A nutrition and exercise intervention program for controlling weight in Samoan communities in New Zealand

OBJECTIVE

To promote weight loss in Samoan church communities through an exercise program and nutrition education.

METHODS

A quasi-experimental design was used to assess weight change, over 1 y, in cohorts of people aged 20-77 y from three non-randomised Samoan church communities (two intervention, n=365 and one control, n=106) in Auckland, New Zealand. The intervention churches received aerobics sessions and nutrition education about dietary fat.

RESULTS

Baseline body mass index for the intervention and control churches was (mean+/-s.e.) 34.8+/-0.4 and 34.3+/-0.9 kg/m(2), respectively. The intervention churches lost an average of 0.4+/-0.3 kg compared to a 1.3+/-0.6 kg weight gain in the control church (P=0.039, adjusted for confounders). The number of people who were vigorously active increased by 10% in the intervention churches compared to a 5% decline in the control church (P=0.007). Nutrition education had little apparent impact on knowledge or behaviour.

CONCLUSION

Samoan communities in New Zealand are very obese and have high rates of annual weight gain. A community-based intervention program arrested this weight gain in the short term.

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.

A pilot urban church-based programme to reduce risk factors for diabetes among Western Samoans in New Zealand

We have assessed the impact of a 2-year pilot church-base diabetes risk reduction programme on major lifestyle predictors of future Type 2 diabetes mellitus: exercise and weight control in a prospective non-randomized controlled study of a modular lifestyle and diabetes awareness intervention programme using a community development model. The study involved two complete church congregations from an ethnic group at high risk of diabetes (Western Samoans) (intervention church n = 78; control church n = 144). Weight remained stable (0+/-4.8 kg) in the intervention church but increased by 3.1+/-9.8 kg in the control church (p = 0.05). In the intervention church, there was an associated reduction in waist circumference (-4+/-10 cm vs +2+/-7 cm in control, p < 0.001), an increase in diabetes knowledge (46+/-26% vs 4+/-17% in control, p < 0.001) and an increase in the proportion exercising regularly (+22% vs -8% in control, p < 0.05). Consumption of key fatty foods was also reduced in the intervention church. We conclude that diabetes risk reduction programmes based upon lifestyle change, diabetes awareness, and empowerment of high risk communities can significantly reduce risk factors for future Type 2 diabetes.

Pregnancy outcomes of Pacific islanders in Hawaii

Percentages of low birth weight are low in American Indian and Mexican-American populations despite a high prevalence of traditional risk factors. Data derived from 1979-1990 Hawaii vital record files were used to examine birth weight, infant mortality, and their correlates in Samoan and Hawaiian residents of Hawaii to assess whether traditional risk factors are adequate predictors of low birth weight and whether low birth weight is an adequate measure of infant mortality risk in Polynesian populations. Despite very low educational attainment, high proportions of unmarried status, and inadequate prenatal care use, low and very low birth weight percentages were less than the US average. High birth weight was common. Unmarried status and primiparity after age 17 increased low birth weight risk, while high educational attainment and Samoan ethnicity decreased the risk. Adequate prenatal care was not associated with reduced low birth weight risk. Higher than expected neonatal mortality, particularly among normal birth weight infants, and high postneonatal mortality among Hawaiian infants suggest that poverty and maternal chronic disease, rather than low birth weight, may be the primary mediators of infant mortality risk in some populations. The need for clearer specification of risk factors and caution in generalized risk assessment in diverse populations is emphasized.

Children of South Sea Island immigrants to Australia: factors associated with adjustment problems

Social-delinquent problem youth of South Sea Island immigrant to Australia parents, were compared to non-problem youth from the same circumstances, on family, sociocultural, personality, and substance abuse variables. Interviews and testing were done by members of their own community. A consistent pattern of differences most pronounced for males was found between the two groups although not all reached statistical significance. The problem youth compared to the non-problem youth tended to come from families somewhat lower in socioeconomic level, somewhat less traditional in culture, and notably more prone to discipline by physical punishment than by verbal reasoning. The problem youth had significantly lower self-esteem, significantly higher maladjustment test scores, and significantly greater use and problems with alcohol and drugs. They were more alienated and had less clearly established direction for their future. Recommendations for remediation are considered.

Angiotensin converting enzyme insertion/deletion polymorphism: association with ethnic origin

OBJECTIVE

To determine the distribution of the insertion/deletion (I/D) polymorphism of the angiotensin converting enzyme (ACE) gene in several ethnic groups: Caucasian Europeans, Black Nigerians, Samoan Polynesians and Yanomami Indians.

