Tonga national emergency medical team response to the 2022 Hunga Tonga-Hunga Ha'apai volcanic eruption and tsunami: the first deployment of the Tonga Emergency Medical Assistance Team (TEMAT).

Problem: The undersea Hunga Tonga-Hunga Ha'apai volcano erupted on 15 January 2022, causing a tsunami that affected Tonga as well as other countries around the Pacific rim. Tonga's international borders were closed at the time due to the coronavirus disease pandemic, but clinical surge support was needed to respond to this disaster. Context: Tonga's Ministry of Health formed the Tonga Emergency Medical Assistance Team (TEMAT) in 2018 to provide clinical care and public health assistance during disasters, outbreaks and other health emergencies. TEMAT was activated for the first time in January 2022 to respond to medical and public health needs following the eruption and tsunami. Action: On 16 January 2022, a five-person TEMAT advance team was deployed to conduct initial damage assessments and provide casualty care. Subsequently, TEMAT rotations were deployed to provide clinical care and public health support across the Ha'apai island group for over 2 months. Outcome: TEMAT deployed to the islands most affected by the volcanic eruption and tsunami within 24 hours of the event, providing emergency clinical, psychosocial and public health services across four islands. TEMAT reported daily to the Ministry of Health and National Emergency Management Office, providing critical information for response decision-making. All TEMAT actions were documented, and an after-action review was conducted following the deployment. Discussion: TEMAT's deployment in response to the 2022 volcanic eruption and tsunami highlighted the importance of national emergency medical teams that are prepared to respond to a range of emergency events.

Strengthening Sugar-Sweetened Beverage Taxation for Non-Communicable Disease Prevention: A Comparative Political Economy Analysis Case Study of Fiji and Tonga.

Diet-related fiscal policy is an effective NCD prevention strategy. However, current sugar-sweetened beverage (SSB) taxes in Fiji and Tonga have not had the desired effect; SSB consumption in Fiji, for example, contributes to mortality more than double the global rates and is highest in the WHO Western Pacific Region. We therefore aimed to better understand the perceived underlying political economy drivers that have and continue to affect change in each country. Our study design utilised a comparative case study that triangulated documentary policy and stakeholder analysis with semi-structured stakeholder interviews in both countries and an in-depth corporate political activity analysis in Fiji. We drew on theoretical frameworks relevant to political economy to collect and analyse policy and stakeholder data, and utilised established corporate political activity frameworks to analyse industry activity. Common findings to both Fiji and Tonga suggested that the SSB tax impact could be increased through multisectoral engagement, embracing a whole-of-society approach, strengthened institutional structures and leveraging off competing priorities across sectors towards more common goals. These findings provide opportunities and lessons for Fiji and Tonga as well as other similar settings seeking to strengthen or upscale the impact of diet-related fiscal policy.

Barriers and facilitators to the introduction of import duties designed to prevent noncommunicable disease in Tonga: a case study.

BACKGROUND: In Tonga, import duties were lowered on tinned fish and seafood in 2013 and raised on soft drinks, dripping and other animal fats. Additional import duties were applied to soft drinks and dripping and other fats in 2016 and duties were also applied to high fat meats, mutton flaps and turkey tails. The objective of this study was to describe barriers to and facilitators of these import duties from a policy-maker perspective. METHODS: A case study was conducted to analyse implementation of policies originally modelled by the Pacific Obesity Prevention in Communities project to reduce mortality in the Kingdom of Tonga. Policymakers (n = 15) from the Ministries of Revenue, Health, Finance and Labour and Commerce involved in the development and implementation of Tonga's food-related policies participated in key-informant interviews. RESULTS: The main facilitator of import duties were strong leadership and management, cross-sector collaboration, awareness raising and advocacy, nature of the policy, and the effective use of data to model policy impacts and inform the general public. The absence of clear lines of responsibility and a decline in collaboration over time were identified as barriers to implementation of the import duties. CONCLUSION: In a small Island state implementing import duties to prevent non-communicable disease can be straight forward providing policymakers and the community have a shared understanding of the health and economic costs of NCDs.

