Dietary intakes of European, Māori, Pacific and Asian adults living in Auckland: the Diabetes, Heart and Health Study

Objective: To compare dietary intakes of European, Māori, Pacific, and Asian men and women living in Auckland. Methods: Daily nutrient intakes were calculated from a self‐administered food frequency questionnaire from participants in a cross‐sectional health screening study carried out between 2002 and 2003. Participants were 4,007 Māori, Pacific, Asian and European people (1,915 men, 2,092 women) aged 35 to 74 years. Results: Compared with Europeans, Māori and Pacific men had higher total energy intakes per day, while Asians had lower intakes. A similar pattern was observed for carbohydrate and fat consumption. While protein and cholesterol consumption tended to be lower in Europeans than the other three ethnic groups, alcohol consumption and calcium intakes were highest among Europeans. Many of the differences between ethnic groups were attenuated when nutrient consumption was expressed as their percentage contribution to total energy intake suggesting that total food consumption was the major determinant of ethnic differences in nutrient intakes. Conclusions: There were substantial differences in dietary habits, food selections and cooking practices between European, Māori, Pacific and Asian participants. However, the observed differences were in the area of serving sizes and frequency of consumption of certain foods than to major differences in the range of foods and nutrients consumed or the percentage contribution of carbohydrate, fat or protein to total energy intake. Implications: The development of strategies to reduce serving sizes and the frequency of consumption of certain foods will be required to help address the major nutrition‐related health problems in New Zealand.     

Predictors of academic success for Māori,Pacific and non-Māori non-Pacific students in health professional education: a quantitative analysis

Tertiary institutions internationally aim to increase student diversity, however are struggling to achieve equitable academic outcomes for indigenous and ethnic minority students and detailed exploration of factors that impact on success is required. This study explored the predictive effect of admission variables on academic outcomes for health professional students by ethnic grouping. Kaupapa Māori and Pacific research methodologies were used to conduct a quantitative analysis using data for 2686 health professional students [150 Māori, 257 Pacific, 2279, non-Māori non-Pacific (nMnP)]. The predictive effect of admission variables: school decile; attending school in Auckland; type of admission; bridging programme; and first-year bachelor results on academic outcomes: year 2–4 grade point average (GPA); graduating; graduating in the minimum time; and optimal completion for the three ethnic groupings and the full cohort was explored using multiple regression analyses. After adjusting for admission variables, for every point increase in first year bachelor GPA: year 2–4 GPA increased by an average of 0.46 points for Māori (p = 0.0002, 95% CI 0.22, 0.69), 0.70 points for Pacific (p < 0.0001, CI 0.52, 0.87), and 0.55 points for nMnP (p < 0.0001, CI 0.51, 0.58) students. For the total cohort, ethnic grouping was consistently the most significant predictor of academic outcomes. This study demonstrated clear differences in academic outcomes between both Māori and Pacific students when compared to nMnP students. Some (but not all) of the disparities between ethnic groupings could be explained by controlling for admission variables.     

‘You don’t ditch your girls’: young Māori and Pacific women and the culture of intoxication

Māori and Pacific Peoples experience a disproportionate burden of alcohol-related harm relative to other ethnic groups, yet little is known about the context in which this drinking occurs. Few studies have explored how and why young Māori and Pacific women drink. Therefore, this article aims to develop a more nuanced and detailed account of Māori and Pacific young women’s drinking practices. The following article reports on an ethnographic study of young Māori and Pacific women aged 18–30. Five Māori participants and six Pacific participants were selected and asked to become researchers within their social groups. Nine female researchers also became participants in the study, accompanying recruited participants to drinking occasions and events. Participants were each given a ‘drinking diary’ to document drinking occasions, which formed the data-set for the project. Three levels of thematic analysis were undertaken. The first noted broad themes with the second and third levels exploring more nuanced themes and identifying intersections across themes. The study demonstrated that Māori and Pacific young women’s engagement with New Zealand’s culture of intoxication is complex: Māori and Pacific women drink for pleasure or to achieve a ‘buzz’ and to be social. Drinking practices are deeply affected by ethnic and peer group collectives (‘the girls’), traditions and expectations. Harm reduction initiatives need to take account of the many pathways specific to how Māori and Pacific young women engage with alcohol use. Additionally, the wider context in which alcohol-related harm occurs needs to be considered in policy and harm reduction debates.     