RESULTS

The ratio of the frequencies of the II, ID and DD genotypes were 1:2:1 in the Europeans, but there was a tendency towards a higher frequency of the D allele in the Nigerians. In contrast, the Samoans and the Yanomami Indians displayed a much higher frequency of the I allele than of the D allele.

CONCLUSION

The relationship between ACE genotype and disease in these latter groups is still not known, but the present results clearly suggest that ethnic origin should be carefully considered in the increasing number of studies on the association between I/D ACE genotype and disease aetiology.

T cell receptor polymorphisms in Caucasians and Polynesians

The purpose of this study was to find genetic polymorphisms that might be useful in studies of Polynesian-Caucasian racial admixture and Polynesian disease susceptibility. The allele frequencies of six T cell receptor locus RFLP were measured in 73 Caucasians and two Polynesian ethnic groups comprising 86 Maoris and 95 Samoans. The RFLP studied were (locus/enzyme/probe): C alpha/Taq1/Y14, V alpha/Taq1/Y14, C beta/BglII/Y35, C gamma/Pvu II/HGP02, V beta 7/BamHI/V beta 7.4 and V beta 8/Bam HI/V beta 8.1. Racial differences in allele frequency were present with all six RFLP (P < 0.001). The allele frequencies of the V alpha/Taq1/Y14 and the V beta 7/BamHI/7.4 RFLP were similar in the two Polynesian groups, both of which differed from the Caucasians. The 1.4 kb allele of the V alpha/Taq1/Y14 RFLP and the 8.0 kb allele of the V beta 7/BamHI/7.4 RFLP were present in low frequency in both Polynesian groups compared to the Caucasian group, consistent with a gene flow effect. These alleles may be useful in studies of Caucasian-Polynesian racial admixture.

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.

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

In 1981 extensive questionnaire and interview data were collected on some 100 young Samoan adults. Five years later in 1986 we determined their whereabouts and divided the data in accordance with migration status. The answers of the 35 who had migrated in the intervening period were contrasted to those 65 who remained in Samoa. The migrants differed in several distinct areas. Migrants reported a higher degree of peer-reliance as a personal adaptive strategy. Migrants also reported larger numbers of individuals in social support networks, a higher quality of support and more community involvement. They also report less expressive display of anger. Those who did not migrate reported a slightly better view of life in Samoa and abroad, as well as better relations with their friends and neighbors. These findings support a hypothesis that migrants are pre-selected to fit into migrant communities and do not appear to be misfits who are unhappy with life in Samoa.

Migration, changing gender roles and stress: the Samoan case

The impact of migration and social change on male and female role expectations is examined in an urban Samoan community. Expanding role expectations and role conflicts in the urban context are linked to differential experiences of stress by gender, which are in turn examined with respect to the health outcomes of arterial pressure, a measure of physical health status, and a psychosomatic complaint index.

Modernization and catecholamine excretion of young Samoan adults

Urinary catecholamine excretion rates have been used as a cross-culturally valid measure of generalized stress. The purposes of this paper are to examine group differences in catecholamine excretion rates in three Samoan groups who differ in degree of modernization and to compare these findings to rates of norepinephrine and epinephrine excretion in other populations. In 1986-1987, 24-hr urine samples were collected from 18-37-year-old Samoans; 46 rural Western Samoan villagers, 53 American Samoans, and 49 Samoans residing in Honolulu. The results show that norepinephrine excretion is significantly higher in more modernized Samoan groups (P less than 0.05), while epinephrine excretion is not significantly different in the three groups. The higher norepinephrine excretion rate in the more modernized Samoan groups may be related to differences in relative work load associated with changes in body weight, work capacity, and work patterns which accompany modernization. Samoan epinephrine excretion rates are relatively high compared to the results of other population studies, while norepinephrine excretion in three Samoan samples ranged from among the lowest rates observed worldwide to among the highest.

Lactose malabsorption in Polynesian and white children in the south west Pacific studied by breath hydrogen technique

Lactose malabsorption was studied by a breath hydrogen technique in 139 Samoan and 68 white schoolchildren. The Samoans were studied in four locations, two in Western Samoa and two in New Zealand, and the white children in both the Cook Islands and New Zealand. The prevalence of malabsorption varied with location: for Samoans it ranged from 41% to 60% in Western Samoa and 0% to 35% in New Zealand; white children had rates of 27% in the Cook Islands and 5% in New Zealand. Environmental factors rather than genetic factors are likely to play the main part in initiating if not perpetuating lactose malabsorption. In both races lactose malabsorption had no effect on the acceptance of, consumption of, and number of gastrointestinal symptoms caused by milk and milk biscuits. Children who had symptoms after consuming a particular dairy product were more likely to say they disliked it than those who reported no symptoms.

