Faasisila Savila

Background: From birth, many young Pacific people in Aotearoa New Zealand experience a disproportionately high burden of psychological distress, metabolic disease, and socioeconomic disparities within education and employment which contribute to significant health inequalities. Further research is needed to understand the drivers influencing these outcomes. Objective: This paper provides a comprehensive overview of the quantitative component of the Pacific Island Families Study: Ala mo Tupulaga Pasifika Aotearoa (PIF:ATP; Life Course Trajectories for Young Pasifika in Aotearoa), the latest follow-up of the longitudinal PIF birth cohort study, which uses a mixed-methods approach. Methods: The PIF Study is a multidisciplinary longitudinal study that tracks the health and development of 1398 Pacific children born in 2000 at Middlemore Hospital, South Auckland, Aotearoa, New Zealand. Data collection has occurred at 10 time points from infancy through young adulthood, with this PIF:ATP assessment phase occurring at ages 25‐26 years, which aims to reach at least 750 cohort members. The assessments will take place at participants’ homes or at Auckland University of Technology for those residing in Auckland. Data collection will be conducted across multiple sites, including Auckland, Wellington, Hamilton, and Whangārei in Aotearoa New Zealand, as well as Brisbane, Sydney, and Melbourne in Australia. Physical measurements such as weight, height, waist and hip circumferences, grip strength, body fat mass and muscle mass, blood pressure and pulse, glucose and lipid screening, and skin carotenoid concentration will be undertaken. In addition, self-reported data will be collected on psychological well-being (eg, depression, anxiety, and family functioning), nutritional and metabolic well-being (eg, food intake and physical activity), and economic well-being (eg, educational attainment, employment status, and job occupation and industry). Results: Data collection is scheduled to commence in June 2025 and conclude by December 2026. The first set of results and analysis is expected to be published from December 2027 onward. Reporting of all results will comply with the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines. Conclusions: This paper presents the protocol for the 25-year follow-up of the first Pacific longitudinal cohort study, which will comprehensively examine psychological, nutritional, metabolic, and economic well-being of Pacific young adults. With 25 years of longitudinal data and extensive expertise in life course research, this protocol outlines the design, methodology, and scope of the quantitative component of the PIF:ATP research program. This phase is uniquely positioned to address key issues identified by Pacific communities and generate evidence to inform meaningful interventions and guide policy development while providing robust, contemporary, high-quality empirical evidence.

Introduction: Physical activity is essential for health in adolescence, however less than half of adolescents in Aotearoa New Zealand are classified as being sufficiently active for health benefits. Pacific adolescents are less likely to be classified as sufficiently active compared to their peers from other ethnic groups. This study explored the association between physical activity in Pacific adolescents and potential protective factors. Methods: This quantitative study uses data from the Youth19 Rangatahi Smart survey. A bivariable logistic regression analysis assessed the relationship between seventeen independent variables and physical activity participation in the past week. Thereafter, a multiple variable stepwise logistic regression analysed the variables significantly associated with physical activity. Results: In the bivariable logistic regression analysis, the significant associations were gender, well-being score, belonging to a cultural group, belonging to a group outside of school, spiritual connectedness, school decile (4 & 8), and the belief that exercise is important. In the multivariable stepwise logistic regression analysis, two factors remained significant: belief that exercise is important (odds ratio = 4.896, 95% CI=3.268, 7.337, p <.001) and belonging to a group outside of school (odds ratio = 2.048, 95% CI = 1.397, 3.003, p <.001). Conclusion: Overall, this study offers insights into the protective factors associated with physical activity in Pacific adolescents. Future qualitative research is needed to gain a more in-depth understanding of these protective factors within Pacific communities to help improve their health and well-being.

Background: Brown Buttabean Motivation (BBM) is an organization providing support for Pacific people and Indigenous Māori to manage their weight, mainly through community-based exercise sessions and social support. It was started by DL, a man of Samoan and Māori descent, following his personal weight loss journey from a peak weight of 210 kg to less than half that amount. DL is a charismatic leader with a high media profile who is successful in soliciting donations from corporations in money and kindness. Over time, BBM’s activities have evolved to include healthy eating, food parcel provision, and other components of healthy living. A co-design team of university researchers and BBM staff are evaluating various components of the program and organization. Objective: The purpose of this study is to build culturally centered system dynamics logic models to serve as the agreed theories of change for BBM and provide a basis for its ongoing effectiveness, sustainability, and continuous quality improvements. Methods: A systems science approach will clarify the purpose of BBM and identify the systemic processes needed to effectively and sustainably achieve the study’s purpose. Cognitive mapping interviews with key stakeholders will produce maps of their conceptions of BBM’s goals and related cause-and-effect processes. The themes arising from the analysis of these maps will provide the initial indicators of change to inform the questions for 2 series of group model building workshops. In these workshops, 2 groups (BBM staff and BBM members) will build qualitative systems models (casual loop diagrams), identifying feedback loops in the structures and processes of the BBM system that will enhance the program’s effectiveness, sustainability, and quality improvement. The Pacific and Māori team members will ensure that workshop content, processes, and outputs are grounded in cultural approaches appropriate for the BBM community, with several Pacific and Māori frameworks informing the methods. These include the Samoan fa’afaletui research framework, which requires different perspectives to be woven together to create new knowledge, and kaupapa Māori–aligned research approaches, which create a culturally safe space to conduct research by, with, and for Māori. The Pacific fonofale and Māori te whare tapa whā holistic frameworks for interpreting people’s dimensions of health and well-being will also inform this study. Results: Systems logic models will inform BBM’s future developments as a sustainable organization and support its growth and development beyond its high dependence on DL’s charismatic leadership. Conclusions: This study will adopt a novel and innovative approach to co-designing culturally centered system dynamics logic models for BBM by using systems science methods embedded within Pacific and Māori worldviews and weaving together a number of frameworks and methodologies. These will form the theories of change to enhance BBM’s effectiveness, sustainability, and continuous improvement. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN 12621-00093-1875; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382320 International Registered Report Identifier (IRRID): PRR1-10.2196/44229

