Acculturation and symptoms: a comparative study of reported health symptoms in three Samoan communities

Traditional lifestyles, transition, and implications for healthy aging: An Example from the remote island of Pohnpei, Micronesia

Lifestyle-related, non-communicable diseases, such as diabetes, hypertension, and obesity have become critical concerns in the Pacific islands of Micronesia. We investigated the relationship between the diminution of traditional lifestyle practices and the decline in the health of the population in the State of Pohnpei, Federated States of Micronesia. To assess this, our interdisciplinary team developed two scales, one to rank individuals on how traditional their lifestyles were and one to rank individuals on the healthiness of their lifestyles. Participants’ locations were categorized as living on a remote atoll, living on the main island, or as a transitional population. Pohnpeians living in transitional communities (e.g. recently moved from a remote atoll to the main island, or the reverse) ranked lowest on both the tradition and health scales, rather than ranking intermediate between the remote and main island groups as we had hypothesized. As predicted, individuals residing on the remote atolls were living the most traditional lifestyles and also had the healthiest lifestyles, based on our rating system. The higher an individual scored on the tradition scale, e.g. the more traditional life they lived, the higher they scored on the health scale, suggesting the importance of traditional lifestyle practices for maintaining health. These findings have significant implications for promoting health and longevity of Micronesians and other Pacific Island peoples. We suggest the process of transition be recognized as a significant lifestyle and health risk and be given the attention we give to other risk factors that negatively influence our health. Based on our findings, we discuss and recommend the revitalization of particular traditional lifestyle practices, which may advance healthy aging among Pohnpeians.

Using multiple correspondence analysis to identify behaviour patterns associated with overweight and obesity in Vanuatu adults

Objective

The present study evaluates the use of multiple correspondence analysis (MCA), a type of exploratory factor analysis designed to reduce the dimensionality of large categorical data sets, in identifying behaviours associated with measures of overweight/obesity in Vanuatu, a rapidly modernizing Pacific Island country.

Design

Starting with seventy-three true/false questions regarding a variety of behaviours, MCA identified twelve most significantly associated with modernization status and transformed the aggregate binary responses of participants to these twelve questions into a linear scale. Using this scale, individuals were separated into three modernization groups (tertiles) among which measures of body fat were compared and OR for overweight/obesity were computed.

Setting

Vanuatu.

Participants

Ni-Vanuatu adults (n 810) aged 20–85 years.

Results

Among individuals in the tertile characterized by positive responses to most of or all the twelve modernization questions, weight and measures of body fat and the likelihood that measures of body fat were above the US 75th percentile were significantly greater compared with individuals in the tertiles characterized by mostly or partly negative responses.

Conclusions

The study indicates that MCA can be used to identify individuals or groups at risk for overweight/obesity, based on answers to simply-put questions. MCA therefore may be useful in areas where obtaining detailed information about modernization status is constrained by time, money or manpower.

Alcohol consumption and gender in rural Samoa

INTRODUCTION AND AIMS

There are significant gender differences in alcohol consumption throughout the world. Here we report the results of an alcohol consumption survey on the rural island of Savaii, in the Pacific nation of Samoa.

DESIGN AND METHODS

Eleven villages were selected for sampling using a randomized stratified cluster sampling methodology. A total of 1049 inhabitants over the age of 40 years (485 males and 564 females) were surveyed about alcohol consumption over the past year, and a 72.2% participation rate was achieved.

RESULTS

A SIGNIFICANT GENDER DIFFERENCE IN ALCOHOL CONSUMPTION WAS FOUND: 97.3% of women and 59.4% of men reported no alcohol consumption over the past year. This is one of the most significant gender differences in alcohol consumption in the world. No significant difference between genders was seen in those who consume only 1-5 alcoholic drinks per week (P = 0.8454). However, significantly more males than females consumed 6-25 drinks per week (P < 0.0001), 26-75 drinks per week (P < 0.0001), and 75+ drinks per week (P < 0.0001).

DISCUSSION AND CONCLUSION

This extreme gender difference in alcohol consumption is attributed to several factors, both general (alcoholic metabolism rates, risk-taking behaviors, general cultural taboos, etc) and specific to Samoa (church influence, financial disempowerment, and Samoan gender roles).

Acculturation and dietary habits of Korean Americans

This is the first study to investigate how food and nutrient intakes vary with the levels of acculturation of Korean Americans using a dietary assessment tool tested for validity and reliability. The respondents were Korean Americans (n 486) resident in the Greater New York metropolitan area, USA. They were divided into two groups according to the total score of acculturation: low- and high-acculturated groups. Using a food-frequency questionnaire and a modified Suinn-Lew Asian self-identity acculturation scale, differences in the frequencies of food items, food groups and nutrient intakes consumed were analysed by level of acculturation. The low-acculturated group tended to consume significantly more rice, mixed rice, soyabean paste chigae (pot stew), saengsun (fish) chigae, kimchi chigae, other fish broiled or baked, eggs, kimchi, spinach, persimmons, and white or brown sugar in coffee or tea. The high-acculturated group demonstrated a statistically greater tendency to consume bread, cereal, spaghetti, ham, green salad, sweetcorn, chocolate, candies and diet soft drinks. The more acculturated an individual, the more significant was the tendency to consume sweets. The more acculturated group had significantly (P<0·05) higher intakes of % energy from total fat, thiamin, vitamin E and folate, while the low-acculturated group consumed greater amounts of Na, niacin and dietary fibre. The information from the present study can be used to describe dietary habits according to various aspects of acculturation, and allows a better understanding of the dynamics of acculturation and dietary habits.

