Trends in weight-related attitudes and behaviours among New Zealand adolescents, between 2007 and 2012.

AIM: To explore secular trends of adolescent weight control concerns and behaviours, between 2007 and 2012, and determine if these vary by body size. METHODS: Data were drawn from two nationally representative youth health surveys, Youth'07 and Youth'12. Multiple logistic regression models were used to determine differences in the prevalence of weight control behaviours and concerns between the two time points, controlling for socio-demographic variables. RESULTS: Between 2007 and 2012, both boys and girls were significantly more likely to report concerns about their weight, though the prevalence of trying to lose weight increased for boys, but not girls. Trends in weight control behaviours varied by body size for boys and girls. Perhaps the most striking findings were the increases in proportions of underweight girls and healthy weight boys who were trying to lose weight. CONCLUSIONS: The current study highlights the growing concerns that young people are experiencing in relation to weight control. Given the persistently high rates of adolescent obesity in New Zealand and globally, greater support for young people with regards to healthy eating and weight management is warranted.

Energy drink consumption among New Zealand adolescents: Associations with mental health, health risk behaviours and body size.

AIM: With the increase in popularity of energy drinks come multiple concerns about the associated health indicators of young people. The current study aims to describe the frequency of consumption of energy drinks in a nationally representative sample of adolescents and to explore the relationship between energy drink consumption and health risk behaviours, body size and mental health. METHODS: Data were collected as part of Youth'12, a nationally representative survey of high school students in New Zealand (2012). In total, 8500 students answered a comprehensive questionnaire about their health and well-being, including multiple measures of mental well-being, and were weighed and measured for height. RESULTS: More than one-third (35%) of young people consumed energy drinks in the past week, and 12% consumed energy drinks four or more times in the past week. Energy drink consumption was significantly associated with greater depressive symptoms, greater emotional difficulties and lower general subjective well-being. Frequent energy drink consumption was also associated with binge drinking, smoking, engagement in unsafe sex, violent behaviours, risky motor vehicle use and disordered eating behaviours. There was no association between consumption of energy drinks and student body size. CONCLUSIONS: Consumption of energy drinks is associated with a range of health risk behaviours for young people. Strategies to limit consumption of energy drinks by young people are warranted.

The association between socioeconomic deprivation and secondary school students' health: findings from a latent class analysis of a national adolescent health survey.

BACKGROUND: The aims of this study were to examine indicators of socioeconomic deprivation among secondary school students and to determine associations between household poverty, neighbourhood deprivation and health indicators. METHODS: Data were from a nationally representative sample of 8500 secondary school students in New Zealand who participated in a health survey in 2012. Latent class analyses were used to group students by household poverty based on nine indicators of household socioeconomic deprivation: no car; no phone; no computer; their parent/s worry about not having enough money for food; more than two people sharing a bedroom; no holidays with their families; moving home more than twice that year; garages or living rooms used as bedrooms; and, no parent at home with employment. Multilevel generalized linear models were used to estimate the cross-level interaction between household poverty and neighbourhood deprivation with depressive symptoms, cigarette smoking and overweight/ obesity. RESULTS: Three groups of students were identified: 80 % of students had low levels of household poverty across all indicators; 15 % experienced moderate poverty; and 5 % experienced high levels of poverty. Depressive symptoms and cigarette smoking were 2-3 times higher in the poverty groups compared to student's not experiencing poverty. There were also higher rates of overweight/ obesity among students in the poverty groups compared to students not experiencing poverty, but once covariates were accounted for the relationship was less clear. Of note, students experiencing poverty and living in affluent neighbourhoods reported higher levels of depressive symptoms and higher rates of cigarette smoking than students experiencing poverty and living in low socioeconomic neighbourhoods. This cross-level interaction was not seen for overweight/ obesity. CONCLUSIONS: Measures of household socioeconomic deprivation among young people should not be combined with neighbourhood measures of socioeconomic deprivation due to non-linear relationships with health and behaviour indicators. Policies are needed that address household poverty alongside efforts to reduce socioeconomic inequalities in neighbourhoods.

