific worldview. In this study, we explored the role of Samoan traditional healers or Taulasea with the research question: ‘What insights are contained in Indigenous and traditional knowledge systems that can be used to design new ways to prevent diet-related diseases among Samoans (and Pacific peoples in general) in NZ?’ Fourteen Taulasea participated in semi-structured narrative interviews (talanoa methodology) from June 2022 to October 2023. Transcribed interviews were coded and analysed using thematic analysis. Four major themes were revealed that examined the sacredness of their knowledge and practice, Taulasea specialisation, treatment methods and holistic views that impact health. These insights highlight why Samoans continue to use traditional healing as the first port of call for their health needs.

Background/Objectives: To assess associations between dietary fibre intake, adiposity, and odds of metabolic syndrome in Pacific and New Zealand European women. Methods: Pacific (n = 126) and New Zealand European (NZ European; n = 161) women (18–45 years) were recruited based on normal (18–24.9 kg/m2) and obese (≥30 kg/m2) BMIs. Body fat percentage (BF%), measured using whole body DXA, was subsequently used to stratify participants into low (<35%) or high (≥35%) BF% groups. Habitual dietary intake was calculated using the National Cancer Institute (NCI) method, involving a five-day food record and semi-quantitative food frequency questionnaire. Fasting blood was analysed for glucose and lipid profile. Metabolic syndrome was assessed with a harmonized definition. Results: NZ European women in both the low- and high-BF% groups were older, less socioeconomically deprived, and consumed more dietary fibre (low-BF%: median 23.7 g/day [25–75-percentile, 20.1, 29.9]; high-BF%: 20.9 [19.4, 24.9]) than Pacific women (18.8 [15.6, 22.1]; and 17.8 [15.0, 20.8]; both p < 0.001). The main source of fibre was discretionary fast foods for Pacific women and whole grain breads and cereals for NZ European women. A regression analysis controlling for age, socioeconomic deprivation, ethnicity, energy intake, protein, fat, and total carbohydrate intake showed an inverse association between higher fibre intake and BF% (β= −0.47, 95% CI = −0.62, −0.31, p < 0.001), and odds of metabolic syndrome (OR = 0.91, 95% CI = 0.84, 0.98, p = 0.010) among both Pacific and NZ European women (results shown for both groups combined). Conclusions: Low dietary fibre intake was associated with increased metabolic disease risk. Pacific women had lower fibre intakes than NZ European women.

Objective: Most wet commercial infant foods are now sold in squeezable ‘pouches’. While multiple expert groups have expressed concern about their use, it is not known how commonly they are consumed and whether they impact energy intake or body mass index (BMI). The objectives were to describe pouch use, and determine associations with energy intake and BMI, in infants and young children. Methods: In this observational cross-sectional study of 933 young New Zealand children (6.0 months–3.9 years), pouch use was assessed by a questionnaire (‘frequent’ use was consuming food from a baby food pouch ≥5 times/week in the past month), usual energy intake using two 24-h recalls, and BMI z-score calculated using World Health Organization standards. Results: The sample broadly represented the wider population (27.1% high socioeconomic deprivation, 22.5% Māori). Frequent pouch use declined with age (infants 27%, toddlers 16%, preschoolers 8%). Few children were both frequent pouch users and regularly used the nozzle (infants 5%, toddlers 13%, preschoolers 8%). Preschoolers who were frequent pouch users consumed significantly less energy than non-users (−580 kJ [−1094, −67]), but infants (115 [−35, 265]) and toddlers (−206 [−789, 378]) did not appear to have a different energy intake than non-users. There were no statistically significant differences in the BMI z-score by pouch use. Conclusions: These results do not support the strong concerns expressed about their use, particularly given the lack of evidence for higher energy intake or BMI.