Equity of expenditure changes associated with a sweetened-beverage tax in Tonga: repeated cross-sectional household surveys.

BACKGROUND: The aim of this study was to examine changes in beverage expenditure patterns before and after a T$0.50/L sweetened-beverage (SB) excise was introduced in Tonga in 2013, by household income, household age composition and island of residence. METHODS: Two cross-sectional surveys involved households being randomly sampled (the Household Income and Expenditure Surveys in 2009 (n = 1982) and 2015/16 (n = 1800)). Changes in soft drink (taxed), bottled water, and milk (both untaxed) expenditure were examined namely: (i) prevalence of households purchasing the beverage; (ii) average expenditure per person (inflation-adjusted); (iii) expenditure as a proportion of household food budget; and (iv) expenditure per person as a proportion of equivalised income. RESULTS: The pattern found was of decreases in all soft drink expenditure outcomes and these appeared to be greater in low-income than high-income households for purchasing prevalence (- 30% and - 25% respectively, t-test p = 0.98), per-capita expenditure (- 37% and - 34%, p = 0.20) and food budget share (- 27% and - 7%, p = 0.65), but not income share (- 6% and - 32%, p = 0.71). The large expenditure increases in bottled water appeared to be greater in low-income than high-income households for purchasing prevalence (355 and 172%, p = 0.32) and food budget share (665 and 468%, p = 0.09), but greater in high-income households for per-capita expenditure (121 and 373%, p < 0.01) and income share (83 and 397%, p = 0.50). CONCLUSIONS: The sweetened-beverage tax was associated with reduced soft drink purchasing and increased bottled water expenditure. Low-income households appeared to have slightly greater declines in soft drink expenditure.

Dietary assessment methodology and reporting in Pacific Island research: a scoping review protocol.

OBJECTIVE: This scoping review aims to identify and describe the methods used to collect and analyze dietary intake data in residents of Pacific Island countries. INTRODUCTION: Dietary assessment explores associations between dietary factors and health outcomes. In regions, including the Pacific Islands, where diet-related, non-communicable diseases are increasing, this is a growing area of research. As this information is used to inform food and nutrition policies and practice, accurate collection, analysis, and interpretation of dietary assessment data relies on robust methods. A greater understanding of how nutrition studies are designed can strengthen the evidence on nutrition and health in Pacific Island settings and inform future research approaches. INCLUSION CRITERIA: The scoping review will consider studies published in peer-reviewed journals, including quantitative and qualitative study designs and gray literature, including government reports, research and technical reports, theses and dissertations that measure and/or assess dietary intake in resident populations of the Pacific Island member countries of the Secretariat of the Pacific Community: American Samoa, Commonwealth of the Northern Mariana Islands, the Cook Islands, the Federated States of Micronesia, French Polynesia, Guam, the Independent State of Papua New Guinea, the Independent State of Samoa, the Kingdom of Tonga, New Caledonia, Niue, Pitcairn Islands, the Republic of Fiji, the Republic of Kiribati, the Republic of the Marshall Islands, the Republic of Nauru, the Republic of Palau, the Republic of Vanuatu, Solomon Islands, Tokelau, Tuvalu, and Wallis and Futuna. METHODS: There will be no time limit and searches will be conducted in PubMed, CINAHL, CABI, Scopus, Cochrane Library, and Web of Science. Results will be limited to English-language articles. Data will be extracted independently by two reviewers into a charting table. Results will be presented graphically and with tables accompanied by a narrative summary.

Sweetened beverage taxes and changes in beverage price, imports and manufacturing: interrupted time series analysis in a middle-income country.