Acceptability and non-compliance in a family-led weight-management programme for obese Pacific children.

OBJECTIVE: To explore factors influencing participation and attrition in a family-led weight-management programme for obese Pacific children. DESIGN: Qualitative study used bilingual in-depth interviews at exit and end of an 8-week weight-management programme. SETTING: New Zealand. SUBJECTS: Forty-two parents/primary caregivers of obese children who were randomised in the intervention weight-management programme. RESULTS: Programmatic factors that enhanced retention included: simultaneous delivery to both children and parents as participants; delivery of the programme in small group settings at local community venues; enabling trustworthy and accountable relationships; providing resources for travel to venues and regular telephone/text messaging follow-up calls reinforcing programme goals; and day and time scheduling. Suggested programme improvements included having ethnic-specific Island-language delivery and practical sessions like cooking classes and shopping expeditions at local food stores. The research found that unpredictable external life crises like extended family deaths, a change in job shift, family illnesses (both acute and those requiring chronic management) and long-term family visitations affected participation and momentum. A loss of momentum through managing life crises was often difficult to overcome for participants, leading them to drop out of the weight-management programme. Most drop-out participants preferred to defer their programme participation with hopes of re-committing to future programmes at another time. CONCLUSIONS: In order for weight-management programmes to be effective, participants must be able to complete them. Identifying factors that predict participation and attrition may serve as a basis for programme improvement.

Family support and weight-loss strategies among adolescents reporting sustained weight loss.

OBJECTIVE: The current research aims to describe the weight-control strategies and family support for young people reporting sustained weight loss in a large, population-based sample. DESIGN: Data were collected as part of Youth'07, a nationally representative survey of the health and well-being of New Zealand youth. SETTING: New Zealand secondary schools, 2007. SUBJECTS: Secondary-school students (n 9107). RESULTS: Among young people who attempted weight loss in the previous year, 51% reported long-term weight loss (lost weight and maintained weight loss for 6 months). Students reporting long-term weight loss were more likely to be male, but did not differ by age, ethnicity, socio-economic deprivation or measured weight status from students who reported temporary/recent weight loss or no weight loss. Students with long-term weight loss also reported healthier weight-control strategies (e.g., exercising, eating fewer fatty foods, eating fewer sweets), high parental support for healthy eating/activity and were less likely to report being teased about their weight by their family and having junk food available at home than students with temporary/recent weight loss or no weight loss. CONCLUSIONS: Approximately 50% of young people attempting weight loss reported sustained weight loss. Young people who reported sustained weight loss appeared to have more family support than those who did not achieve this, suggesting the importance for weight-control services and interventions in adolescents of actively engaging the family.

Clustering of adolescent health concerns: a latent class analysis of school students in New Zealand.

AIMS: The aims of this study are to identify clinically meaningful groups of adolescents based on their engagement in high levels of risk behaviours or severe emotional health concerns and to describe the demographic characteristics of these groups in two populations of school students in New Zealand. METHODS: A nationally representative sample of secondary school students was surveyed in 2007; alternative education (AE) students in Auckland and Northland were surveyed in 2009. A total of 9107 secondary school students and 335 AE students completed a youth health questionnaire using Internet tablets. Latent class analysis (LCA) was used to identify groups of students on the basis of distinct profiles of their risk behaviours and mental health concerns. RESULTS: The majority (80%) of students in secondary schools are 'healthy' and report few health concerns, 16% are considered 'risky' or 'distressed', and 4% report 'multiple' risk behaviour profiles or emotional health concerns. In AE, only 21% of students were considered 'healthy' with most featuring in the 'risky' or 'multiple' groups. Females were more likely to be 'distressed', whereas males were more likely to feature in the 'risky' or 'multiple' groups. CONCLUSIONS: Clinically-concerning health risk behaviours and emotional health concerns 'cluster' in up to 20% of students in secondary schools and up to 79% of students in AE. Gender, ethnic and socio-economic disparities are also observed. This highlights the importance of comprehensive psychosocial assessment and appropriate service provision, particularly for at-risk groups.

