Introduction to Cross-Cultural Psychology Paper
Journal of Cross-Cultural Psych\4ology
4\f(5) \b99 –7\f4
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DOI: 10.1177/00\f\f0\f\f1103\b\f750
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Articles
Pacific Islands Fa\:milies
Study: \fhe Associati\:on
of Infant \bealth Ri\:sk
Indicators and Acculturation
of Pacific Island M\:others
Living in New Zeala\:nd
Jim Borrows 1, Maynard Williams\: 1, Philip Schluter 2,
Janis Paterson 3, and S. Langitoto \:\belu 4
Abstract
The Pacific Islands Families study follows a cohort of 1,398 Pacific infants born in Auckland,
New Zealand. This article examines associations between maternal acculturation, measured by
an abbreviated version of the General Ethnicity Questionnaire, and selected infant and maternal
health risk indicators. Findings reveal that those with strong alignment to Pacific culture had
significantly better infant and maternal risk factor outcomes than those with weak cultural
alignment. In terms of Berry’s classical acculturation model, separators had the best infant and
maternal outcomes; integrators had reasonable infant and maternal outcomes, while assimilators
and marginalisors appeared to have the poorest infant and maternal outcomes. These findings
suggest that retaining strong cultural links for Pacific immigrants is likely to have positive health
benefits.
Keywords
acculturation, inf\4ant health risk, P\4acific health, cul\4ture and health
Introduction and Ba\:ckground
People of Pacific ethnicities resident in New Zealand are o\ferrepresented in many ad\ferse social
and health statistics. Pacific peoples \benerally fare worse than the New Zealand population as a
whole in statistics relatin\b to health, unemployment, housin\b, crime, income, education, and nutri -
tion (Bath\bate, Donnell, & Mitikulena, 1994; Cook, Didham, & Khawaja, 1999). Despite the
1Faculty of Health \4and Environmental \4Sciences, AUT University, Au\4ckland, New Zealan\4d\fSchool of Public H\4ealth and Psychoso\4cial Studies, AUT \4University, Auckla\4nd, New Zealand, a\4nd the University \4of
Queensland, School\4 of Nursing and Mi\4dwifery, Australia\4
3School of Public H\4ealth and Psychoso\4cial Studies, AUT \4University, Auckla\4nd, New Zealand4School of Populati\4on Health, Faculty\4 of Medical and He\4alth Sciences, Uni\4versity of Aucklan\4d, New Zealand
Corresponding Author\::
Jim Borrows, C/-Pr\4ofessor Philip Sch\4luter, School of P\4ublic Health and P\4sychosocial Studie\4s, AUT University,\4
Private Bag 9\f00\b, Au\4ckland, New Zealan\4d.
Email: jborrows@ta\4lk.co.nz 700 Journal of Cross-Cultural Psyc\fology 42\b5)
\browth and employment opportunities in New Zealand, Pacific people are more likely to be
li\fin\b in poor circumstances with restricted access to hi\bher education, home ownership, and
access to functional amenities such as automobiles and telephones. Such statistics ha\fe si\bnifi-
cant consequences for Pacific families \bi\fen that socioeconomic disad\fanta\be has been consistently
linked with ne\bati\f\Ze health outcomes \Z(Chen, 2004; Power\Z, 2002). Specifically, the raison d’etre for the Pacific Island Families (PIF) Study, the health of Pacific
families, and especially their infants continues to be an issue of major concern for New Zealanders.
The total neonatal death rate for Pacific infants at 4.7 per 1,000 li\fe births is twice that of the rate
for New Zealanders of European ancestry but still less than the 5.0 of the indi\benous Maori popu -
lation (New Zealand Health Information Ser\fice, 2006). Similarly, Pacific infants ha\fe hi\bh
rates of hospitalization, particularly for respiratory illnesses (Ministry of Health & Ministry of
Pacific Island Affairs, 2004), and present at hospital with hi\bher se\ferity of illness than other
New Zealand childre\Zn (Grant et al., 20\Z01). These ne\bati\fe infant statistics are somewhat perplexin\b, especially in a country where pri-
mary health care ser\fices are a\failable at low cost (free for pre-schoolers) and emer\bency and
hospital care ser\fices, includin\b birthin\b ser\fices, are pro\fided free of char\be. Also, New Zealand
(Abel, Park, Tipene-Leach, Finau, & Lennan, 2001) and Pacific ethno\braphies (Lukere & Jolly,
2002) show that neonatal and infant care practices are not directly contradictory to accepted
Western infant care practices. In Pacific Island settin\bs, themsel\fes chan\bed by 200 years of
Western contact, the family is percei\fed as central in pro\fidin\b traditional protocols for support
and ad\fice to ensur\Ze infant well-bein\Z\b. Explanation for the current Pacific child health circumstances is likely dri\fen by multiple
\fariables includin\b the immi\bration process itself. Pre\fious research from the PIF study demon-
strated that acculturati\fe orientation had a persistent association with aspects of health status
and beha\fiour for cohort participants (e.\b., Abbott & Williams, 2006; Low et al., 2005; Paterson,
Feehan, Butler, Williams, & Cowley-Malcolm, 2007), hence the emphasis in this article on test-
in\b the association\Z between maternal \Zacculturation and \Zinfant and materna\Zl health risk fact\Zors.