BACKGROUND: The Pacific Island nation of Tonga (a middle-income country) introduced a sweetened beverage tax of T$0.50/L in 2013, with this increasing further in 2016 (to T$1.00/L), and in 2017 (T$1.50/L; US$0.02/oz). Given the potential importance of such types of fiscal intervention for preventing chronic disease, we aimed to evaluate the impact of these tax changes in Tonga. METHODS: Interrupted time series analysis was used to examine monthly import volumes and quarterly price and manufacturing 1 year after each tax change, compared with a counterfactual based on existing trends. Autocorrelation was adjusted for when present, and adjustments were made for changes in GDP per capita, visitor numbers, season and T$/US$ exchange rate. RESULTS: In the year after the 2013, 2016 and 2017 tax increases, the price of an indicator soft drink increased by 16.8% (95%CI: 6.3 to 29.6), 3.7% (- 0.6 to 8.3) and 17.6% (6.0 to 32.0) respectively. Imports of sweetened beverages decreased with changes of - 10.4% (- 23.6 to 9.0), - 30.3% (- 38.8 to - 20.5) and - 62.5% (- 73.1 to - 43.4) respectively. Juice imports changed by - 54.2% (- 93.2 to - 1.1), and sachet drinks by - 15.5% (- 67.8 to 88.3) after the 2017 tax increase. Tonga water bottling (T$) increased in value by 143% (69 to 334) after the 2016 tax increase and soft drink manufacturing increased by 20% (2 to 46, albeit 5% market share). CONCLUSIONS: Consistent with international evaluations of sugar-sweetened beverage taxes, the taxes in Tonga were associated with increased prices, decreased taxed beverages imports, and increased locally bottled water.

Incorporating mammography into an overseas referral metric: Tongan doctors' assessments of patient eligibility for medical travel.

Tonga's largest public hospital received its second-although its first fully functioning-mammogram machine in 2016. If diagnosed with breast cancer, Tongan women must travel to New Zealand or Australia to access biomedical treatment (e.g. chemotherapy), but many can only do so with financial support from the Tongan government. Given limited funding, strict referral guidelines require doctors to quantify patients into calculations of risk. According to these guidelines, which I argue serve as an overseas referral metric, only "low-risk" patients-as determined by prognosis and treatment cost-are supposed to be funded. At present, doctors can sometimes draw on qualitative knowledge, such as long-term clinical experience, to circumvent referral guidelines. However, as mammography touts new epidemiological capabilities, it also has the potential to reinforce emphases on quantifiable evaluations of referral eligibility, which are often preferred by program funders. This could potentially exclude some women from treatment, as already-limited funding is increasingly reserved for those deemed "low-risk" according to numerical assessments. Based on recent ethnographic fieldwork (2016-2017) in Nuku'alofa, Tonga, I draw on in-depth interviews and conversations with local doctors to elucidate the interplay between mammography access and practitioners' processes of cancer diagnosis, patient risk assessment, and overseas referral. In following doctors' efforts to maximize accountability and risk management in referrals, I show how broader emphases on quantification and efficiency in global-health practice can generate intense moral dilemmas for those who must grapple with their implementation in the day-to-day. Significantly, these experiences demonstrate how numerical trends in global health not only permeate local health-care practices but also impact transnational health-care seeking, shaping a political economy of medical travel that structures opportunities for some women (and not others) to access biomedical treatment abroad.

Sociodemographic factors influencing island foods consumption in the Pacific Islander Health Study.