Health and well-being of secondary school students in New Zealand: trends between 2001, 2007 and 2012.

AIM: To describe indicators of health and well-being for New Zealand secondary school students; explore changes between 2001, 2007 and 2012; and compare these findings to international estimates. METHODS: Three national health and well-being surveys of randomly selected New Zealand secondary school students were conducted. Data are presented as prevalence and variation over time (adjusted odds ratio (aOR)). Comparisons with international estimates were made with subsets of the data. RESULTS: Between 2001 and 2012, students reported reductions in cigarette use (aOR 0.27, 95% confidence interval (CI) 0.23-0.32), alcohol use (aOR 0.39, 95% CI 0.33-0.46), marijuana use (aOR 0.37, 95% CI 0.31-0.43), sexual abuse (aOR 0.52, 95% CI 0.46-0.58), fighting (aOR 0.63, 95% CI 0.55-0.73), seatbelt use (aOR 1.47, 95% CI 1.31-1.65) and risky driving behaviours (aOR 0.39, 95% CI 0.33-0.45). Positive connections to school (perception that the school cares, aOR 1.22, 95% CI 1.10-1.35; liking school, aOR 1.55, 95% CI 1.33-1.82) and family (good family relationship, aOR 1.83, 95% CI 1.70-1.97) also improved. Indicators that did not improve and compared poorly with international estimates were protected sex (condom use at last sexual intercourse, aOR 0.77, 95% CI 0.68-0.87) and healthy life-style (daily physical activity, aOR 0.88, 95% CI 0.78-0.99; overweight/obese, aOR 1.09, 95% CI 0.92-1.31). Exposure to family violence (aOR 1.37, 95% CI 1.11-1.68) and depressive symptoms (aOR 1.03, 95% CI 0.91-1.17) also did not improve. CONCLUSIONS: There have been important improvements in the health and well-being of New Zealand adolescents over a relatively short period. These findings demonstrate that population rates of adolescent risk behaviours are amenable to change. Current policy efforts should not lose momentum, while identified priority areas must be adequately resourced to ensure young people have opportunities to thrive now and in the future.

Predictors of cigarette use amongst Pacific youth in New Zealand.

BACKGROUND: Despite progressive population health policies to reduce tobacco harm, smoking prevalence continues to be inequitable amongst key ethnic groups in New Zealand. The purpose of this study is to describe the predictors of cigarette use amongst Pacific youth in New Zealand. METHODS: Data were collected as part of Youth'07, a nationally representative survey of the health and well-being of New Zealand adolescents. The study sample comprised 5471 students and this includes 1,178 were Pacific youth. RESULTS: The smoking prevalence rate for Pacific youth was twice that of New Zealand European youth. Pacific girls and older age groups, ages 16-17, smoked more than Pacific boys and younger adolescents. Pacific youth from higher and mid-deprivation neighbourhoods smoked at twice the rate of youth from low deprivation areas. Local neighbourhood stores (dairies) were the most used location for purchasing cigarettes, and only 12.7% of under-aged adolescents were asked "most of the time" for age identification. Pacific adolescent smoking was associated with parental smoking, peer-group smoking and binge drinking. Parents not knowing the whereabouts of adolescents during after-school hours and night-times were also associated with adolescent smoking. A majority of Pacific adolescent smokers (70.2%) had tried to quit smoking. CONCLUSION: The strategies for addressing ethically the issue of equal health for all is to allocate increased public health investments towards targeted quit-smoking treatment programmes for Pacific youth in New Zealand. Further qualitative studies with Pacific youth to inform the development of culturally-appropriate youth-focused quit-substance interventions is recommended.

Prevalence of weight-related concerns and behaviours among New Zealand young people.