Empowering Indigenous youth in their communities and within their own social-cultural contexts is an essential approach to developing their capacity as community advocators. We adapted an established youth empowerment programme for use among 51 Indigenous New Zealand youth. The key learnings of the programme reported: (a) youth highly rated their understanding and confidence across various social-health contexts based on the programmes’ stance of developing the youths’ knowledge and social change in understanding their own health and well-being as community catalysts; and (b) incorporating Māori (Indigenous people of New Zealand) worldview to their understandings of mental wellness was important because it enabled youth to understand mental health issues in a culturally relevant and safe way, this was positively compounded by having a strong identity as Māori. This study adds to a small body of literature on the use of empowerment programmes for improving the health and well-being of Indigenous youth.

Baby food pouches are becoming an increasingly popular way to assist the transition from breast milk or infant formula to solid foods, both in New Zealand (NZ) and worldwide. These pouches have overtaken the market in NZ supermarkets, with 63.9% of total baby foods sold in 2021 being in pouch form. While most pouches are aimed at infants, some are pitched to an older age group, and it is possible that some toddlers and preschoolers continue to consume baby food pouches well beyond 12 months of age. Despite concerns raised by a number of health agencies, there has been almost no research undertaken on the use of “baby” food pouches by children, and related health effects. Therefore, this study aims to describe how “baby” food pouches are being used by young children in NZ. In Young Foods NZ, an observational cross-sectional study, 287 participants with children aged 1–3.9 years completed a feeding questionnaire about the child’s “baby” food pouch consumption including frequency, method of use, and setting. The majority (85.4%) of children had used a pouch at some time in their life; however, only 11.1% were current ‘frequent’ pouch users (i.e., used baby food pouches five or more times a week). Sixty-five percent of pouch users always consumed the contents by sucking straight from the nozzle. Chair (22.8%), highchair (25.7%), and while “on the go” (23.1%) were the most common locations where pouches were consumed. Overall, while most young children had tried a “baby” food pouch at some point in their life, relatively few were considered frequent pouch users. These findings suggest pouches are not contributing substantially to most young NZ children’s diets. However, over half of pouch users sucked the contents directly from the nozzle, and this may have implications for dental health and oral motor skill development.

The majority of children and young people in Aotearoa New Zealand (NZ) experience good health and wellbeing, but there are key areas where they compare unfavourably to those in other rich countries. However, current measures of wellbeing are critically limited in their suitability to reflect the dynamic, culture-bound, and subjective nature of the concept of ‘wellbeing’. In particular, there is a lack of measurement in primary school-aged children and in ways that incorporate Māori perspectives on wellbeing. A Better Start National Science Challenge work in the areas of Big Data, Healthy Weight, Resilient Teens, and Successful learning demonstrates how research is increasing our understanding of, and our ability to enhance, wellbeing for NZ children. As we look ahead to the future, opportunities to support the wellbeing of NZ young people will be shaped by how we embrace and mitigate against potential harms of new technologies, and our ability to respond to new challenges that arise due to climate change. In order to avoid increasing inequity in who experiences wellbeing in NZ, wellbeing must be monitored in ways that are culturally acceptable, universal, and recognise what makes children flourish.

Optimal nutrition during early childhood is essential to support physiological and cognitive development. However, data on nutrient intakes and associations with socioeconomic deprivation are lacking in young children living in New Zealand (NZ). As a component of Young Foods NZ, a multi-centre cross-sectional study, this research aims to determine nutrient intakes and their associations with socioeconomic deprivation in young NZ children aged 1–3.9 years. Dietary intake data (two 24 h diet recalls) and socioeconomic deprivation (NZDep2018) were collected from 289 children living in Auckland, Wellington, and Dunedin. The multiple source method was utilised to determine the usual dietary intake. All participants exceeded the Estimated Average Requirement (EAR) for protein (12 g/day), with a mean (SD) intake of 45.5 (10.4) g/day. Using the full probability approach, the prevalence of inadequate intake for iron was 38.2%, with an overall mean (SD) intake of 6.6 (2.2) mg/day. The prevalence of inadequate intake for fibre (<14 g/day) was 54.3%, with a mean (SD) intake of 14.0 (4.4) g/day. Saturated fat contributed 14%, and total sugars contributed 23% of the total energy intake. Living in a neighbourhood of low deprivation (NZDep1–3) is a significant predictor of higher dietary fibre and iron intakes and lower fat intake for young children compared with those living in deprivation (NZDep4–10). In this cohort, a high proportion of children do not have the best start in life due to the suboptimal intake of iron and dietary-fibre-containing foods, and the disproportionate consumption of saturated fat and sugar-rich foods. Children living in areas of deprivation are particularly at risk. Effective policies are needed to reduce these disparities and ensure that all children have equitable access to healthy and nutritious foods.