Objectives: Pacific Islander Americans are a small, but quickly growing population that experiences alarming disparities in obesity and obesity-related chronic illnesses influenced by dietary patterns. This population also has a unique culinary heritage including traditional foods and more contemporary imports such as tinned meats and refined carbohydrates. This analysis is a novel attempt to understand the sociodemographic factors influencing island foods consumption.Design: A sample of 240 Samoan and Tongan adults in California from the Pacific Islander Health Study was used. Following univariate and bivariate analyses, a series of four multivariable regression models were created to predict past week frequency of island foods consumption after sequential adjustment for demographic, socioeconomic, and cultural covariates.Results: Participants reported consuming island foods an average of 2.93 times in the previous week, with the largest proportion of participants (20.42%) reporting eating island foods 6 or more times. Age and Samoan ethnicity were initially significant, positive predictors of island foods consumption, but their effect was attenuated after addition of cultural covariates. With the third model that adjusted for birthplace, financial insecurity and Tongan birthplace were positive predictors. Both lost significance in the fourth and final model upon addition of cultural affinity, which was positively associated with island foods.Conclusion: Understanding how sociodemographic factors are associated with island foods consumption is a first step in understanding the broad way in which an ethnically specific dietary pattern may be associated with obesity-related chronic illness risk among Pacific Islander Americans.

Honoring Motherhood: The Meaning of Childbirth for Tongan Women.

PURPOSE: The purpose of this ethnographic study was to describe the meaning of childbirth for Tongan women. STUDY DESIGN AND METHODS: In this qualitative descriptive study, 38 Tongan women, 18 from Tonga and 20 from the United States, who had given birth in the past year were invited to share their perceptions of childbirth. Themes were generated collaboratively by the research team. FINDINGS: The overarching theme was honoring motherhood; other themes include using strength to facilitate an unmedicated vaginal birth, describing the spiritual dimensions of birth, adhering to cultural practices associated with childbearing, and the influence of the concept of respect on childbearing. IMPLICATIONS FOR CLINICAL PRACTICE: Understanding the value Tongan women and their families place on motherhood can help nurses to give culturally sensitive nursing care. Tongan beliefs and cultural practices should be respected. Nurses should assess women's personal preferences for their care and advocate for them as needed. Sensitivity to stoicism is important, especially on pain control and patient education. Nurses should be aware of Tongan values regarding modesty and respect, and provide an appropriate care environment. A culturally competent nurse understands the importance of sociocultural influences on women's health beliefs and behaviors and generates appropriate interventions.

Developing antitobacco mass media campaign messages in a low-resource setting: experience from the Kingdom of Tonga.

Tobacco use has become the leading cause of preventable death in Tonga, a small island nation in the South Pacific. One pragmatic and economical strategy to address this worrying trend is to adapt effective antitobacco mass media materials developed in high-income countries for local audiences. Using Tonga as an example, this paper shares the practical steps involved in adapting antitobacco campaign materials for local audiences with minimal resources, a limited budget and without the need for an external production team. The Tongan experience underscores the importance of an adaptation process that draws from evidence-based best-practice models and engages local and regional stakeholders to ensure that campaign materials are tailored to the local context and are embedded within a mix of antitobacco strategies.

Evaluation of the child oral health promotion 'MaliMali' Programme based on schools in the Kingdom of Tonga.

INTRODUCTION: The South Pacific Medical Team (SPMT) has supported oral health care for Tongan juveniles since 1998. This voluntary activity, named the MaliMali ('smile' in Tongan) Programme, is evaluated in detail in this paper. METHODS: This evaluation was guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. The objectives were to explore: (i) whether the programme was accessible to Tongan schoolchildren (Reach); (ii) the impact of the programme on decayed, missing and filled teeth (DMFT) scores and toothbrushing habits (Effectiveness); (iii) factors that affected the adoption of the programme (Adoption); (iv) whether implementation was consistent with the programme model (Implementation); and (v) the long-term sustainability of the programme (Maintenance). RESULTS: The MaliMali Programme has grown into an international project, has spread countrywide as a uniform health promotion and is reaching children in need. Following implementation of this programme, the oral health of Tongan juveniles has improved, with a decrease in the mean DMFT index and an increase in toothbrushing. To provide training that will allow Tongans to assume responsibility for the MaliMali Programme in the future, dental health education literature was prepared and workshops on oral hygiene and the MaliMali Programme were held frequently. At present, the programme is predominantly managed by Tongan staff, rather than by Japanese staff. CONCLUSIONS: This evaluation found the MaliMali Programme to be feasible and acceptable to children and schools in the Kingdom of Tonga. The programme promotes oral health and provides accessible and improved oral health care in the school setting, consistent with the oral health-promoting school framework.