Background: Buttabean Motivation (BBM) is a Pacific-led organisation which aims to reduce obesity amongst Pacific and Māori people in New Zealand enabling them to choose a healthy and active life-style for the duration of their lives, their children, their wider family and the community. BBM offers a holistic approach to weight loss, recognising that mental health, family and cultural factors all play essential and critical role in nutrition and physical activity patterns. This study aims to evaluate the effectiveness of BBM for sustained health and wellbeing outcomes among its predominantly Pacific and Māori participants for both general BBM members and those with morbid obesity attending the ‘From the Couch’ programme.Methods: Quasi-experimental pre-post quantitative cohort study design with measured or self-reported weight at various time intervals for both cohorts. Weight will be analysed with general linear mixed model for repeated measures, and compared with a prediction model generated from the literature using a mixed method meta-analysis. The secondary outcome is change in pre- and post scores of Māori scale of health and well-being, Hua Oranga.Discussion: Multiple studies have shown that many diet and physical activity programmes can create short-term weight loss. The fundamental question is whether BBM members maintain weight loss over time. In New Zealand, Pacific and Māori engagement in health enhancing programmes remains an important strategy for achieving better health and wellbeing outcomes, and quality of life. Internationally, the collectivist cultures of indigenous and migrant and minority populations, living within dominant individualist western ideologies, have much greater burdens of obesity. If BBM members demonstrate sustained weight loss, this culturally informed community-based approach could benefit to other indigenous and migrant populations.Trial registration: Australian New Zealand Clinical Trial RegistryACTRN12621000931875(BBM general members) First submitted 10 May 2021, registration completed 15 July 2021.ACTRN126210016768087 (From the Couch) First submitted 28 October 2021, registration completed 7 December 2021.

Background: In New Zealand (NZ), children of Pacific heritage are generally born heavier and gain weight more quickly than non-Pacific children. Immigrants' health is commonly expected to converge with the host population through acculturation. The aim of this analysis was to examine whether mothers' acculturation is associated with less-rapid weight gain in NZ Pacific children, and whether this differs by mothers' nativity. Methods: In a birth cohort of 1249 children followed 2000–2011, birth weight and weight and standing height, measured at years 2, 4, 6, 9, and 11, were quantified as sex- and age-specific weight (weight-for-age; WFA) and BMI z-scores. Maternal acculturation (range, 11–54) was assessed at baseline and years 4, 6, and 11. Results: In adjusted models using generalized estimating equations to account for repeated measures, maternal acculturation was not significantly associated with children's WFA or BMI z-scores overall. In stratified analyses, change in maternal acculturation score was inversely associated with WFA z-score change among children of NZ-born, but not immigrant, mothers (beta=−0.021; 95% confidence interval, −0.036 to −0.007; p=0.006; interaction, p=0.005). Conclusions: Our study provides the first evidence in a longitudinal sample that changes in maternal acculturation can influence children's growth, suggesting the importance of lifestyle or behavioral factors related to a mother's cultural orientation. Given the high risk of obesity and its related conditions in the NZ Pacific population, critical next steps are to identify mediating factors, as well as to understand the processes influencing growth among children of immigrant mothers.

Background: Since 2000, the longitudinal Pacific Island Families study has measured the weight, height and body mass index (BMI) of 582 girls and 643 boys at 2, 4, 6 and 9 year data collection phases. Aim: To extend and record the age-related distribution of weight, height and BMI measures in Pacific children aged 2–10 years and to compare the distribution to population and clinical growth charts. Methods: Gender-specific age-related centile curves were derived using the LMS method for weight, height and BMI. The 50th centiles from the World Health Organisation growth reference for 2–5 year olds and the Centres for Disease Control (CDC) for 5–10 year olds were compared. Overweight and obesity were defined by the CDC BMI 85th and 95th centiles. Results: The proportion of children whose weight and height were above the reference 50th centile increased with age. At age 10, using CDC criteria, more than 50% of the children were classified as obese and 70% were overweight. Conclusions: These charts support the need to prioritize interventions for Pacific families to address childhood obesity. These centile curves could help assess the relative growth of Pacific children and identify children for further assessment and treatment.