Status incongruity in Samoan youth: a biocultural analysis of culture change, stress, and immune function

In Samoa, the presence of a matai title in the family has historically been a valued source of social status. However, as the process of Westernization continues, new sources of social status are emerging. This study explores the degree to which new and old markers of social status agree--or disagree--and the consequences they have for the experience of stress in 329 Samoan adolescents. The study integrates cultural and biological methods and data, and measures an aspect of immune function (antibodies against the Epstein-Barr virus) as a biomarker of psychosocial stress. Results indicate that status "incongruent" adolescents experience significantly more stress (indicated by reduced immune function), and that emerging markers of social status are becoming inextricably linked to "traditional" markers in such a way that discordance between them is a significant source of stress. This study proposes new conceptual models for future studies of culture change and suggests that biomarkers may represent ethnographic tools that can provide insight into hidden cultural dynamics and the experience of stress.

Sociocultural change and health status among the Seri Indians of Sonora, Mexico

The influence of changes in sociocultural status on obesity, arterial blood pressure, and depression was examined in a cohort of 81 Seri Indians living in two communities in Sonora, Mexico. Residents of the less acculturated and modernized community, Desemboque, exhibited significantly higher waist circumference and prevalence of obesity than did residents of the more acculturated and modernized community of Punta Chueca. The prevalence of obesity was also significantly associated with low levels of acculturation and modernization, while the prevalence of clinically significant depressive symptoms was associated with low levels of modernization and household income. Lifestyle incongruity was a significant independent risk factor for body mass index and depressive symptom scores but not for arterial blood pressure. The results support the notion of a curvilinear relationship between health status and sociocultural change in which health status initially declines with increasing lifestyle incongruity but eventually improves with increasing acculturation, modernization, and income.

Review of social epidemiologic research on migrants' health: findings, methodological cautions, and theoretical perspectives

The phenomenon of world-wide immigration and migration has major implications for the health of the migrants in addition to its impact upon social and other service providers. Studies of migrants that utilize social epidemiologic methods fall within the traditional boundaries of descriptive and analytic approaches; this article reviews some of the studies that exemplify these approaches. It then suggests specific methodological issues and cautions pertaining to research on migrants and provides a theoretical model for organizing the diverse research studies that have been conducted. By stimulating discussion regarding social epidemiologic research on migrants' health, this model is intended to serve as a compass point for future research and needed interventions.

Migration and acculturation among Samoans: some sources of stress and support

Daily excretion of the stress hormone, epinephrine, has been employed to study potential stressors associated with acculturation and migration. Young men and women from Samoan communities in Hawaii (HI), American Samoa (AS) and Western Samoa (WS) which differ in exposure to American culture were included. Psychosocial factors associated with elevations in hormone excretion were assumed to be stressors, while associations with reduced excretions were assumed to be supportive or buffers. Hormone excretion levels were similar in all locations, but there were different associations which could be attributed to migration and acculturation. Among all migrants (HI) ethnic networks were apparent stressors, while a high degree of community involvement was stressful for migrant women. In sites of culture contact (HI, AS) certain adult members of the extended family were supportive, as was a superior knowledge of Samoan cultural concepts. For women in Samoa (WS, AS) community involvement was supportive. In contrast for men in WS and AS, but not in HI, being of mixed ancestry or having close family of mixed ancestry was stressful. It is concluded that hormone analysis can provide meaningful clues concerning social stressors in acculturating or migrant communities. Also that migration or acculturation do not necessarily result in increased levels of stress.

The development and application of a scale of acculturation

As Australia is one of the most multicultural societies in the world, acculturation of migrants and changes in migrants' health status should be an important focus of public health research. The absence of an accepted measure of acculturation is one barrier to exploring the relationship between acculturation and health. This paper presents data from a study of 851 Arabic-speaking adults attending 20 Arabic-speaking general practitioners in Canterbury, Sydney. An eight-item scale assessing acculturation was developed with a structural equation modelling program (LISREL). This acculturation scale was based on similar scales used with Hispanic populations, was theoretically grounded and had high internal consistency and criterion-related validity. To show the application of a scale of acculturation, patients' preferences for participation in medical decision making, according to level of acculturation, were examined. After adjustment for age, sex and highest level of formal education, significant inverse associations between acculturation and preferences for patient (versus family) involvement in medical decision making were found. Mechanisms for how acculturation affects health need to be explored.

Psychosocial factors in blood pressure variation: a comparative study of young Samoans

Traditional peoples contacting modern cultures frequently experience increased levels of blood pressure. The aim of this investigation was to identify some acculturation-related psychosocial factors which might contribute to those elevations. Young Samoans living in a traditional village, in modernizing American Samoa, and as migrants in Hawaii were studied. Casual blood pressure, anthropometric measurements, and extensive interview data were collected. The most important factor predicting variation in blood pressure was body mass (BMI). This finding was particularly evident among the acculturated and migrant Samoans. In those locations women's abandonment of breast feeding may contribute to their higher BMI. Among acculturated and migrant women, measures of social support favored lower blood pressures. Among men in all locations a greater number of close social ties was linked to higher blood pressures with the exception of ties with parents. Parental ties were linked to substantially lower blood pressures. A knowledge of Samoan traditions favored lower blood pressure among migrant men, while knowledge of American culture favored higher pressures. Coping strategies and complaint behavior were also significant contributors in all locations.