Youth health-risk behavior assessment in Fiji: the reliability of Global School-based Student Health Survey content adapted for ethnic Fijian girls

OBJECTIVE

The Global School-based Student Health Survey (GSHS) is an assessment for adolescent health-risk behaviors and exposures, supported by the World Health Organization. Although already widely implemented - and intended for youth assessment across diverse ethnic and national contexts - no reliability data have yet been reported for GSHS-based assessment in any ethnicity or country-specific population. This study reports test-retest reliability for GSHS content adapted for a female adolescent ethnic Fijian study sample in Fiji.

DESIGN

We adapted and translated GSHS content to assess health-risk behaviors as part of a larger study investigating the impact of social transition on ethnic Fijian secondary schoolgirls in Fiji. In order to evaluate the performance of this measure for our ethnic Fijian study sample (n=523), we examined its test-retest reliability with kappa coefficients, % agreement, and prevalence estimates in a sub-sample (n=81). Reliability among strata defined by topic, age, and language was also examined.

RESULTS

Average agreement between test and retest was 77%, and average Cohen's kappa was 0.47. Mean kappas for questions from core modules about alcohol use, tobacco use, and sexual behavior were substantial, and higher than those for modules relating to other risk behaviors.

CONCLUSIONS

Although test-retest reliability of responses within this country-specific version of GSHS content was substantial in several topical domains for this ethnic Fijian sample, only fair reliability for the module assessing dietary behaviors and other individual items suggests that population-specific psychometric evaluation is essential to interpreting language and country-specific GSHS data.

Validity and reliability of a Fijian translation and adaptation of the Eating Disorder Examination Questionnaire

OBJECTIVE

Assessment of disordered eating has uncertain validity across culturally diverse populations. This study evaluated Eating Disorder Examination Questionnaire (EDE-Q) performance in an ethnic Fijian study population.

METHOD

The EDE-Q was translated, adapted, and administered to school-going Fijian adolescent females (N = 523). A subsample (n = 81) completed it again within approximately 1 week. We assessed feasibility, internal consistency, and test-retest reliability; evaluated construct validity through factor analysis and correlation with similar constructs; and examined the marginal utility of an additional question on traditional purgative use.

RESULTS

Internal consistency reliability was adequate for the global scale and subscales (Cronbach's alpha = 0.66-0.91); retest reliability was adequate for both the languages (range of ICCs, 0.50-0.79, and of kappas, 0.46-0.81, excluding purging items). Construct validity was supported by significant correlations with measures of similar constructs. Factor analysis confirms multiple dimensions of eating disorder symptoms but suggests possible culture-specific variation in this population. The majority of respondents endorsing traditional purgative use (58%) did not endorse conventional EDE-Q items assessing purging.

DISCUSSION

The EDE-Q is a valid measure of eating disorder pathology for ethnic Fijian adolescent females and measures a unitary underlying construct.

Adaptation and evaluation of the Clinical Impairment Assessment to assess disordered eating related distress in an adolescent female ethnic Fijian population

OBJECTIVE

Measurement of disease-related impairment and distress is central to diagnostic, therapeutic, and health policy considerations for eating disorders across diverse populations. This study evaluates psychometric properties of a translated and adapted version of the Clinical Impairment Assessment (CIA) in an ethnic Fijian population.

METHOD

The adapted CIA was administered to ethnic Fijian adolescent schoolgirls (N = 215). We calculated Cronbach's alpha to assess the internal consistency, examined the association between indicators of eating disorder symptom severity and the CIA to assess construct and criterion validity, and compared the strength of relation between the CIA and measures of disordered eating versus with measures of generalized distress.

RESULTS

The Fijian version of the CIA is feasible to administer as an investigator-based interview. It has excellent internal consistency (alpha = 0.93). Both construct and criterion validity were supported by the data, and regression models indicated that the CIA predicts eating disorder severity, even when controlling for generalized distress and psychopathology.

DISCUSSION

The adapted CIA has excellent psychometric properties in this Fijian study population. Findings suggest that the CIA can be successfully adapted for use in a non-Western study population and that at least some associated distress and impairment transcends cultural differences.