AIM: The study aims to describe the prevalence of weight loss behaviours and weight-related concerns among a nationally representative sample of adolescents in New Zealand. METHODS: Data for this study were collected as part of Youth'07, a nationally representative survey of the health and well-being of 9107 secondary school students in New Zealand. RESULTS: More than one third of males and 65% of females tried to lose weight in the past year. Approximately 10% of males and 29% of females reported using at least one of the unhealthy weight control behaviours in the past year (fasted, skipped meals, smoked, vomited, diet pills). Among females and males, using unhealthy weight control behaviours was most prevalent among those who were older, overweight and lived in high-deprivation areas. CONCLUSION: Unhealthy weight control behaviours among New Zealand adolescents are common and warrant future research and discussion to understand why so many young people use unhealthy weight loss strategies.

Economic incentives to promote healthier food purchases: exploring acceptability and key factors for success.

Despite increasing interest, little is known about the beliefs and views of the public in relation to the use of economic incentives as a means to promote healthy eating. This study explores views of ethnically and socioeconomically diverse shoppers regarding acceptability of economic incentives to promote healthier food purchases, and factors likely to affect the success of such schemes. Six focus groups (n = 36 participants; 14 Maori, 12 Pacific, 10 non-ethnic specific low income), were held in Auckland, New Zealand, in October 2009. A general inductive approach was used to identify common themes. The single most important reported food purchasing influence was cost. Focus group participants viewed the concept of economic incentives to promote healthy eating positively, as long as such schemes provided worthwhile incentives, and were simple and convenient to use. The preferred option for delivery was a pre-loaded electronic swipe card. Fruit and vegetables were the food group most participants said they would like to see incentivized. There was marked variability in the incentive amount thought sufficient to promote participation in such a scheme. Our findings suggest economic incentives hold promise as a means to promote healthier household food purchases, and their effectiveness should be evaluated using robust, randomized trials.

Using appreciative inquiry methodology to develop a weight management program for obese children in New Zealand.

OBJECTIVES: Paediatric obesity predicts adult obesity, and alarming new data in New Zealand reveals that obesity among the young continues to rise. In this study, we used a novel solution-focused paradigm, or appreciative inquiry perspective, to explore the factors that influence not just obese but non-obese states (that is, healthy weight as well as obesity), in Pacific adolescents (aged 13-17) living in socioeconomically deprived neighbourhoods. METHODS: Sixty-eight parents and adolescents from 30 families were recruited and interviewed, resulting in 15 obese and 15 healthy weight adolescents participating in the study. RESULTS: Our findings showed that, despite living in low socioeconomic circumstances, parents were able to alter their micro-environments to prevent obesity in their children. Parents with healthy weight adolescents had food rules in the home and monitored their children's eating and television viewing time. CONCLUSIONS: An appreciative inquiry approach to obesity research can uncover resiliency factors within families that can be applied to obesity prevention and treatment programs. Implications for public health: Appreciative inquiry methodology is a promising alternative qualitative research strategy for developing health interventions for low-income ethnic minority communities.

Risk and Protective Factors for Suicidal Behaviors Among Pacific Youth in New Zealand.

BACKGROUND: New Zealand has the second highest youth suicide rate in the OECD and particularly among Pacific New Zealanders, who have a threefold higher risk of suicide attempt compared with the general population. AIMS: Protective and risk factors for suicide attempts among New Zealand Pacific adolescents were assessed using data from Youth'12, an adolescent health and well-being survey. METHOD: This randomly selected nationally representative sample of New Zealand secondary school students included 1,445 Pacific high school students aged 12-17 years. RESULTS: One in 10 (11.6%) Pacific adolescents reported attempting suicide. Risk factors for suicide included: being female, household food insecurity, low levels of family connections and family monitoring, life dissatisfaction, having a religious affiliation, and previous suicide by a family member or friend. Of those who had made a suicide attempt, 71% also experienced both suicide ideation and self-harm. CONCLUSION: This study suggests that given the high rates of suicide ideation and attempts among Pacific young people, targeted trials for new ways of support should be prioritized for this high-risk group. The Pacific family environment, which continues to be the critical space for intervening, and the school environment, as a provider of health services, were both protective of suicide attempt.