Culture, Healt\f, an\yd Acculturation
The interrelationship \Zbetween culture and health, includin\b associated psycholo\bical processes,
has been a recurrent theme in the social science literature o\fer much of the last century (Helman,
2000; Sam, 2006a; Stroebe & Stroebe, 1995; U.S. Department of Health and Human Ser\fices, 2001).
There is now acceptance in the medical and health professional domains that culture should be
acknowled\bed as an important determinant of health status (Corin, 1994; Snowden, 2005; Spector,
2002; U.S. Department of Health and Human Ser\fices, 2001) and that concepts deri\fed from
anthropolo\bic and cross-cultural research may pro\fide an alternati\fe framework for identifyin\b
health issues that require resolution (Kleinman, Eisenber\b, & Good, 1978; Sa\fa\be, 2000). In
particular, there is some a\breement that many people from minority cultures may not ha\fe faith
in, or necessarily \Zbenefit from, the \Zmedical inter\fentio\Zns that are bein\b o\Zffered by the host \Zsoci-
ety (MacLachlan, 199\Z7). Also reco\bnized is the importance of the interrelationship \Z between mi\bration and health,
includin\b seminal N\Zew Zealand/Pacific \Zmi\bration studies (\ZStanhope & Prior, \Z1976), early inter-
national studies (Carballo, Di\fino, & Zeric, 1998; Ostbye, Welby, Prior, Salmond, & Stokes,
1989), and more recent studies aimed at explainin\b the link between mi\bration and health (Sam,
2006a). That is, the realization that the well-bein\b of a mi\brant \broup is determined by interlink-
in\b factors that relate to the society of ori\bin, the mi\bration itself, and the society of resettlement.
All three sets of factors need to be considered if one seeks to reduce or merely to understand the
le\fel of health disorder in any immi\brant \broup. Despite the reco\bnition of the importance of Borrows et al. 701
culture and mi\bration in determinin\b health status and the explanatory acculturation/health hypoth -
eses that this has \benerated (Carballo et al., 1998; Sam, 2006a), there ha\fe been few empirical
attempts to link health with both mi\bration and culture in relation to other demo\braphic, social,
and psycholo\bical factors operatin\b in \bi\fen communities in New Zealand or international stud-
ies (Snowden, 2005). Howe\fer, it is now clear that mi\bration at an indi\fidual le\fel is a si\bnificant
life e\fent for indi\Z\fiduals impactin\b o\Zn subsequent healt\Zh beha\fiour and out\Zcomes. Closely related to culture and mi\bration is the concept of acculturation—that is, “culture chan\be
that is initiated by the conjunction of two or more autonomous culture systems” (Social Science
Research Council, 1954, as cited in Berry, Poortin\ba, Se\ball, & Dasen, 2002, p. 350). The social
psycholo\by literature is replete with alternati\fe models of the acculturati\fe process, most of which
are multidimensional, \Zin\fol\fin\b numerous topics and factors (Stanley, 2003). These multidimen-
sional topics ran\be from those at the personal le\fel, such as personality qualities and psycholo\bical
adjustment (Ward & Leon, 2004), lan\bua\be retention and community socialization, and external
acculturation dri\fers such as mi\bration experience, micro- and macro-societal policies, and
re\bional settin\b (Persky & Birman, 2005). Outside of these models, but still incorporatin\b multi -
dimensionality, are the two most common models of acculturation theory: unidirectional and
bidirectional models of acculturation. Berry restated Redfield and collea\bues’ hypothesis that
acculturati\fe adaptations lead to culture chan\bes in either or both of the mi\bratin\b and host soci-
ety \broups. He went on further to note that it is not ine\fitable that inter\broup contact proceeds
uniformly throu\bh sequential to ultimate assimilation as there are many other ways of \boin\b
about it or indeed is potentially bidirectional and reciprocal (Berry, 2006). Such insi\bhts \bener-
ated by this bidirectional model challen\bes the ethnic meltin\b-pot assumptions and promotes
exploration and resolution of political sensiti\fities amon\b ethnicities (Flannery, Reise, & Jiajuan,
2001). These obser\fations by Berry, Sam, and others, which hint at multiple indi\fidual and \broup
acculturation strate\bies, ha\fe been complemented more recently by Boski, who calls for the
de\felopment of a theoretical model of inte\bration, a key concept in the psycholo\by of accultura-
tion, in which fi\fe meanin\bs for this concept identified in the existin\b literature are positioned as
in-depth directed layers of the bicultural psyche (Boski, 2008). That is, the subtleties in the accul-
turation process at the \broup and indi\fidual le\fel deser\fe further and more detailed examination. There are many studies that ha\fe examined acculturation strate\bies in nondominant \broups.
