Schluter 2023 Slides.pdf

The Pacific Islands Families (PIF) Study: longitudinal studies in life course research Philip Schluter Professor of Population Health Rm 319, Rehua Building, Ilam, Christchurch Email: [email protected] Pacific people in Aotearoa | New Zealand Approximately how many Pacific people li...

The Pacific Islands Families (PIF) Study: longitudinal studies in life course research Philip Schluter Professor of Population Health Rm 319, Rehua Building, Ilam, Christchurch Email: [email protected] Pacific people in Aotearoa | New Zealand Approximately how many Pacific people live in Aotearoa | New Zealand? – (a) 100,000 (b) 200,000 (c) 300,000 (d) 400,000 Are the living/work visas the same for Samoan, Tongan, Cook Islands Māori, and Niuean people? – (a) Yes (b) No Is it better for Pacific people’s health to retain their culture or assimilate into the dominant culture when moving here? – (a) Yes (b) No Lecture plan Introducing some key aspects of Pacific children/families health (and challenges) in Aotearoa | New Zealand Introduce the Pacific Islands Families (PIF) study Focus on one thread within this study: cultural orientation and health Before we begin… Settlement in Aotearoa | New Zealand: a brief history Māori settlement around 1200-1300 AD European colonisation from late 18th century Polynesian post-Māori migration limited – 1945 Census – 2,000 people of Pacific origin Second great Polynesian wave 1950-1980s – Economic opportunities: shortage of labour in manufacturing, agricultural and forestry sectors – Economic sustainability issues in home islands Settlement in Aotearoa | New Zealand: a brief history Following the economic downturn in the mid-late 1970s and throughout the 1980s and 1990s, many Pacific people were afflicted by decreases in wages and employment opportunities Relationship further soured when Pacific immigrants were specifically targeted for random checks for their residency permits (e.g. Dawn Raids in mid-1970s) and were deported in often humiliating circumstances (see: https://www.nzonscreen.com/title/dawn-raids-2005) Immigration now for economic and family reasons Around 66.4% Aotearoa |New Zealand born Pacific people in Aotearoa | New Zealand Ethnicity: 59.4% one ethnic identification; 40.6% with two or more ethnic identifications (c.f. 84.1% European) Samoan; Tongan; Cook Islands Māori; Niuean 66% reside in Auckland (4% in Canterbury) Median age 23.4 years (c.f. 41.4 years European) Median income: $24,300 (c.f. $34,600 European) Reducing health inequalities: a global public health priority The WHO agenda – Priority to improve health outcomes in poor, disadvantaged, vulnerable groups – Supporting and harnessing research, information, evidence But is reducing these health inequalities an issue for Aotearoa | New Zealand? While not extreme; our ethnic inequalities are large [stark] [Blakey, NZMJ, 2008; Editorial, The Lancet, 2018] Pacific people face particular social and economic issues affecting their health that must be addressed [Ministers of Health and Pacific Peoples, 2018] Optimal health for Pacific peoples through promoting & funding health research Focuses strongly on capacity building But is reducing these health inequalities an issue for Aotearoa | New Zealand? Dearth of quality empirical Pacific social/behavioural information... [Oakley Browne MA, Wells JE, Scott KM. Te Rau Hinengaro: The New Zealand Mental Health Survey. Wellington: Ministry of Health; 2006] The Pacific Islands Families (PIF) Study Designed to address Pacific information deficit & needs Aims: – Determine optimum pathways for Pacific children and families during critical developmental periods – Make empirically based recommendations to promote the wellbeing of Pacific children & families – Build Pacific public health researcher capacity The Pacific Islands Families (PIF) Study Please go to: https://www.youtube.com/watch?v=VGAp_qVNYo0 The PIF Study Birth cohort study of 1,398 Pacific infants born at Middlemore hospital in 2000 Includes triad: – Mother – Father – Child Ethnically representative Powered to investigate ethnic differences PIF Study measurement waves… Mother Child Father 6 weeks █ █ 1 year █ █ █ 2 years █ █ █ 4 years █ █ 6 years █ █ 9 years █ █ 11 years █ █ 14 years █ █ 16 years █ █ █ Teacher █ █ █ █ █ █ PIF Study numbers... 