Hepatitis delta virus infection: a recently imported disease in New Zealand

In a study of 565 hepatitis B antigen (HBsAg) positive persons from the Auckland region, antibody to the hepatitis delta virus was detected in 38. The largest number were in Samoans (61%) although the infection was present in some other Pacific Islanders. Among HBsAg positive healthy blood donors, antenatal patients and acute hepatitis patients between 3.8 and 4.8% were anti-delta positive; while 28% of chronic hepatitis patients were positive suggesting an association between this disease and delta infection. Some positive results were also found in sera from intravenous drug addicts. By contrast, anti-delta was uncommon in New Zealand born Maoris or Europeans. Delta infection can be detected in some Pacific Islanders, some European immigrants as well as intravenous drug addicts and has the potential to spread in an epidemic form to HBsAg carriers in the general community. Widespread vaccination against hepatitis B is recommended to eventually reduce the number of HBsAg carriers in New Zealand.

Compliance by Samoans in Hawaii with service norms in pediatric primary care

American Samoans are one in a number of Pacific Basin groups for which the U.S. Government provides health care assistance and one in a large number of recent immigrant groups to the United States. Although these groups often have health care beliefs inconsistent with Western primary care, their compliance with basic provider expectations (such as appointment keeping and appropriate emergency room use) remains largely unstudied. In the case of Samoans in Hawaii, concern is often expressed that a group much in need of health care (pediatric hospitalization and acute illness visit rates are high) often seems "out-of-sync" with Western health care. Four measures of noncompliance were studied in the Hawaii pediatric primary care residency training program. Enrolled Samoan patients were compared with an aggregation of more established ethnic groups. Four matched case-control studies controlled for socioeconomic status and the presence or absence of medical insurance and a home telephone. Samoans were more likely than the comparison group to miss health maintenance appointments, to drop in without an appointment, and to use the emergency room for nonurgent problems when a same-day-notice clinic visit would have usually sufficed.

Migration and biocultural adaptation: Samoans in California

The consequences of migration for the Samoan population of California are discussed within the context of other studies focusing on Samoan native and migrant populations in Samoa and Hawaii. The social, cultural and economic characteristics of California Samoans are described and data are presented for body morphology, blood pressure, psychosocial stress and social support, general morbidity patterns and mortality rates for 1978-1982. Although the nature of disease risks appear profound in this population, particularly patterns of extreme obesity and psychosocial stress, mortality rates for heart disease and stroke are less than might be expected among other American groups. Such unexpectedly low mortality rates may represent the relatively healthy experience of older cohorts of migrants, or be a result of proportionally few individuals having lived long enough in California to develop cardiovascular and other chronic disease that have lengthy natural histories. We postulate that at present Samoan social structure, particularly the high status that accrues with aging in traditional Samoan society, may act as a buffer for the risk factors we observed and their expected outcomes. If so, the U.S.-born Samoans who are currently passing through childhood and early adult years with progressively less awareness of Samoan values of family and social structure will exhibit the same risks we describe here, but lack the available social buffers that currently exist for their parents.

Pacific Islanders--migration and health

Native Hawaiians and peoples from American Samoa, Guam and the Trust Territories of the Pacific Islands are all recipients of US subsidized health care. Categorized as Pacific Islanders they are a heterogeneous group with differences in biology, cultural adaptation to varied ecological settings, historical influences resulting from colonialism and present-day political factionalism. Yet, westernization on home islands and migration to Hawaii and the western United States have created similarities in disease patterns among these culturally diverse peoples. They have high rates of the chronic diseases of civilization: cardiovascular disease, diabetes mellitus and hypertension. Obesity, associated with these ailments, has become a major health problem among Pacific Islanders and may be attributed to changes in local food production and consumption in conjunction with sedentarization. Culturally and linguistically distinct from the American mainstream, these people as migrants or residents are marginal within the US social structure and find if difficult to obtain adequate medical treatment.