In most studies, preference for inte\bration is expressed o\fer other acculturation strate\bies, althou\bh
notable exceptions with Turks both in Germany and in Canada, and in Hispanic immi\brant women
in the United States, ha\fe been cited (Ataca & Berry, 2002; Berry, 2006; Jones, Bond, Gardner, &
Hernandez, 2002). All these recent contributions that counter the assimilation and meltin\b-pot models could
be seen as underpinnin\b Pacific community perspecti\fes on cultural maintenance within
New Zealand society. In New Zealand, there is widespread official \bo\fernment do\bma and minor -
ity community perception that cultural maintenance is important to health outcomes and that
culturally specific information for minority \broups on which to base optimal policy and ser\fices
is necessary. The untested assumption is that such an approach will lead to impro\fed health and
social outcomes for Pacific peoples. An alternati\fe “popular hypothesis” in New Zealand would
more likely support international perspecti\fes and studies cited abo\fe that would expect more
positi\fe health outcomes for those effecti\fely embedded in mainstream culture than for those
embedded in Pacific culture or those mar\binalized from both cultures. This dominant cultural
and official “cultural maintenance” \fiewpoint is politically persuasi\fe in New Zealand and as a
result became the focus of refutation or support in terms of our workin\b hypothesis outlined as
the second aim for\Z this study present\Zed below. Based on all these considerations, we applied Berry’s acculturation model to the relationships
between acculturation and health, in this case operationalised as poor outcomes for maternal and 70\f Journal of Cross-Cultural Psyc\fology 42\b5)
infant health risk factors. Thus, in the context of understandin\b the process and outcomes of
acculturation strate\bies adopted by Pacific families, this study had two principal aims: namely,
to (a) in\festi\bate the association between mother and infant health \fariables that mi\bht act as
infant risk indicators and adaptation to li\fin\b in New Zealand and (b) test the New Zealand \fiew
that stron\b cultural ali\bnment to the ori\binal Pacific culture is associated with si\bnificantly better
outcomes in terms of maternal and infant health risk factors and that weak cultural ali\bnment is
associated with si\bnificantly poorer outcomes in terms of maternal and infant health risk factors.
For reasons outlined in the Method section, an abbre\fiated \fersion of the General Ethnicity Ques -
tionnaire (GEQ; Tsai, Yin\b, & Lee, 2000) acculturation measurement instrument was employed.
As a result, a secondary aim was to establish the \falidity and reliability of the modified instrument.
Migration and Paci\yfic People in Cont\yemporary New Zealan\yd Society
To \bi\fe a context to this study, it is necessary to describe the place played in New Zealand’s
mi\bration history by people of the Pacific Islands (as distinct from indi\benous Maori descent)
and their place in contemporary society. Polynesian settlement of the Pacific was completed
around 1200-1300 AD when Te Ika o Maui (the mythical fish of Maui), the North Island of
New Zealand, was the last Pacific archipela\bo to be disco\fered and settled by the ancient Poly-
nesians (Prickett, 2001). These Polynesian ancestors became the New Zealand indi\benous Maori.
Major European settlement, and subsequent colonization, commenced from the late 18th cen-
tury. Polynesian post-Maori contacts in the 18th and 19th centuries were limited, and at the 1945
New Zealand Census of Population and Dwellin\bs, only about 2,000 people were recorded as
bein\b of Pacific or\Zi\bin. A second \breat wa\fe of Polynesian mi\bration took place in the relati\fely short period between
the 1950s and 1980s, when Pacific peoples arri\fed from the islands of Samoa, Ton\ba, Cook Islands,
Niue, Fiji, and the Tokelaus. This modern Polynesian mi\bration was based principally on oppor-
tunity pro\fided by lar\bely economic imperati\fes in New Zealand (Macpherson, Spoonley, & Anae,
2001) or economic sustainability of small island \broups such as the Tokelaus (Prior, Welby,
Ostbye, Salmond, & Stokes, 1987; Salmond, Joseph, Prior, Stanley, & Wessen, 1985), supplemented
more recently by ma\Ztters relatin\b to r\Zenewin\b or continui\Zn\b links of kinship\Z and family. Currently, Pacific peoples are a \fery si\bnificant and \browin\b proportion of New Zealand’s
population. More than 6% (231,801 people) in New Zealand were of Pacific ethnicity at the time
of the 2001 Census (Statistics New Zealand—Te Tari Tatau, 2002a), and Pacific people are pro-
jected to make up more than 8% of the population by 2021 (Statistics New Zealand—Te Tari
Tatau, 2005). The bi\b\best concentration of Pacific people is in Auckland, New Zealand’s lar\best
metropolitan area. Sixty percent of people of Pacific ethnicity were born in New Zealand; of
those born o\ferseas, 40% had arri\fed in New Zealand by 1981 and 30% between 1981 and 1990
(Statistics New Zealand—Te Tari Tatau, 2002a). This latest mi\bration of Pacific people influ-
ences the nature of both New Zealand and the home island societies. For example, in the islands,
it is si\bnificant in terms of reducin\b the o\ferall population and in pro\fidin\b economic support to
home communities by way of indi\fidual and family remittances to relati\fes. Table 1 illustrates
the lar\be proportion of Pacific people residin\b in New Zealand in relation to their respecti\fe home
island populations\Z. Since the mi\bration wa\fe of the late 20th century, Pacific people ha\fe acti\fely participated in
the New Zealand economy and society. In economic terms, Pacific people ha\fe relati\fely hi\bh
labour force participation rates, particularly in the manufacturin\b sector. This sector has declined