Background A woman’s vulnerability to sleep disruption and mood disturbance is heightened during the perinatal period and there is a strong bidirectional relationship between them. Both sleep disruption and mood disturbance can result in significant adverse outcomes for women and their infant. Thus, supporting and improving sleep in the perinatal period is not only an important outcome in and of itself, but also a pathway through which future mental health outcomes may be altered. Methods Using scoping review methodology, we investigated the nature, extent and characteristics of intervention studies conducted during the perinatal period (pregnancy to one-year post-birth) that reported on both maternal sleep and maternal mental health. Numerical and descriptive results are presented on the types of studies, settings, sample characteristics, intervention design (including timeframes, facilitation and delivery), sleep and mood measures and findings. Results Thirty-seven perinatal interventions were identified and further described according to their primary focus (psychological ( n = 9), educational ( n = 15), lifestyle ( n = 10), chronotherapeutic ( n = 3)). Most studies were conducted in developed Western countries and published in the last 9 years. The majority of study samples were women with existing sleep or mental health problems, and participants were predominantly well-educated, not socio-economically disadvantaged, in stable relationships, primiparous and of White race/ethnicity. Interventions were generally delivered across a relatively short period of time, in either the second trimester of pregnancy or the early postnatal period and used the Pittsburgh Sleep Quality Index (PSQI) to measure sleep and the Edinburgh Postnatal Depression Scale (EPDS) to measure mood. Retention rates were high (mean 89%) and where reported, interventions were well accepted by women. Cognitive Behavioural Therapies (CBT) and educational interventions were largely delivered by trained personnel in person, whereas other interventions were often self-delivered after initial explanation. Conclusions Future perinatal interventions should consider spanning the perinatal period and using a stepped-care model. Women may be better supported by providing access to a range of information, services and treatment specific to their needs and maternal stage. The development of these interventions must involve and consider the needs of women experiencing disadvantage who are predominantly affected by poor sleep health and poor mental health.

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.

ABSTRACT This paper provides insights from a community-centre intervention study that was co-designed by youth, health providers and researchers. The aims of the paper were to highlight the effectiveness of a co-designed community centred diabetes prevention intervention, and to determine whether a culturally tailored approach was successful. The study participants (n = 26) were at risk of developing prediabetes and represented the working age group of Pasifika peoples in NZ (25–44-year olds). The community-centre intervention consisted of 8 weeks of community physical activity organised and led by the local youth, a community facilitator, and the community provider. Semi-structured interviews with each of the intervention participants using a Pasifika narrative approach (talanoa) was carried out. Each interview was transcribed, coded and analysed and compared using thematic analyses. The study highlights four major themes illuminating positive successes of the community-centre intervention programme, and conclude that co-designing interventions for Pasifika peoples, should be culturally tailored to meet the realities of the communities and require strong support from associated community providers.

Co-design is a relatively new method employed in public health-based interventions to identify problems, generate and implement solutions through harnessing knowledge and creativity of citizens and staff . Researchers use different co-design steps in the design and implementation of intervention programmes. The co-design approach has been successfully used in redesigning health care services to fit the needs of the consumers and has extended to develop health interventions for communities . In New Zealand, co-design methods have been used to develop health interventions among minority and indigenous groups. Previous research highlighted that co-design fits well when collaborating with these groups as it allows tool redevelopments and re-fining based on the socio-cultural needs of participants. This method captures and understands the needs of the Tongan community, as well as foster expression, reflection, and sharing to inform the development of the intervention. The generation of discussion in co-design aligns with the indigenous knowledge of systems, creation stories and oral stories which provide a culturally empowering way to generate discussion and insights from Tongan communities.