Changes in the sexual health behaviours of New Zealand secondary school students, 2001-2012: findings from a national survey series.

OBJECTIVE: To describe trends in self-reported sexual and reproductive health behaviours among New Zealand secondary school students. METHODS: Nationally representative health and wellbeing surveys conducted in 2001 (n=9,699), 2007 (n=9,107) and 2012 (n=8,500) were analysed. Logistic regressions were used to explore variations in sexual health outcomes between 2001 and 2012. RESULTS: 'Ever had sex' (-6.9%, p<0.001); 'currently sexually active' (- 2.3%, p<0.001); 'always use condoms' (-3.3%, p=0.006); 'condoms at last sex' (-7.0, p=0.002); 'contraception at last sex' (-5.8%, p<0.001) and sexually transmitted infections (-0.3%, p=0.001) have reduced over time. 'Always use contraception' did not change significantly (-1.4%, p=0.514) over time. Maori (OR 0.7), Pacific (OR 0.5) and socioeconomically deprived students (OR 0.7) less frequently used condoms. Maori (OR 0.6), Pacific (OR 0.4), Asian (OR 0.5), younger (OR 0.6), and socioeconomically deprived (OR 0.6) students less frequently used contraception. CONCLUSIONS: Students in 2012 were more likely to delay sexual activity, but were less likely to use condoms and contraception consistently, compared to students in 2001. Declining contraceptive use over an 11-year period suggests that current strategies are inadequate, particularly for Maori, Pacific and socioeconomically deprived students. Appropriate and accessible sexual and reproductive health services are urgently required.

Prevalence and Recent Trends in Overweight, Obesity, and Severe Obesity among New Zealand Adolescents.

BACKGROUND: Around the world, there have been numerous reports of a leveling of the prevalence of obesity. Given that New Zealand has among the highest rates of child and adult obesity in the Organization for Economic Cooperation and Development (OECD), the aim of the current study was to document the prevalence of, and recent trends in, overweight, obesity, and severe obesity among adolescents in New Zealand. METHODS: Data were collected as part of two nationally representative surveys in 2007 and 2012. In both surveys, a nationally representative group of students was selected to participate in the health and well-being surveys from a nationally representative sample of secondary schools. Across the two surveys, more than 17,000 students participated in the survey, which also included measured heights and weights. RESULTS: In 2012, nearly 40% of adolescents in New Zealand were overweight, obese, or severely obese. Between 2007 and 2012, there were no decreases in the prevalence of obesity for the general population or any demographic subgroup. However, the prevalence of obesity and severe obesity for Pacific young people increased significantly. Of note, the prevalence of severe obesity for Pacific young people increased from 9% in 2007 to 14% in 2012. CONCLUSIONS: Findings from the current study indicate the need for an urgent investment in obesity prevention, particularly to address the growing inequalities in obesity for Pacific young people.

Predictors of drinking patterns in adolescence: a latent class analysis.

BACKGROUND: Uni-dimensional measures of alcohol consumption may be unable to fully capture the complexity of adolescent drinking and experience of alcohol-related harms. Latent class analysis provides an empirical method to understand different adolescent drinking patterns. METHODS: Latent class analysis was used to create typologies of drinking among the 5018 current drinkers in the national Youth '07 survey. Determinants of drinking patterns were identified using multinomial logistic regression. RESULTS: Four latent classes were identified, demonstrating an overall increase in risk of alcohol-related outcomes from increasing consumption. One class strongly deviated from this pattern, having moderate consumption patterns but disproportionately high levels of alcohol-related problems. Multinomial logistic regression found that the strongest predictors of belonging to high-risk drinking typologies were having a positive attitude to regular alcohol use, buying own alcohol, peers using alcohol, and obtaining alcohol from friends and/or other adults. Other significant predictors included being male, having a strong connection to friends, having parents with a low level of knowledge of their daily activities and poor connection to school. Class membership also varied by ethnicity. CONCLUSION: The latent class approach demonstrated variability in alcohol-related harms across groups of students with different drinking patterns. Longitudinal studies are necessary to determine the causes of this variability in order to inform the development of targeted policy and preventative interventions. Legislative controls, such as increasing the legal purchase age and reducing the commercial availability of alcohol, will continue to be important strategies for reducing harm in young people.