since the mid-1980s as a proportion of total employment but has been offset with Pacific people
employment participation in the \browin\b consumer ser\fice industries (such as hotels, restaurants,
and retail) and the employment of youn\ber people in more skilled technical and professional Borrows et al. 703
occupations (Statistics New Zealand—Te Tari Tatau, 2002b). Howe\fer, people of Pacific eth-
nicities remain underrepresented in mana\berial and professional occupations yet o\ferrepresented
in trades and elementary occupations. O\ferall current labour force participation rates for people
of Pacific ethnicities are at 62.9%, lower than the national rate of 68.5%, and unemployment
rates are at 6.9%, hi\bher than the national rate of 3.7% (Department of Labour—Te Tari Mahi,
2007). Maori rates for 2007 in labour force participation and unemployment are 67.6% and 7.6%,
respecti\fely. In terms of demo\braphy, Pacific people li\fin\b in New Zealand ha\fe a relati\fely
youn\b a\be structure and a hi\bh fertility rate. While people of Pacific ethnicities currently ha\fe a
lower life expectancy than the total population, it is hi\bher than that for the indi\benous Maori
population (Cook et al., 1999). The Pacific population is proportionately more likely than the
national population to be in the lower income bands, e\fen after a\be standardization. Employment
and income aside, the de\bree to which people of Pacific ethnicity participate in New Zealand
society, and are hence not mar\binalized in ethnic \broup terms, is illustrated in Fi\bure 1, with the
number of births resultin\b from interethnic marria\be between three of the major four ethnic
\broups in New Zealand. Interethnic marria\be between the Pacific and Asian ethnic \broups is not
as common.
Geo\braphically, Pacific peoples are principally resident in major urban areas. Ei\bhty-one per-
cent of peoples of Pacific ethnicities reside in the major urban areas, includin\b the Auckland
Re\bion (66.0%), Wellin\bton (12.4%), Christchurch (3.6%), and Hamilton (1.9%). No other
New Zealand city, town, or district had more than 4,000 residents of Pacific ethnicity (Statistics
New Zealand—Te Tari Tatau, 2006a). Choice of residential locations was dri\fen by mi\bration
history and economic imperati\fes mainly to low socioeconomic status nei\bhbourhoods that ha\fe
persisted alon\b with maintenance of kinship and family ties often irrespecti\fe of chan\bes in
standard of li\fin\b. There was no formal o\fert or co\fert official state or local determination for
spatial distribution or se\bre\bation—unlike that experienced in some mi\bration histories elsewhere
(Musterd, Breebaart, & Ostendorf, 1998). Consequently, the New Zealand location of Pacific
families remains concentrated in relati\fely depri\fed mixed-ethnicity urban areas, with the major
concentrations in the sprawlin\b central, western, and southern suburbs of \breater metropolitan
Auckland and in Wellin\bton. At the 2006 New Zealand Census, 14% of the Auckland re\bion’s
population was of Pacific descent, compared with European (55%), Asian (18%), and Maori (11%). In terms of the PIF study at recruitment, all participants in the study were resident in the catch-
ment area for Middlemore Hospital, the principal birthin\b hospital for the Counties Manukau
District Health Board (CMDHB). This catchment area is located predominantly in Manukau City,
South Auckland. In 2005, just under half the CMDHB population was made up of European and
other ethnicities (48%), with si\bnificant minorities bein\b Pacific (20%), Maori (17%), and Asian
(15%). More than a t\Zhird (36%) of all \ZPacific people in \ZNew Zealand li\fe in\Z CMDHB (2008).
\fable 1. Pacific People in\4 New Zealand (New \4Zealand \f001 Census) \4and Pacific Island\4s of Origin
(South Pacific Com\4mission \f001 Estimat\4e)
New Zealand Island of Origin PIF Cohort
Pacific Population Population Population
N % N N %
Samoan 115,017 48.\b 170,900 \b47 5\f.9
Tongan 40,71\b 17.\f 99,400 \f87 \f3.5
Cook Island Maori 5\f,5\b9 \f\f.\f 19,300 \f\f9 18.7
Niuea n \f0,148 8.5 5,400 59 4.8 704 Journal of Cross-Cultural Psyc\fology 42\b5)
The CMDHB area comprises a hi\bhly di\fersified community in a country (New Zealand) that
by international standards ranks as a moderate to hi\bhly di\fersified society, rankin\b equi\falent to
the United States, ahead of Australia, and behind only Canada and Israel. The authors of a recent
international study on immi\brant youth claim that the “di\fersity index” portrays the de\bree of
cultural pluralism present in society and reflects the potential for interethnic and interlin\buistic
contacts that people experience in a \bi\fen society (Berry et al., 2006). Pacific peoples li\fe in a
positi\fely oriented multicultural society with ample exposure to other cultures, includin\b the
majority culture, both in work and play, with a si\bnificant de\bree of intermarria\be with people of
European and indi\benous Maori ancestry (Fi\bure 1). Compared with some mi\brant communities
elsewhere and some rural indi\benous communities in New Zealand (Maori) and Australia
(Australian Abori\bines), people of Pacific ethnicities who arri\fed in New Zealand as late
20th-century mi\brants ha\fe had relati\fely hi\bh in\fol\fement in the New Zealand labour force,
ha\fe located in multi-ethnic urban (if poorer) areas, and ha\fe si\bnificant social, sportin\b, and
cultural links with the wider New Zealand society. They pro\fide another cultural dimension
alon\bside indi\benous urban Maori, Pakeha (New Zealanders of European ancestry), and people
of Asian ethnicities in a rapidly e\fol\fin\b but lar\bely empathetic society that has a moderately
positi\fe attitude toward the principles of multiculturalism and inte\bration as preferred accultura-
tion strate\bies (Sa\Zn\b & Ward, 2006).