Anthropology, brokerage, and collaboration in the development of a Tongan public psychiatry: Local lessons for global mental health.

The Global Mental Health (GMH) movement has raised questions of the translatability of psychiatric concepts and the challenges of community engagement. In Tonga, the local psychiatrist Dr Puloka successfully established a publicly accessible psychiatry that has improved admission rates for serious mental illnesses and addressed some of the stigma attached to diagnosis. On the basis of historical analysis and ethnographic fieldwork with healers, doctors, and patients since 1998, this article offers an ethnographic contextualization of the development and reception of Puloka's three key interventions during the 1990s: (a) collaboration with traditional healers; (b) translation of psychiatric diagnoses into local cultural concepts; and (c) encouraging freedom of movement and legal appeal to involuntary admission. Dr Puloka's use of medical anthropological and transcultural psychiatry research informed a community-engaged brokerage between the implications of psychiatric nosologies and local needs that can address some of the challenges of the Global Mental Health movement.

Maternal quality and safety outcomes for Asians and Pacific Islanders in Hawai'i: an observational study from five years of statewide data.

BACKGROUND: Empirical evidence regarding maternal quality and safety outcomes across heterogeneous Asian and Pacific Islanders subgroups in the United States is limited, despite the importance of this topic to health disparities research and quality improvement efforts. METHODS: Detailed discharge data from all Hawai'i childbirth hospitalizations (n = 75,725) from 2008 to 2012 were considered. Validated measures of maternal quality and safety were compared in descriptive and multivariable models across seven racial/ethnic groups: Filipino, Native Hawaiian, other Pacific Islander (e.g., Samoan, Tongan, Micronesian), Japanese, Chinese, white, and other race/ethnicity. Multivariable models adjusted for age group, payer, rural vs. urban hospital location, multiple gestation, and high-risk pregnancy. RESULTS: Compared to whites, Japanese, Filipinos, and Other Pacific Islanders had significantly higher overall delivery complication rates while Native Hawaiians had significantly lower rates. Native Hawaiians also had significantly lower rates of obstetric trauma in vaginal delivery with and without instruments compared to whites (Rate Ratio (RR):0.66; 95% CI:0.50-0.87 and RR:0.62; 95% CI:0.52-0.74, respectively). Japanese and Chinese had significantly higher rates of obstetric trauma for vaginal deliveries without instruments (RR:1.52; 95% CI:1.27-1.81 and RR:1.95;95% CI:1.53-2.48, respectively) compared to whites, and Chinese also had significantly higher rates of birth trauma in vaginal delivery with instrument (RR 1.42; 95% CI:1.06-1.91). Filipinos and Other Pacific Islanders had significantly higher rates of Cesarean deliveries compared to whites (RR:1.15; 95% CI:1.11-1.20 and RR:1.16; 95% CI:1.10-1.22, respectively). Other Pacific Islanders also had significantly higher rates of vaginal births after Cesarean (VBAC) deliveries compared to whites (RR: 1.28; 95% CI:1.08-1.51) and Japanese had significantly lower rates of uncomplicated VBACs (RR:0.77; 95% CI:0.63-0.94). CONCLUSIONS: Significant variation was seen for Asian and Pacific Islander subgroups across maternal quality and safety outcomes. Notably, high rates of obstetric trauma were seen among Chinese and Japanese vaginal deliveries. Filipinos and other Pacific Islanders had high rates of Cesarean deliveries. Native Hawaiians had better quality and safety outcomes than whites on several quality and safety measures, including obstetric trauma during vaginal delivery. Other Pacific Islanders had high rates of VBACs, while Japanese had lower rates. This information can help guide clinical practice, research, and quality improvement efforts.