Pacific secondary school students' access to primary health care in New Zealand.

AIM: Previous research states Pacific peoples' experience barriers to primary care. A better understanding of young Pacific peoples' experiences and perspectives on health services can improve responsiveness to young Pacific New Zealanders' health needs. This study identifies primary health (including dental care) barriers in access, utilisation and unmet need for Pacific youth ages 13-17 years. METHODS: Data were collected as part of Youth'07, a nationally representative survey of the health and wellbeing of New Zealand (NZ) adolescents. 1178 Pacific students who identified any of their ethnicities as Samoan, Cook Islands, Tongan, Niue, Tokelauan, Fijian, or Other Pacific Peoples were included. RESULTS: Compared to their NZ European peers, Pacific youth accessed primary health care services, including dental care less often in the previous year; Pacific students were twice more likely to forego accessing health care and dental care when needed; were more likely to find it difficult to get healthcare for specific health issues like injuries/accident; to stop smoking, alcohol/drugs use and for chronic conditions. Not knowing how to access healthcare and rating unfair treatment by health professionals due to their ethnicity were significant factors impacting access. CONCLUSION: Good access and utilisation of primary care services is an important resource of preventable health for Pacific New Zealanders. This study finds that Pacific youth are an underserved group experiencing inequitable access within the current primary healthcare sector. Innovative approaches to specialist youth-oriented healthcare services, professional training and increasing the Pacific health workforce are recommended interventions.

Neighbourhood social capital and adolescent self-reported wellbeing in New Zealand: a multilevel analysis.

The association between neighbourhood social capital and individual health and wellbeing has been explored mainly by focussing on adult outcomes. This study explores the relationship between neighbourhood social capital and adolescent subjective wellbeing, and its interaction with adolescents' socioeconomic status. Data was taken from a random sample of 9107 students who participated in a nationally representative health survey of high school students in New Zealand in 2007. Students' wellbeing was measured by questions on general mood, life satisfaction and WHO-5 Wellbeing Index. Neighbourhood social capital was assessed according to five indicators: neighbourhood social cohesion, facilities, physical disintegration, membership in community organisations, and residential stability. All neighbourhood measures were created based on students' responses aggregated to the neighbourhood level. Neighbourhood was defined as a Census Area Unit, with a median population of 2000 people. Analyses included only neighbourhoods with more than 10 students, and were conducted using cross-classified random intercept multilevel models controlling for students' age, sex, ethnicity and socioeconomic status, with both schools and neighbourhoods treated as random effects. A total of 5567 students within 262 neighbourhoods were considered in the analysis. Students living in neighbourhoods characterised by higher levels of social cohesion and membership in community organisations reported higher levels of wellbeing. The association between student self-reported wellbeing and neighbourhood membership in community organisations varied according to the individual socioeconomic status of students. Neighbourhood membership in community organisations showed a stronger protective effect for students who were more socioeconomically deprived.

Pacific parents' rationale for purchased school lunches and implications for obesity prevention.