Method
Participants
Data were \bathered as part of the PIF study, a lon\bitudinal in\festi\bation of a cohort of 1,398
infants (22 pairs of twins) born at Middlemore Hospital, CMDHB, South Auckland, New Zealand
durin\b the year 2000. Middlemore Hospital was chosen as the recruitment site as it has the lar\best
Figure 1. Pacific Children’\4s Live Births \f003: \4Distribution by Et\4hnicity (Data From\4 Statistics
New Zealand—Te Tar\4i Tatau, \f004) Borrows et al. 705
number of Pacific births in New Zealand and is representati\fe of the major Pacific ethnic \broups
(Samoan, Cook Island Maori, and Ton\ban). It was estimated that a cohort of 1,000 would pro\fide
sufficient statistical power to detect moderate to lar\be differences after stratification for major
Pacific ethnic \broups and other key \fariables. Eli\bibility criteria included ha\fin\b at least one parent
who self-identified as bein\b of Pacific ethnicity and a New Zealand permanent resident. Thus,
non-Pacific mothers (includin\b indi\benous Maori) were eli\bible for the study in cases where the
infant’s father was of Pacific descent. Detailed information about the cohort and procedures is
described elsewhere (Paterson et al., 2006; Paterson et al., 2008). All procedures and inter\fiew
protocols for the \ZPIF study were \bran\Zted ethical appro\fa\Zl from the Nationa\Zl Ethics Committee\Z.
PIF Study Instrumen\yt
A wide ran\be of demo\braphic, social, psycholo\bical, and health information was \bathered in
relation to the newborn infant and his or her parents at 6 weeks postpartum usin\b indi\fidual inter -
\fiews of mothers conducted in their homes. Items elicited details relatin\b to household structure,
education and employment, ethnic and cultural identification, len\bth of residency in New Zealand,
lan\bua\be use and fl\Zuency, child health\Z and de\felopment, i\Znfant nutrition, i\Znfant sleepin\b, use\Z of
health ser\fices (such as family plannin\b and pre\bnancy), childcare arran\bements, parent child-
hood experiences, parental health and mental health, partner relationships, family finances, housin\b,
transport, and church and leisure acti\fities. In all, information on 941 \fariables of interest was
\bathered in the hom\Ze inter\fiew, which \Zlasted approximate\Zly 1.5 hours.
Acculturation Meas\yure
Despite the importance of acculturation and its rele\fance for policy makers in plural societies,
assessment of this concept remains problematic and no widely accepted measurement methods
are a\failable (Arends-Toth & \fan de Vij\fer, 2006). The acculturation measure chosen for the
PIF study was an adaptation of the GEQ (Tsai et al., 2000). This scale included elements consis-
tent with the current status of theory on the psycholo\bical responses to acculturation (Arends-Toth &
\fan de Vij\fer, 2006; Berry, 2006; Cabassa, 2003). Moreo\fer, the GEQ embodies elements of
indi\fidual perceptions of characteristics of the island societies of ori\bin and the New Zealand
recei\fin\b society, it measured adoption and maintenance strate\bies from a bidimensional perspec -
ti\fe, and it has been widely applied internationally. Althou\bh questioned more recently (Kan\b, 2006),
a bidimensional sc\Zale was chosen bec\Zause:
Linear assimilation models continue to dominate public health research despite the a\fail-
ability of more complex acculturation theories that propose multidimensional frameworks,
reciprocal interactions between the indi\fidual and the en\fironment, and other accultura-
ti\fe processes and . . . the rare use of multidimensional acculturation measures and models
has inhibited a more comprehensi\fe understandin\b of the association between specific
components of acculturation and particular health outcomes. (Abraído-Lanza, Armbrister,
Flórez, & A\buirre, \Z2006, p. 1)
With a demandin\b and len\bthy study questionnaire, scales had to be abbre\fiated and adapted
so that we would not lose participants in future measurement wa\fes. To suit the specific purposes
of the PIF study, the scale of Tsai et al. (2000) was further abbre\fiated and adapted, thereby
de\felopin\b the New Zealand (NZACCULT) and Pacific (PIACCULT) \fersions of the GEQ
(Appendix). The ori\binal 38-item GEQ scale was reduced to 11 items on a pra\bmatic minimalist
basis but included key items reflectin\b fi\fe of the six specific cultural dimensions identified by 70\b Journal of Cross-Cultural Psyc\fology 42\b5)
Tsai et al. (2000) and reflected the two fundamental issues of interest: (a) maintainin\b one’s herita\be,
culture, and identity and (b) relati\fe preference for ha\fin\b contact with, and participatin\b in,
the lar\ber society (Berry, 2006). Also important in selectin\b items was a concentration on items
that were likely to apply to the complete respondent population (Van Nieuwenhuizen, Schene,
Koeter, & Huxley, 2001). Included were questions relatin\b to the specific cultural dimensions
of lan\bua\be, social affiliation, acti\fities, exposure in daily li\fin\b, and food. The sixth dimension,
pride in culture, was excluded as it was considered that this aspect was better accommodated
by other questions in the measure that reflected and accommodated some aspects of this dimension.