To love them and to leave them? A review of a Samoan community and health service research project in New Zealand

The place of Samoan and other Polynesian healing practices and related community projects in New Zealand society has only recently become a subject for study. This paper is an attempt to circumscribe for the people, both Samoan and non-Samoan, with whom I have been working, some of our cross-cultural associations in this field. To do this I have focused on moments in a process which has as many histories and as many futures as there are people participating in it. The interpretation presented here is a chronicle of significant information and events belonging to a 3-year period (1978-1980 inclusive). Behind the choice, to concentrate on describing the process of our dialogue and action rather than the end results--our 'successes' past and present--lie some fundamental questions. Can the growing understanding and on-going communication of people involved in community projects be documented so that this process is appreciated as valuable? This work takes a long commitment by researchers, even if they are members of the community project, and questions of practicality are raised. Is there a method of documentation which is acceptable both to the funding institutions that sponsor community health projects and to the people who are engaged in them? Could the present commonly accepted short-term assessment of end results, which I find objectionable, be right? And researchers evaluating community health projects, should they continue to become involved with the people they are studying for short times and then withdraw--to love them and leave them?

Biocultural risks in longevity: Samoans in California

Because migration is such a widespread phenomenon, studies of the effects of accompanying life change on the health and well-being of the migrant have special significance in areas like California that support large migrant communities. Previous studies have shown that increased weight and elevated blood pressure may be linked to changes in diet, exercise habits, and the altered sociocultural milieu of the migrant. Among Samoans, a Pacific Island population of Polynesian descent, these changes appear to be particularly prominent in segments of the population that have moved to the environment of Hawaii, which epidemiologic studies have characterized as "intermediate-modern.' Preliminary findings from a survey of weight, height, blood pressure, fasting glucose levels, and mortality records among Samoans living in California indicate that individuals living under more highly urbanized conditions exhibit even more pronounced changes. Adult weight among Samoans in California (San Francisco) greatly exceeds that of their counterparts in Hawaii and Samoa. Elevated blood pressures are also seen, though the extent to which this is associated with excessive weight gain is unclear. The number of individuals with high (greater than or equal to 160 mg/dl) fasting plasma glucose levels would be consistent with a population in which the prevalence of diabetes is many times higher than in the U.S. population. Although mortality patterns are difficult to determine for this population, available records suggest an excess mortality from cardiovascular diseases of all types among adult Samoans under age 50. Further investigations will attempt to link biobehavioral changes in the migrants' lifestyle to these observed patterns of risk.

Massive obesity in a migrant Samoan population

Peoples of the Pacific Islands tend to become overweight when they migrate or are exposed to modernization in situ. Recent evidence suggests that Samoans are particularly susceptible, exhibiting a high prevalence of obesity and hypertension following migration to Hawaii. We report the preliminary results of a survey of height, weight, blood pressure, and fasting plasma glucose (FPG) among an urbanized Samoan community the the San Francisco Bay Area. Although the participants' average height fell between the 25th and 50th percentile of the US population, about one-half our sample exceeded the 95th percentile for weight. The extreme overweight was accompanied by elevated blood pressure and, in females, by elevated FPG. The massive adult weight of migrants from the Pacific Islands carries serious public health implications for areas that support large migrant communities.

Leprosy in Auckland

The purpose of this paper is to alert practitioners to the possibility of leprosy by giving practical points from local experience together with a modicum of background information. Local experience of 45 patients is described in the form of a recent survey done in 1979 in Auckland together with illustrative records.

Clinical experience with Samoans in Auckland, New Zealand

Samoans constitute the second largest ethnic Polynesian minority group in New Zealand. Generally, this is a socially and culturally deprived group from a European viewpoint. Causative factors of social and emotional stress and coping mechanisms are described. A number of culturally determined syndromes are encountered clinically. These are categorized. A practical, clinical approach to the Samoan patient is suggested.

Hepatitis B surface antigen and antibody among Samoans living in Christchurch

Ninety-six Western Samoan volunteers were examined for the presence of hepatitis B surface antigen (HBsAg) and antibody (anti-HBs). Seventy-two volunteers were full blooded Samoans and four were found to be asymptomatic carriers of HBsAg. No mixed blood volunteers had detectable HBsAg by either haemagglutination or radioimmunoassay techniques. Fifty of the 72 full blooded Samoans had anti-HBs detectable by radioimmunoassay. Eight of these reactions were only weakly positive. Seventeen of the 24 mixed blood volunteers had detectable anti-Hbs. All were Samoan born. This study suggests that Samoan born Somoans should provide a valuable source of anti-HBs if New Zealand preparation of this antibody is contemplated.