Managing Communication Tensions and Challenges During the End-of-Life Journey: Perspectives of Māori Kaumātua and Their Whānau

The purpose of this study is to explore the cultural practices and communication tensions perceived among Māori kaumātua (elders) and their whānaunga (extended family) during the end-of-life journey. Further, the study aims to explore the manner in which the tensions are managed. The study was framed by relational dialectics theory and included interviews with 21 kaumātua and focus groups with 39 whānau members. The study identified three cultural practices (dying at home, prayer, and song) that helped to build connection among the family members and also helped to connect the dying person to the spiritual world. Further, four communication tensions were noted: (a) autonomy and connection; (b) conflict and connection; (c) isolation and connection; and (d) balancing the needs of self and other. To manage these tensions, the following strategies were used: (a) coordination conversations; (b) inclusion in decision-making conversations; (c) emotional support within the whānau; and (d) passing on lessons to the next generation.     

Nutrition and physical activity behaviours among Mäori, Pacific and NZ European children: identifying opportunities for population-based interventions

Objectives: To describe how the prevalences of nutrition and physical activity behaviours vary by ethnicity, while controlling for other socio‐demographic characteristics, and to identify appropriate points of intervention for defined ethnic populations of New Zealand children. Methods: Secondary data analysis of the 2002 National Children's Nutrition Survey. Results: Few ethnic differences were significant for fruit and vegetable consumption and indicators of physical activity. Where ethnic differences in physical activity were significant, Mäori children and Pacific children were more active than New Zealand European/Other (NZEO) children. Pacific children and Mäori children were significantly more likely to skip meals than NZEO children. Pacific children and Mäori children were significantly more likely to buy some/most of the food they consumed at school from the tuckshop or dairy while NZEO children were more likely to bring their school food only from home. Likewise, Pacific children and Mäori children were significantly more likely to be high consumers of some fatty and sugary foods than NZEO children. Conclusions and Implications: Meal skipping and purchasing food away from home were common for Mäori children and Pacific children; school‐based programs that aim to improve access to and subsidise the price of healthy foods, including breakfast, could greatly benefit Mäori and Pacific students. Efforts to improve fruit and vegetable consumption and physical activity should be more universally applied and made culturally appropriate for all children.     

The biopolitics of Māori biomass: towards a new epistemology for Māori health in Aotearoa/New Zealand

In this paper we consider what impact a biopolitics that creates a compliant self-governing weight-focused population has had on Māori health in Aotearoa/New Zealand. We frame this discussion with three vignettes that in different ways demonstrate the deleterious effects of the individualisation of health on Māori. We argue that the current biopolitics is best explained as ‘the health of Maoris’ not ‘Māori Health’. To counter this current biopolitics we put forward an alternative epistemology, the ‘Atua Matua’ framework. This epistemology pays respect to a Māori view of health that is holistic, encompassing physical, emotional, spiritual, cultural and familial well-being and does not give ground to the requirement for individualism so prevalent in neoliberalism. Finally, we consider what this new epistemology might offer to the public health agendas in Aotearoa and other countries where indigenous populations suffer ill health disproportionately. Thus, our implications have potential not only for Māori health but human health in general.     

Dietary intakes and lifestyle patterns of Korean children and adolescents with atopic dermatitis: Using the fourth and fifth Korean National Health and Nutrition Examination Survey (KNHANES IV,V), 2007–11

We investigate dietary intake and lifestyle patterns of atopic children and adolescents (N = 539) by obesity level using a national survey of South Korea. Intakes of calcium, iron, and vitamin C in the underweight group were less than those of other groups. The frequency of drinking milk of the overweight group was higher than that of the normal weight group. Majority of the subjects had not applied nutrition labeling in food choices, had no experience of nutrition education, and were vitamin D deficient. In conclusion, most of the atopic subjects had little knowledge of nutrition and were vitamin D deficient.     

Obesogenic Dietary Practices of Latino and Asian Subgroups of Children in California: An Analysis of the California Health Interview Survey, 2007–2012