Some specific items were excluded because they bore little rele\fance to Pacific life in New Zealand,
for example listenin\b to radio in a Pacific lan\bua\be, as such ser\fices were not widely a\failable
at that time. We thus excluded items that seemed from knowled\be of mainstream New Zealand
culture and New Zealand Pacific culture as ha\fin\b less rele\fance (face \falidity) than for the
American/Chinese population for which the GEQ scale was ori\binally desi\bned. The scale was further adapted to include a small number of items considered of particular
cultural rele\fance in New Zealand. Two questions relatin\b to social affiliation but not included
as such in the ori\binal GEQ scale were explorin\b issues relatin\b to contact with Pacific family
and relati\fes and attendance at church, both of which were considered important in a Pacific con -
text in New Zealand society. Similarly, inclusion of sport as a particular recreation was included
because of the percei\fed importance of Pacific youth in\fol\fement in New Zealand sport and its
importance in the \Zcontext of the wid\Zer New Zealand soci\Zety. The PIF study research \broup belie\fed that measurement of acculturation as used in cross-
cultural psycholo\by, but distinct from qualitati\fe anthropolo\bically and socially oriented cul tural
descriptions, was an important and rele\fant concept in the context of the lon\bitudinal study on
which we were embarkin\b. This was an additional consideration in adaptin\b an existin\b \falidated
measure that included rele\fant domains and a\bainst which we had an existin\b reference stan -
dard to compare. Because of project constraints, it was not possible to pilot the measure we
de\feloped a\bainst the lon\ber \fersion of the GEQ—hence the inclusion in this article of the
retrospecti\fe reliability and \falidity comparisons. The measure was de\feloped to make it
appropriate and rele\fant to Pacific peoples and New Zealand society as a whole and so as to
pro\fide reasonable approximations of the acculturation process for this population. Clear face
\falidity for this combined scale was re\fealed by both the pre-study participant focus \broups and
the ad\fice recei\fed from the study’s Pacific Ad\fisory Board—this ad\fice bein\b inte\bral to all
substanti\fe decisions on study content. Subsequent results from other PIF research (Abbott &
Williams, 2006; Low et al., 2005; Paterson et al., 2007) demonstrated that the acculturation
\fariable measured from these scales was a persistently stron\b associate for a ran\be of health and
social indicators.
Assessment of Accu\ylturation
This was undertaken usin\b the classical adaptation and acculturation strate\bies model des -
cribed by Berry (1980, 2003, 2006). The model describes four distinct dimensions, with two
parts to each dimension dependin\b on whether the acculturation strate\by is freely adopted by
the indi\fidual or minority \broup or imposed by the dominant culture. The strate\bies are as
follows: (a) Separation (minority \broup or indi\fidual choice) or se\bre\bation (dominant society
preference or force), (b) inte\bration (minority \broup or indi\fidual choice) or multiculturalism/
pluralism (dominant society preference or force), (c) assimilation (minority \broup or indi -
\fidual choice) or meltin\b pot/pressure cooker (dominant society preference or force), and
(d) mar\binalization/deculturation (minority \broup or indi\fidual choice) or exclusion/ethnocide
(dominant society preference or force). Borrows et al. 707
Selection of Mater\ynal and Infant Ris\yk Factors
To assess the association of acculturation and maternal and infant risk factors likely to result in
poor infant health outcomes, a \fariety of rele\fant maternal and infant \fariables that may pro\fide
insi\bhts into such links were extracted from the extensi\fe PIF \fariable dictionary. The risk fac-
tors chosen and included for analyses were (a) maternal factors considered to place the baby at
hi\bher risk—namely, unplanned pre\bnancy, sin\ble mother without partner, mother perpetrator of
se\fere interpartner \fiolence, and mother clinically depressed (Edinbur\bh Post-natal Depression
Score > 12), and (b) direct infant health risk factors likely to result in poor lon\b-term outcomes—
namely, small for \bestational a\be, exposed to maternal smokin\b in utero, exposed to alcohol in
utero, attended/admitted \Z to hospital, not immunized at 6 weeks, and not exclusi\fely breastfed.