6 weeks 1 year 2 years 4 years 6 years PIF Study publications Authored/co-authored papers on: – Intimate partner violence/discipline – SIDS – Household crowding – Injury – Mental health – Gambling – Oral health – Immunisation – Breast feeding – Physical activity – Methodological – ... Acculturation Culture is intrinsically linked to health Acculturation is “culture change that is initiated by the conjunction of two or more autonomous culture systems” That is... attitudes, behaviours, values, beliefs modified through contact with another culture (individual or group) Multiple acculturation conceptualizations – bi-directional [Berry et al. 2003] Not inevitable uniform progression to assimilation; may be bi-directional & reciprocal Acculturation tools Acculturation typically crudely defined & measured [Thomson et al. 2009] – years in country/place of birth PIF Study uses adaption of GEQ Bi-directional: New Zealand & Pacific scales Piloted with Pacific Advisory Group & focus groups Good psychometric properties – Cronbach’s α > 0.8 [Tsai et al. 2000] New Zealand scale New Zealand acculturation (NZAccult) questions 1 I was brought up in the New Zealand way. 2 I am familiar with New Zealand practices and customs. 3 I can understand English. 4 I have several non-Pacific friends. 5 Most of my friends speak English. 6 I participate in New Zealand sports and recreation. 7 I speak English language. 8 I have contact with non-Pacific families and relatives. 9 I visit Western-trained medical doctors when I have an illness. 10 I go to a church that is mostly attended by non-Pacific people. 11 I eat non-Pacific foods. 5-point Likert scale: 1=strongly disagree, ..., 5=strongly agree Pacific scale Pacific Islands acculturation (PIAccult) questions 1 I was brought up in the Pacific way. 2 I am familiar with Pacific practices and customs. 3 I can understand a Pacific language. 4 I have several Pacific friends. 5 Most of my friends speak a Pacific language. 6 I participate in Pacific sports and recreation. 7 I speak a Pacific language. 8 I have contact with Pacific families and relatives. 9 I visit a traditional Pacific healer when I have an illness. 10 I go to a church that is mostly attended by Pacific people. 11 I eat Pacific foods. 5-point Likert scale: 1=strongly disagree, ..., 5=strongly agree Acculturation: a dynamic process Elicited at 6-weeks, 4-years and 6-years postpartum 895 (70%) immigrated to New Zealand & 381 (30%) lived their life in New Zealand Lived entirely within New Zealand Immigrated to New Zealand 0.8 0.8 Standardized PIAccult score 1.0 0.6 0.4 0.2 Lived entirely within New Zealand Immigrated to New Zealand 1.0 0.6 0.4 0.2 0.0 0.0 0 10 20 30 40 0 10 Years in New Zealand 20 30 40 0 10 20 30 40 0 10 20 30 Years in New Zealand [Schluter P., Tautolo E.-S., Paterson J. (2011) Acculturation of Pacific mothers in New Zealand over time: findings from the Pacific Islands Families Study. BMC Public Health, 11(1):307] 40 Acculturation groups Type Description PIAccult NZAccult Integrator Aligned to both cultures ↑ ↑ Separator More aligned to traditional culture ↑ ↓ Assimilator More aligned to dominant culture ↓ ↑ Aligned to neither culture ↓ ↓ Marginal In most studies, preference for integration is expressed over other acculturation strategies Maternal & infant health outcomes Maternal Infant Unplanned pregnancy Small for gestational age Single parent Not exclusively breastfed Depression Hospital admission Gestational smoking Not immunised Gestational alcohol Perpetration of intimate partner violence Health outcomes by acculturation status Cultural Type Adjusted Odds Ratio* (Estimated marginal OR means over all 10 investigated risk factors) Separator (↑Pacific ↓NZ) Integrator (↑Pacific ↑NZ) Marginal (↓Pacific ↓NZ) Assimilator (↓Pacific ↑NZ) 1.00 1.53 (1.23, 1.91) 1.84 (1.50, 2.26) 2.03 (1.66, 2.48) *Adjusted for: mother’s age, ethnicity, highest educational qualification, household income Key messages Acculturation has demonstrated and evidenced important influence on health outcomes Higher Pacific cultural orientation associated with reduced level of negative risk factors Separators (↑Pacific ↓NZ) significantly lower level of risk than Integrators (↑Pacific ↑NZ) – unlike that found in most studies [Notable exceptions: Turkish immigrants in Germany & Canada; Hispanic immigrant women in USA] Provides empirical evidence – rather than anecdotal evidence Policies needed to strengthen cultural identity/utilise culture in our services – rather than weaken them... Reducing health inequalities “The unequal distribution of health-damaging experiences is not in any sense a ‘natural’ phenomenon but is the result of a toxic combination of poor social policies and programmes, unfair economic arrangements, and bad politics” [CSDH, 28 August 2008]