AIM: The primary objective of this study was to determine the effect of a mobile health (mHealth) intervention on the wellbeing of Pasifika peoples, and to explore factors associated with Pasifika wellbeing. METHODS: The OL@-OR@ mHealth programme was a co-designed smartphone app. Culturally relevant data was collected to examine holistic health and wellbeing status, at baseline, and at 12 weeks (end of the trial). The concept of wellbeing was examined as part of a two-arm, cluster randomised trial, using only the Pasifika data: 389 (of 726) Pasifika adults were randomised to receive the mHealth intervention, while 405 (of 725) Pasifika adults were randomised to receive a control version of the intervention. Culturally relevant data was collected to examine holistic health and wellbeing status, at baseline, and at 12 weeks (end of the trial). The intervention effects and the association of demographic and behavioural relationships with wellbeing, was examined using logistic regression analyses. RESULTS: Relative to baseline, there were significant differences between the intervention and control groups for the 'family/community' wellbeing, at the end of the 12-week trial. There were no significant differences observed for all other wellbeing domains for both groups. Based on our multivariate regression analyses, education and acculturation (assimilation and marginalisation) were identified as positively strong factors associated to Pasifika 'family and community' wellbeing. CONCLUSION: Our study provides new insights on how Pasifika peoples' characteristics and behaviours align to wellbeing. Our findings point to 'family and community' as being the most important wellbeing factor for Pasifika peoples.

Issue Empowerment is a concept over-used in health promotion, yet it is an important process that can used in developing the capacity and capability of young people for creating social change to improve healthier lives. Methods The Youth Empowerment Program (YEP), a pilot study aimed at empowering 15 youth (18-24 years) to lead healthier lives. We present secondary outcomes of the original YEP study, using focus groups and mobile-mentary approaches to capture the impact of the YEP through the youths' understanding of the program. Thematic analyses to examine the pragmatic usefulness of the empowerment program. Results We identified three major themes: (aa)Knowledge: education and awareness of healthy living and understanding of the wider social health issues, compound the health complexities of obesity; (b)Youth as catalysts for change: the youth viewed themselves as agents of social change; and (c)Transformation:the youth recognised themselves as catalysts for change that can positively transform communities into action. Conclusion This study contributes new insights and depth of understanding about how the empowerment program can strengthen the process of individual capacity in an effort to mobilise social change for the betterment of the whole community, particularly among indigenous Pasifika population groups. So what? Developing empowerment principles will enable others to consider "how apply" empowerment more practically when working with young people and not use it flippantly with no real action-oriented outcome.

BACKGROUND:Cleaning is associated with an increased risk of asthma symptoms, but few studies have measured functional characteristics of airway disease in cleaners. AIMS:To assess and characterize respiratory symptoms and lung function in professional cleaners, and determine potential risk factors for adverse respiratory outcomes. METHODS:Symptoms, pre-/post-bronchodilator lung function, atopy, and cleaning exposures were assessed in 425 cleaners and 281 reference workers in Wellington, New Zealand between 2008 and 2010. RESULTS:Cleaners had an increased risk of current asthma (past 12 months), defined as: woken by shortness of breath, asthma attack, or asthma medication (OR = 1.83, 95% CI = 1.18-2.85). Despite this, they had similar rates of current wheezing (OR = 0.93, 95% CI = 0.65-1.32) and were less likely to have a doctor diagnosis of asthma ever (OR = 0.62, 95% CI = 0.42-0.92). Cleaners overall had lower lung function (FEV1 , FVC; P < .05). Asthma in cleaners was associated with less atopy (OR = 0.35, 95% CI = 0.13-0.90), fewer wheezing attacks (OR = 0.40, 95% CI = 0.17-0.97; >3 vs ≤3 times/year), and reduced bronchodilator response (6% vs 9% mean FEV1 -%-predicted change, P < .05) compared to asthma in reference workers. Cleaning of cafes/restaurants/kitchens and using upholstery sprays or liquid multi-use cleaner was associated with symptoms, whilst several exposures were also associated with lung function deficits (P < .05). CONCLUSIONS AND CLINICAL RELEVANCE:Cleaners are at risk of some asthma-associated symptoms and reduced lung function. However, as it was not strongly associated with wheeze and atopy, and airway obstruction was less reversible, asthma in some cleaners may represent a distinct phenotype.