Objectives. We examined obesogenic dietary practices among Latino and Asian subgroups of children living in California.Methods. We analyzed 2007, 2009, and 2011–2012 California Health Interview Survey data to examine the differences in dietary practices among Mexican and non-Mexican Latino children and 7 ethnic subgroups of Asian children. We used multivariable regression to examine the sociodemographic factors associated with specific dietary practices.Results. Latino subgroups of children had few differences in obesogenic dietary practices, whereas Asian subgroups of children exhibited significant differences in several obesogenic dietary practices. Korean and Filipino children were more likely than Chinese children to consume fast food and have low vegetable intake. Filipino children, followed by Japanese children, had the most obesogenic dietary practices compared with Chinese children, who along with South Asian children appeared to have the least obesogenic dietary practices. In general, income, education, and acculturation did not explain the dietary differences among Asian groups.Conclusions. Our findings suggest the need to disaggregate dietary profiles of Asian and Latino children and to consider nontraditional sociodemographic factors for messaging and counseling on healthy dietary practices among Asian populations.Dietary practices among pediatric racial and ethnic minority groups highlight possible contributions to the nation’s significant obesity disparities. High consumption of sugar- sweetened beverages (SSBs) and fast food and low consumption of fruits and vegetables have been found among Latino and African American children compared with White children.1–4 These dietary differences have been associated with environmental factors such as access to fresh foods and social factors such as family income, education level, and acculturation. Many of these factors have been understudied among Asian children. This gap in the literature is problematic given the emerging evidence that Asian children have notable differences in dietary practices compared with White children and that Asian Americans with the same body mass index (BMI; defined as weight in kilograms divided by the square of height in meters) are at a higher risk for cardiovascular diseases and type 2 diabetes than non-Hispanic Whites.5–8 Furthermore, children of various Asian and Latino ethnic groups with distinct historical, migration, and social contexts are generally grouped together in research analyses, making it difficult to understand the ethnicity-specific salient roles that education, income, and acculturation may play in specific dietary practices.9,10Acculturation has been described as both a protective factor and a risk factor for healthy dietary practices among immigrants. For example, acculturation among Latinos has been associated with higher consumption of fruits and vegetables but also with higher rates of fast food and sugary food consumption in both pediatric and adult Latino populations.11–13 Less is known about the role of acculturation in dietary practices among Asian and Latino ethnic subgroups.5,6,14,15 We examined dietary practices within ethnic subgroups of Latino and Asian children and the associated role of sociodemographic factors. On the basis of the thin literature that has examined dietary practices among Latino subgroups of children, we hypothesized that children of Mexican descent would have healthy dietary practices compared with other Latino groups and that Asian ethnic groups of children would show a wide variety of dietary practices. In addition, we hypothesized that acculturation, after controlling for education and income, would have an independent effect on dietary practices for all ethnic groups of children.     

Confidence and connectedness: Indigenous Māori women's views on personal safety in the context of intimate partner violence

Māori (New Zealand) women, similar to women belonging to Indigenous and minority groups globally, have high levels of lifetime abuse, assault, and homicide, and are over-represented in events that compromise their safety. We sought insights into how Māori women view safety. Twenty Māori women's narratives revealed safety as a holistic concept involving a number of different elements. We found women had developed an acute sense of the concept of safety. They had firm views and clear strategies to maintain their own safety and that of their female family and friends. These women also provided insights into their experiences of feeling unsafe.     

Impact of Dietary Fructose and High Salt Diet: Are Preclinical Studies Relevant to Asian Societies?

Fructose consumption, especially in food additives and sugar-sweetened beverages, has gained increasing attention due to its potential association with obesity and metabolic syndrome. The relationship between fructose and a high-salt diet, leading to hypertension and other deleterious cardiovascular parameters, has also become more evident, especially in preclinical studies. However, these studies have been modeled primarily on Western diets. The purpose of this review is to evaluate the dietary habits of individuals from China, Japan, and Korea, in light of the existing preclinical studies, to assess the potential relevance of existing data to East Asian societies. This review is not intended to be exhaustive, but rather to highlight the similarities and differences that should be considered in future preclinical, clinical, and epidemiologic studies regarding the impact of dietary fructose and salt on blood pressure and cardiovascular health worldwide.     

Dietary sources of sugars in adolescents’ diet: the HELENA study

Objective

To report dietary sugars consumption and their different types and food sources, in European adolescents.

Methods

Food consumption data of selected groups were obtained from 1630 adolescents (45.6% males, 12.5–17.5 years) from the HELENA study using two nonconsecutive 24-h recalls. Energy intake, total sugars and free sugars were assessed using the HELENA-DIAT software. Multiple regression analyses were performed adjusting for relevant confounders.

Results

Total sugars intake (137.5 g/day) represented 23.6% and free sugars (110.1 g/day), 19% of energy intake. Girls had significantly lower intakes of energy, carbohydrates, total sugars and free sugars. 94% of adolescents had a consumption of free sugars above 10% of total energy intake. The main food contributor to free sugars was ‘carbonated, soft and isotonic drinks,’ followed by ‘non-chocolate confectionary’ and ‘sugar, honey, jam and syrup.’ Older boys and girls had significantly higher intakes of free sugars from ‘cakes, pies and biscuits.’ Free sugars intake was negatively associated with low socioeconomic status for ‘non-chocolate confectionary’ and ‘sugar, honey and jam’ groups; with low maternal educational level for carbonated and ‘soft drinks,’ ‘sugar, honey and jam,’ ‘cakes and pies’ and ‘breakfast cereals’ groups; and with high paternal educational level for ‘carbonated and soft drinks’ and ‘chocolates’ group.

Conclusions

The majority (94%) of studied adolescents consumed free sugars above 10% of daily energy intake. Our data indicate a broad variety in foods providing free sugars. Continued efforts are required at different levels to reduce the intake of free sugars, especially in families with a low educational level.