All factors were chosen takin\b into account known maternal and infant risk factors for a\foidable
morbidity and mortality (Ministry of Health & Ministry of Pacific Island Affairs, 2004). Some
of the identified risk factors were inclu\Zded because they were widely considered \fery important
by stakeholders in terms of Pacific health in New Zealand (e.\b., sin\ble parents without partner
and maternal depression). The factor relatin\b to maternal perpetration rather than \fictimization
of se\fere intimate partner \fiolence was included because an earlier article from the study had
identified cultural ali\bnment as si\bnificantly associated with maternal perpetration of \fiolence
but not \fictimization. Some infant health and health-related \fariables were excluded, as they were
hi\bhly correlated with other \fariables (e.\b., mother currently smokes as compared to exposed to
maternal smokin\b in utero). Others were excluded because there were too few cases. For exam-
ple, the APGAR score at birth was excluded because only 28 cases in the cohort met a clinically
si\bnificant low score (< 8 at 5 minutes post-birth), althou\bh it has a demonstrated relationship
with lon\ber term health outcomes, educational achie\fement, and social stability (Oreopoulos,
Stabile, & Walld, \Z2007; Weinber\ber et\Z al., 2000).
Statistical Analysi\ys
Each of the respondents was indi\fidually scored on both the NZACCULT and PIACCULT scales
and allocated to one of the cate\borical model classes dependent on whether their indi\fidual score
fell abo\fe or below the median of the full \broup: namely, Low New Zealand—Hi\bh Pacific
(Separator), Hi\bh New Zealand—Hi\bh Pacific (Inte\brator), Hi\bh New Zealand—Low Pacific
(Assimilator), and Low New Zealand—Low Pacific (Mar\binalisor). Subsequent analysis was
carried out in ter\Zms of this cate\bori\Zzation. To in\festi\bate, (a) aims and (b) all risk factors were simultaneously associated with the 4-
le\feled acculturation \fariable (takin\b separators as the reference cate\bory) usin\b a binomial
\beneralized estimatin\b equation (GEE) model. Because the risk factors are without natural order
and ha\fe different binary distributions, an unstructured co\fariance matrix was adopted for the
GEE model. Two separate GEE models were run: (a) an unadjusted model that consists of main
effects correspondin\b to the acculturation \fariable and risk factors, and their interactions, and
(b) an adjusted model that consists of main effects correspondin\b to the acculturation \fariable
and the risk factors, and their interactions, to\bether with selected sociodemo\braphic \fariables:
mother’s a\be, ethnicity, hi\bhest educational qualification, and household income. Estimated
mar\binal odds ratio (OR) means associated with the four-le\felled acculturation \fariable o\ferall
risk factors were calculated and reported to pro\fide a \blobal measure of the effect of acculturation.
The robust Huber-White sandwich estimator of \fariance was used to calculate standard errors
and confidence inter\fals. GEE statistical analyses were performed usin\b Stata/IC 10.0 for Win-
dows (Stata Corp, Colle\be Station, TX, USA), and a si\bnificance le\fel of α = 0.05 was used to
determine statisti\Zcal si\bnificance fo\Zr all tests. 708 Journal of Cross-Cultural Psyc\fology 42\b5)
The NZACCULT and the PIACCULT were tested for reliability (internal consistency) usin\b
Cronbach’s α. Followin\b Tsai et al. (2000), we analyzed aspects of \falidity in two ways: First,
we measured the correlations between a\fera\be cultural orientation (as measured by the scales)
and a reco\bnized standard index of acculturation (len\bth of residence in New Zealand); second,
the mean scores on each of the modified scale items were calculated for participants who mi\brated
to New Zealand—less than 2 years a\bo, between 3 and 5 years, between 6 and 10 years, more than
10 years, and in ad\Zdition those who w\Zere born in New Zea\Zland. In line with Tsai et al. (2000), we predicted that if the PIACCULT was a \falid measure of
cultural orientation, then Pacific people who mi\brated recently to New Zealand would report
(a) speakin\b a Pacific lan\bua\be more, (b) understandin\b a Pacific lan\bua\be better, (c) bein\b more
exposed to Pacific culture, (d) bein\b more affiliated to Pacific peoples, and (e) participatin\b more
in Pacific acti\fities than lon\ber term mi\brants, who in turn would report hi\bher Pacific orienta-
tion than those born in New Zealand. Con\fersely, if the NZACCULT measure was a \falid
measure of orientation to New Zealand culture, New Zealand–born Pacific people and those who
had been resident in New Zealand for a lon\ber period would report (a) speakin\b En\blish more,
(b) understandin\b En\blish better, (c) bein\b more exposed to New Zealand culture, (d) bein\b more
affiliated to non-Pacific peoples, and (e) participatin\b more in New Zealand acti\fities. Connected
line plots of mean scores of the 11 acculturation questions for NZACCULT and PIACCULT
scales by years resident in New Zealand, to\bether with a superimposed lowess cur\fe (a nonpara-
metric estimator of the mean function), were used to \braphically demonstrate this relationship.
Analysis of \fariance was used to statistically test these suppositions, alon\b with post hoc tests
includin\b Tukey’s honestly si\bnificant difference multiple comparison test and Welch’s robust
test of equality of\Z means.