Pilot assessment of soil-transmitted helminthiasis in the context of transmission assessment surveys for lymphatic filariasis in Benin and Tonga.

BACKGROUND: Mass drug administration (MDA) for lymphatic filariasis (LF) programs has delivered more than 2 billion treatments of albendazole, in combination with either ivermectin or diethylcarbamazine, to communities co-endemic for soil-transmitted helminthiasis (STH), reducing the prevalence of both diseases. A transmission assessment survey (TAS) is recommended to determine if MDA for LF can be stopped within an evaluation unit (EU) after at least five rounds of annual treatment. The TAS also provides an opportunity to simultaneously assess the impact of these MDAs on STH and to determine the frequency of school-based MDA for STH after community-wide MDA is no longer needed for LF. METHODOLOGY/PRINCIPAL FINDINGS: Pilot studies conducted in Benin and Tonga assessed the feasibility of a coordinated approach. Of the schools (clusters) selected for a TAS in each EU, a subset of 5 schools per STH ecological zone was randomly selected, according to World Health Organization (WHO) guidelines, for the coordinated survey. In Benin, 519 children were sampled in 5 schools and 22 (4.2%) had STH infection (A. lumbricoides, T. trichiura, or hookworm) detected using the Kato-Katz method. All infections were classified as light intensity under WHO criteria. In Tonga, 10 schools were chosen for the coordinated TAS and STH survey covering two ecological zones; 32 of 232 (13.8%) children were infected in Tongatapu and 82 of 320 (25.6%) in Vava'u and Ha'apai. All infections were light-intensity with the exception of one with moderate-intensity T. trichiura. CONCLUSIONS: Synchronous assessment of STH with TAS is feasible and provides a well-timed evaluation of infection prevalence to guide ongoing treatment decisions at a time when MDA for LF may be stopped. The coordinated field experiences in both countries also suggest potential time and cost savings. Refinement of a coordinated TAS and STH sampling methodology should be pursued, along with further validation of alternative quantitative diagnostic tests for STH that can be used with preserved stool specimens.

A test of the resource security and the body mass index reference point hypotheses of body dissatisfaction amongst adolescents in eight countries.

OBJECTIVE: This study aimed to identify cultural-level variables that may influence the extent to which adolescents from different cultural groups are dissatisfied with their bodies. DESIGN: A sample of 1730 male and 2000 female adolescents from Australia, Fiji, Malaysia, Tonga, Tongans in New Zealand, China, Chile, and Greece completed measures of body satisfaction, and the sociocultural influences on body image and body change questionnaire, and self-reported height and weight. Country gross domestic product and national obesity were recorded using global databases. RESULTS: Prevalence of obesity/overweight and cultural endorsement of appearance standards explained variance in individual-level body dissatisfaction (BD) scores, even after controlling for the influence of individual differences in body mass index and internalization of appearance standards. CONCLUSIONS: Cultural-level variables may account for the development of adolescent BD.

Using rapid assessment and response to operationalise physical activity strategic health communication campaigns in Tonga.

ISSUES ADDRESSED: The aim of the present study was to identify stakeholder and program beneficiary needs and wants in relation to a netball communication strategy in Tonga. In addition, the study aimed to more clearly identify audience segments for targeting of communication campaigns and to identify any barriers or benefits to engaging in the physical activity program. METHODS: A rapid assessment and response (RAR) methodology was used. The elicitation research encompassed qualitative fieldwork approaches, including semistructured interviews with key informants and focus group discussions with program beneficiaries. Desk research of secondary data sources supported in-field findings. RESULTS: A number of potential barriers to behavioural compliance existed, including cultural factors, gender discrimination, socioeconomic factors, stigmatising attitudes, the threat of domestic violence, infrastructure and training issues. Factors contributing to participation in physical activity included the fun and social aspects of the sport, incentives (including career opportunities, highlighting the health benefits of the activity and the provision of religious and cultural sanctions by local leaders towards the increased physical activity of women. CONCLUSIONS: The consultative approach of RAR provided a more in-depth understanding of the need for greater levels of physical activity and opportunities for engagement by all stakeholders. The approach facilitated opportunities for the proposed health behaviours to be realised through the communication strategy. Essential insights for the strategy design were identified from key informants, as well as ensuring future engagement of these stakeholders into the strategy. So what? The expanded use of RAR to inform the design of social marketing interventions is a practical approach to data collection for non-communicable diseases and other health issues in developing countries. The approach allows for the rapid mobilisation of scarce resources for the implementation of more strategic, targeted communication campaigns to support behavioural changes.