     

The validity and reliability of EQ-5D health state valuations in a survey of Māori

This note reports on a 2000 study of the content validity of the EQ-5D's representation of health for 66 Māori (New Zealand's indigenous people, comprising 14.5% of the population) accessed through cultural networks. Also examined was the construct validity of the health state valuation instrument and its test–retest reliability based on repeated valuations for the two extreme health states. The possibility that the EQ-5D fails to capture what Māori regard as ‘health’ derives from the so-called ‘Māori health model’ that augments biological health with mental, spiritual and family well-being. Seventy six percent of respondents considered the EQ-5D's representation of health to be adequate. This proportion is not statistically significantly different from the rates for non-Māori and Māori respectively in an earlier study and might suggest the EQ-5D has content validity for Māori. However, the high prevalence of missing valuations, particularly for dead, and logical inconsistencies suggests that the health state valuation instrument lacks construct validity, although there is evidence of test–retest reliability.     

Community screening for cardiovascular risk factors and levels of treatment in a rural Māori cohort

Objectives : To document levels of cardiovascular disease (CVD), diagnosed and undiagnosed risk factors and clinical management of CVD risk in rural Māori. Methods : Participants (aged 20–64 years), of Māori descent and self‐report, were randomly sampled to be representative of age and gender profiles of the community. Screening clinics included health questionnaires, fasting blood samples, blood pressure and anthropometric measures. Data were obtained from participants’ primary care physicians regarding prior diagnoses and current clinical management. New Zealand Cardiovascular Guidelines were used to identify new diagnoses at screening and Bestpractice© electronic‐decision support software used to estimate 5‐year CVD risk. Results : Mean age of participants (n=252) was 45.7±0.7, 8% reported a history of cardiac disease, 43% were current smokers, 22% had a healthy BMI, 30% were overweight and 48% obese. Hypertension was previously diagnosed in 25%; an additional 22% were hypertensive at screening. Dyslipidaemia was previously diagnosed in 14% and an additional 43% were dyslipidaemic at screening. Type‐2 diabetes was previously diagnosed in 11%. Glycaemic control was achieved in only 21% of those with type‐2 diabetes. Blood pressure and cholesterol were above recommended targets in more than half of those with diagnosed CVD risk factors. Conclusions : High levels of diagnosed and undiagnosed CVD risk factors, especially hypertension, dyslipidaemia and diabetes were identified in this rural Māori community. Implications : There is a need for opportunistic screening and intensified management of CVD risk factors in this indigenous population group.     

Evaluation of the Centers for Disease Control and Prevention's Concussion Initiative for High School Coaches: “Heads Up: Concussion in High School Sports”

BACKGROUND: To reduce the number of sports-related concussions, the Centers for Disease Control and Prevention (CDC), with the support of partners and experts in the field, has developed a tool kit for high school coaches with practical, easy-to-use concussion-related information. This study explores the success of the tool kit in changing knowledge, attitudes, and practices related to the prevention and management of concussions. METHODS: A mail questionnaire was administered to all eligible high school coaches who received the tool kit. Follow-up focus groups were conducted for additional information. Both quantitative data from the surveys and qualitative data from the focus groups were analyzed to support the objectives of the study. RESULTS: Respondents self-reported favorable changes in knowledge, attitudes, and practices toward the prevention and management of concussions. Qualitative responses augmented the quantitative data. CONCLUSION: Barriers to concussion prevention and management are complex; however, these results highlight the role that coaches can play in school settings in establishing a safe environment for their athletes.     

A Descriptive Analysis of School and School Shooter Characteristics and the Severity of School Shootings in the United States, 1999–2018

PurposeThe aim of the study was to determine whether characteristics related to the school, shooter, and guns used are associated with school shooting severity (casualty rates, fatality rates, and likelihood of fatality).MethodsWe analyzed associations between individual-, school-, gun-level factors and school shooting severity in the United States from April 1999 through May 2018.ResultsHandguns were used in most school shootings (81%); however, substantially, more fatalities occurred when rifles (relative risk [RR] =14.74, 95% confidence interval [CI] [5.00, 43.41]) or shotguns (RR = 8.84, 95% CI [2.20, 35.54]) were used. Fatal shootings were more likely to happen in schools that were majority white, taught younger students, and were rural or suburban. When shooters were aged ≥20 years, shootings were more likely to be fatal (RR = 2.44, 95% CI [1.18, 5.07]), have more casualties (RR = 5.15, 95% CI [2.06, 12.90]), and more deaths (RR = 20.13, 95% CI [4.86, 83.28]). No significant differences were observed based on the presence of resource officers.ConclusionsMore severe shootings were associated with shooters who were older and therefore unlikely to be students, whereas the presence of a school resource officer was unassociated with any reduction in school shooting severity. Importantly, the type of gun used was strongly associated with casualties and fatalities. Study findings suggest a need for prevention efforts beyond those commonly used in schools, as well as the need for improved laws.