OBJECTIVES:Recreational physical activities of New Zealand women were examined to develop ethnic-specific suggestions encouraging physical activity (PA) participation as a targeted approach to reduce obesity rates among different groups. METHODS:Healthy Māori, Pacific and European women (n=331; 16-45 years of age) completed an online Recent Physical Activity Questionnaire to assess recreational PA and adherence to PA guidelines. Existing PA preferences were tailored to make ethnic-specific suggestions aimed at increasing PA participation. RESULTS:Achievement of PA guidelines was: Māori 74%; Pacific 60%; European 70%. Highest participation across all women was for walking (Māori 72%, Pacific 60%, European 83%), followed by floor exercise (Māori 54%, Pacific 37%, European 56%). Gym-type activities (e.g. weights, aerobics) and jogging were also common across ethnic groups. Group/team activities (dance, netball, touch football) were among the top 10 activities for Māori and Pacific, but not European women. CONCLUSION:Obesity rates among specific ethnic groups of New Zealand women might be reduced by promoting activities that are: family/whānau-oriented (netball, touch), community-linked (hula, dance) and outdoor-based. Implications for public health: Tailoring existing PA preferences to develop ethnic-specific sets of activity suggestions could be important avenues to increase PA participation, improving the PA habits and subsequent health of New Zealand women and their communities.

Background: Cleaners have an increased risk of hand dermatitis. Objectives: To assess the risk and determinants of dermatitis, urticaria and loss of skin barrier function in cleaners, and any modifying effects of atopy. Methods: Dermatitis, urticaria, atopy and skin barrier function were assessed in 425 cleaners and 281 reference workers using questionnaires, skin prick tests, and transepidermal water loss (TEWL)

The obesity rate in New Zealand is one of the highest worldwide (31%), with highest rates among Māori (47%) and Pasifika (67%). Codesign was used to develop a culturally tailored, behavior change mHealth intervention for Māori and Pasifika in New Zealand. The purpose of this article is to provide an overview of the codesign methods and processes and describe how these were used to inform and build a theory-driven approach to the selection of behavioral determinants and change techniques. The codesign approach in this study was based on a partnership between Māori and Pasifika partners and an academic research team. This involved working with communities on opportunity identification, elucidation of needs and desires, knowledge generation, envisaging the mHealth tool, and prototype testing. Models of Māori and Pasifika holistic well-being and health promotion were the basis for identifying key content modules and were applied to relevant determinants of behavior change and theoretically based behavior change techniques from the Theoretical Domains Framework and Behavior Change Taxonomy, respectively. Three key content modules were identified: physical activity, family/whānau [extended family], and healthy eating. Other important themes included mental well-being/stress, connecting, motivation/support, and health literacy. Relevant behavioral determinants were selected, and 17 change techniques were mapped to these determinants. Community partners established that a smartphone app was the optimal vehicle for the intervention. Both Māori and Pasifika versions of the app were developed to ensure features and functionalities were culturally tailored and appealing to users. Codesign enabled and empowered users to tailor the intervention to their cultural needs. By using codesign and applying both ethnic-specific and Western theoretical frameworks of health and behavior change, the mHealth intervention is both evidence based and culturally tailored.