Pacific children and adolescents are burdened with higher prevalences of obesity compared to other groups in New Zealand. Previous research shows Pacific young people purchase their lunch food items significantly more than other groups. The aim of this study is to describe school lunch food consumption patterns and the influences on these among low-income Pacific adolescents and their parents. Using mixed-methodology design; a self-completion questionnaire was administered to 4216 students who participated in the New Zealand arm of the Obesity Prevention In Communities (OPIC) project. Thirty Pacific households (33 adolescents and 35 parents) were interviewed in the qualitative phase of the study. Results found a greater proportion of Pacific students purchased school food items compared to other ethnic groups. Purchasing school food was related to having higher amounts of daily food money (>=NZD 6-15) and this was associated with increased quantities of soft drink consumption and after-school food purchasing of high-fat, high-sugar snack foods. There were no differences in school food purchasing behaviour by Pacific weight status (n=2485), with both Healthy weight (67.6%) and Obese students (66.9%) sourcing lunch from school canteens or shops outside of school rather than from home. Time-constrained parents confirmed convenience, poverty compensation and valuing students' independence as three reasons for choosing to make money available for students to purchase lunch food items. The social effects of poverty affect the health-promoting behaviours of Pacific communities in New Zealand. Social policies that decrease social inequities should be the intervention priority.

Binge drinking and alcohol-related behaviours amongst Pacific youth: a national survey of secondary school students.

AIM: Previous studies show Pacific youth polarised as either non/occasional drinkers or heavy binge drinkers. The aim of this study is to describe the demographic, cultural, home and neighbourhood environments of the two types of Pacific drinkers (non-binge drinkers and binge drinkers) to develop risk and protective profiles for alcohol related behaviours. METHODS: Data were collected as part of Youth'07, a nationally representative survey of the health and well-being of New Zealand youth. 1,190 Pacific students who identified any of their ethnicities as Samoan, Cook Islands, Tongan, Niue, Tokelauan, Fijian, or Other Pacific Peoples were included. RESULTS: Data was available on 974 students of whom 31.6% were binge drinkers. Students who were younger and had parental Pacific language use at home were less likely to binge drink than other students. Parents' knowledge of young people's activities after school and at night time was also protective of binge drinking, while participating in sports teams or a sports club was associated with increased risk of binge drinking. CONCLUSION: This study indicates the transnational nature of Pacific communities in New Zealand who bring and maintain traditional cultural practices which seem health protective. While participation in sports activities may have health benefits, our findings indicate the need for a more proactive approach on the part of policymakers and the sporting sector to address the associated risk of binge drinking. Alcohol interventions that de-normalise alcohol overconsumption are warranted for young Pacific New Zealanders.

Body image and its relation to obesity for Pacific minority ethnic groups in New Zealand: a critical analysis.

The stimulus behind most of the early investigations into Pacific or Polynesian peoples' body image, particularly those that looked to compare with Western or Westernised groups, is the assumption that Pacific peoples valued and therefore desired very large bodies, and in relation to obesity-risk, this is a problematic cultural feature to have. This may be driven by popular anecdotes which are captured in the title of one such study "Do Polynesians still believe that big is beautiful?" To the author's knowledge, no research in Pacific peoples' body image has been conducted in the New Zealand (NZ) context by Pacific researchers. This study makes a contribution to the literature gap and more importantly through an emic viewpoint. A critique of the current literature is provided below which calls into question the initial catalyst behind earlier investigations which have led to the perpetuation of particular types of body image research for Pacific groups. Using mixed-methods, the specific objective of this study was to describe the behaviours, beliefs and values of Pacific adolescents and their parents, that are related to body image. A self-completion questionnaire was administered to 2495 Pacific students who participated in the New Zealand arm of the Obesity Prevention In Communities (OPIC) project. Sixty-eight people (33 adolescents and 35 parents) from 30 Pacific households were interviewed in the qualitative phase of the study. This study found Pacific adolescents and their parents did not desire obesity-sized bodies but desired a range of average-sized bodies that met their Pacific-defined view of health. It is not clear whether body image research makes any meaningful contribution to obesity prevention for Pacific people, given the cultural-bounded nature of the concept "body image" which sits communication and understanding between obesity interventionists and all healthcare workers generally and Pacific communities. For obesity interventions to be acceptable and useful for Pacific people, they must be responsive to the beliefs and desires of these communities.