Selective migration from Samoa: a longitudinal study of pre-migration differences in social and psychological characteristics

Use of mammography screening among older Samoan women in Los Angeles county: a diffusion network approach

Minority migrant populations, such as older Samoan women, are likely to underuse preventive health services, including mammography screening. The purpose of this paper is to explore how informal (lay peers from churches) and formal (health care providers) health communication networks influence mammography screening use among older Samoan women. To do so, we apply diffusion of innovation theory and network analysis to understand how interpersonal networks may affect mammography use in this urban-dwelling, migrant population. The data come from a survey of 260 Samoan women, aged 50 years or older, who attended 39 randomly sampled Samoan churches in Los Angeles County (USA) between 1996 and 1997. Retrospective data, based over a 20-year period from this sample's year of first use of mammography screening, suggest that interpersonal networks may have accounted for the dramatic increase in the rate of adoption within the past 5 years of the survey. Using this information, we categorized women into mutually exclusive stages of mammography use and regressed these stages of mammography use on formal (had a provider referral) and informal (level of connectedness with peers in churches) health communication networks. The results indicated that being well-connected within women's informal, church-based health communication networks increased the likelihood of being in the decision (planned to have) and implementation and confirmation (had a recent mammogram) stages, but having a provider referral for a mammogram (formal networks) only increased the likelihood of being in the latter stages compared to women in the knowledge and persuasion stages. Formal and informal health communication networks influence recent use of mammography screening, but informal networks, in and of themselves, are also influential on future intention to use mammography screening.

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.

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.

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

A health questionnaire, which included a 91 item list of symptoms was administered to three groups of young Samoan adults. These young adults resided in a traditional Samoan village in Western Samoa (n = 50), several villages in modernizing American Samoa (n = 50) and in urban Honolulu, Hawaii (n = 52). Each yes response to a symptom was followed by an expanded interview providing details. The yes answer frequency and the contents of the expanded answers were examined with respect to site of residence. Western Samoan responses differed from the other sites in a number of areas suggesting possible differences related to the process of modernization. These response differences suggest four areas in which the stressors of modernization may have health influences: (1) wage employment outside of the family, (2) increased size of support networks by including non-family members and non-Samoans (3) the greater availability of alcohol, and (4) changes in the perceptions of food.