Breakfast skipping as a risk correlate of overweight and obesity in school-going ethnic Fijian adolescent girls

The prevalence of overweight and obesity has increased globally, and population data suggest that it is also increasing among ethnic Fijian youth. Among numerous behavioural changes contributing to overweight in youth residing in nations undergoing rapid economic and social change, meal skipping has not been examined as a potential risk factor. The study objectives were to assess the prevalence of overweight, obesity, and breakfast skipping and examine their cross-sectional association in a community sample of school-going ethnic Fijian adolescent girls (N=523). We measured height and weight, and assessed dietary patterns, eating pathology, dimensions of acculturation, and other socio-demographic and cultural data by self-report. We observed a high prevalence of both overweight (41%, including 15% who were obese) and breakfast skipping (68%). In addition, in multivariable analyses unadjusted for eating pathology, we found that more frequent breakfast skipping was associated with greater odds of overweight (odds ratio (OR)=1.15, confidence interval (CI)=1.06, 1.26, p<0.01) and obesity (OR=1.18, CI=1.05, 1.33, p<0.01). Regression models adjusting for eating pathology attenuated this relation so that it was non-significant, but demonstrated that greater eating pathology was associated with greater odds of both overweight and obesity. Future research is necessary to clarify the relation among breakfast skipping, eating pathology, and overweight in ethnic Fijian girls, and to identify whether breakfast skipping may be a modifiable risk factor for overweight in this population.

Feasibility of a School-based Study of Health Risk Behaviors in Ethnic Fijian Female Adolescents in Fiji: The HEALTHY Fiji Study

OBJECTIVE

Behavioral risk assessment is critical to developing intervention strategies to promote adolescent health, but also presents logistical, ethical, and scientific challenges. This paper reports on feasibility of a school-based study of health-risk behaviors in ethnic Fijian adolescent girls.

METHODS

We assessed feasibility of school-based participation and implementation of assessment in the local vernacular language by examining observational data and by calculating response rates and as well as language selection and item completion rates.

RESULTS

All invited study area schools participated (n=12). Response rates were >70% for study participation among eligible study participants in the overall sample as well as the peri-urban and rural sub-samples. The majority of respondents (71.9%) selected the local Fijian vernacular language version rather than the English version (28.1%). Although 43.6% of respondents completed a questionnaire in a language not spoken as the primary language at home, only ten respondents (1.9%) were assessed as having difficulty with the language of the self-report questionnaire. Item completion rates for the primary outcomes were >90% for both study phases and in both language versions. Study participant response rate for further assessment of concerning symptoms was also very high and teachers were successfully recruited for participation in training and accepting referrals to support these students at each participating school.

CONCLUSION

School-based behavioral risk data collection in the vernacular language was feasible. Evaluation and referral of individual study participants with concerning symptoms to educators for further assistance and support also appeared feasible. We suggest that close collaboration among Fiji-based and specialty consultants to address scientific, linguistic, logistical, and ethical challenges were contributing factors to study feasibility.

Prevalence and Socio-demographic Correlates of Cigarette Smoking, Alcohol Use, and Unsafe Sexual Behavior among Ethnic Fijian Secondary Schoolgirls

INTRODUCTION

The HEALTHY Fiji Study examines the impact of social transition on health risk behaviors among school-going ethnic Fijian adolescent girls. The primary aim of the present study was to assess prevalence and socio-demographic correlates of three risk behaviors, alcohol use, cigarette smoking, and unsafe sexual behavior in the study population.

METHODS

We used an adapted version of the Global School-based Health Survey (GSHS) to assess health risk behaviors in a school-based sample of ethnic Fijian girls (n=523) in June and July 2007. We calculated prevalence of risk behaviors and then examined their relation to socio-demographic variables in logistic regression models.

RESULTS

Prevalence estimates for any current alcohol use and cigarette smoking (20.1% and 17.6%) and lifetime history of sexual intercourse (20.8%) indicate that substantial percentage of this study sample has engaged in one of these health risk behaviors. Alcohol use was associated with two other risk behaviors, recurrent cigarette smoking and lifetime history of sexual intercourse. Although prevalence of alcohol use was lower than in several other Pacific populations, it was higher than previously reported among Fijian girls.

CONCLUSIONS

The prevalence of alcohol use, cigarette smoking, and unsafe sexual behaviors in this study population warrants concern. Comparison with estimates from previous health behavior surveys in Fiji suggest that mode of assessment may impact prevalence estimates for health risk behaviors.