The Pacific Obesity Prevention in Communities project: project overview and methods.

Obesity is increasing worldwide with the Pacific region having the highest prevalence among adults. The most common precursor of adult obesity is adolescent obesity making this a critical period for prevention. The Pacific Obesity Prevention in Communities project was a four-country project (Fiji, Tonga, New Zealand and Australia) designed to prevent adolescent obesity. This paper overviews the project and the methods common to the four countries. Each country implemented a community-based intervention programme promoting healthy eating, physical activity and healthy weight in adolescents. A community capacity-building approach was used, with common processes employed but with contextualized interventions within each country. Changes in anthropometric, behavioural and perception outcomes were evaluated at the individual level and school environments and community capacity at the settings level. The evaluation tools common to each are described. Additional analytical studies included economic, socio-cultural and policy studies. The project pioneered many areas of obesity prevention research: using multi-country collaboration to build research capacity; testing a capacity-building approach in ethnic groups with very high obesity prevalence; costing complex, long-term community intervention programmes; systematically studying the powerful socio-cultural influences on weight gain; and undertaking a participatory, national, priority-setting process for policy interventions using simulation modelling of cost-effectiveness of interventions.

The role of policy in improving diets: experiences from the Pacific Obesity Prevention in Communities food policy project.

There is global interest in using multisectoral policy approaches to improve diets, and reduce obesity and non-communicable disease. However, there has been ad hoc implementation, which in some sectors such as the economic sector has been very limited, because of the lack of quality evidence on potential costs and impacts, and the inherent challenges associated with cross-sectoral policy development and implementation. The Pacific Obesity Prevention in Communities food policy project aimed to inform relevant policy development and implementation in Pacific Island countries. The project developed an innovative participatory approach to identifying and assessing potential policy options in terms of their effectiveness and feasibility. It also used policy analysis methodology to assess three policy initiatives to reduce fatty meat availability and four soft drink taxes in the region, in order to identify strategies for supporting effective policy implementation.

Psychosocial profiles of adolescent nonsmokers in the Pacific.

Studies examining adolescent smoking have focused on at-risk individuals, while overlooking the psychosocial profiles of those adolescents who have managed to remain nonsmokers. Accumulating evidence suggests that positive emotions such as happiness may be associated with the adoption of healthy practices, but limited evidence has emerged from developing countries. This study examined the association between non-smoking and positive emotions and psychosocial correlates in 3 large population samples of Pacific youths (N = 5659) living in Tonga, Vanuatu, and Pohnpei in the Federated States of Micronesia. Across all 3 samples, being confident was significantly associated with nonsmoking and being happy (Tonga, odds ratio [OR] = 1.39, 95% confidence interval [CI] = 1.12-1.73; Vanuatu, OR = 1.29, 95% CI = 1.02-1.63; Pohnpei, OR = 2.34, 95% CI = 1.60-3.34). Some cross-country differences in relationships were found in the associations between societal factors (ie, perceived connections with school, teachers, and peers, and perceived community importance and involvement) and nonsmoking and happiness. Findings have implications for developing innovative strategies aimed at preventing smoking uptake and suggest the need for focusing on identifying the determinants of nonsmoking and measuring positive emotions.