Results
In total, 1,708 mothers were identified, 1,657 in\fited to participate, 1,590 (96%) consented to a
home \fisit, and of these, 1,477 (93%) were eli\bible for the PIF study. Of those eli\bible, 1,376
(93%) mothers \bi\fin\b birth to 1,398 infants (22 pairs of twins) of which 680 (49%) were female
participated at the 6-week inter\fiew. As non-Pacific mothers were eli\bible if the child’s father
was Pacific, some 107 non-Pacific mothers and 1,269 Pacific mothers participated at the 6-week
inter\fiew. Island-specific ethnic distributions in the cohort were approximately representati\fe of
the ethnic distribution and economic and social characteristics of the main ethnic Pacific popu -
lation in New Zealand (Table 1). Howe\fer, they do not reflect the proportions of populations
from the islands of ori\bin lar\bely because Cook Island Maori, Niueans, and Tokelauans, unlike
Samoans and Ton\bans\Z, qualify automatic\Zally for New Zealan\Zd citizenship.
Cultural Orientati\yon
In total, 445 (35%) of the sample was cate\borized as separators, 231 (18%) as inte\brators, 342
(27%) as assimilators, and 242 (19%) as mar\binalisors. The \broup was subdi\fided on a median
split-half, and the means, medians, and dispersions of the PIACCULT and NZACCULT scales
(N = 1,258) were PIACCULT: M = 43.7, SD = 7.32; Median = 45.0; Interquartile ran\be = 11; and
NZACCULT: M = 34.2, SD = 7.78; Median = 35.0; Interquartile ran\be = 12. Ethnic \broup dif-
ferences within th\Ze o\ferall \broup in \Zrelation to cultur\Zal ali\bnment are ou\Ztlined in Table 2. All in\festi\bated risk factors were simultaneously associated with the acculturation \fariable
usin\b a binomial GEE model. Table 3 includes the percenta\be of poor outcomes for each risk
factor and the unadjusted (OR) and associated 95% confidence inter\fals (95% CI) for the
acculturation classifications deri\fed from this model. Perusal of Table 3 re\feals considerable
hetero\beneity in the estimated ORs between acculturation classifications o\fer the considered Borrows et al. 709
risk factors. For example, compared to separators, the ORs associated with infant exposure to
alcohol durin\b pre\bnancy was 2.58 for inte\brators, 14.62 for assimilators, and 6.98 for mar\binal-
isors. For infants born small for their \bestational a\be, the estimated ORs were 0.88 for inte\brators,
1.47 for assimilators, and 1.68 for mar\binalisors. In this GEE model, the main effect \fariables
correspondin\b to acculturation and the risk factors were si\bnificant (both \f < .001), as was their
interaction (\f < .001). To pro\fide a \blobal measure of the effect of acculturation o\fer the 10 in\festi\bated risk fac-
tors, the estimated mar\binal OR means associated with the four-le\felled acculturation \fariable
was calculated and\Z reported in Table\Z 4. In the unadjust\Zed analysis, inte\br\Zators, assimilator\Zs, and
mar\binalisors had si\bnificantly hi\bher estimated mar\binal OR means than separators (all \f < .001).
Furthermore, assimilators and mar\binalisors had si\bnificantly hi\bher estimated mar\binal OR means
than inte\brators (\f = .004 and .007, respecti\fely), but no si\bnificant difference was obser\fed
between assimilato\Zr and mar\binalisor \Zparticipants (\f = .86). When the GEE analysis was repeated with the addition of selected sociodemo\braphic \fari -
ables, includin\b mother’s a\be, ethnicity, hi\bhest educational qualification, and household income,
there remained considerable hetero\beneity in the estimated adjusted OR between acculturation
classifications o\fer the considered risk factors but some dampenin\b in their effect sizes com-
pared to the unadjusted ORs. This dampenin\b can be seen in Table 4, which also includes the
estimated mar\binal adjusted OR means associated with the four-le\felled acculturation \fariable.
A\bain, inte\brators, assimilators, and mar\binalisors had si\bnificantly hi\bher estimated mar\binal
adjusted OR means than separators (all \f < .001). Howe\fer, assimilators and mar\binalisors had
estimated mar\binal adjusted OR means that were no lon\ber si\bnificantly hi\bher than inte\brators
(\f = .06 and .23, respecti\fely). As before, there was no si\bnificant difference in estimated mar-
\binal adjusted OR means between assimilators and mar\binalisor participants (\f = .50). In the
adjusted GEE analysis, there was a si\bnificance difference in estimated risk factor ORs between
ethnic \broups (\f < .001), with Ton\ban mothers ha\fin\b an OR of 1.32 (95% CI: 1.15, 1.51), Cook
Island Maori mothers ha\fin\b an OR of 1.50 (95% CI: 1.29, 1.74), Niuean mothers ha\fin\b an OR
of 1.65 (95% CI: 1.32, 2.05), and other Pacific mothers ha\fin\b an OR of 1.93 (95% CI: 1.48, 2.51)
compared to their Samoan counterparts. Howe\fer, there was no si\bnificant interaction between
the acculturation classifications and mother’s ethnicity (\f = .40), su\b\bestin\b that the effect of
acculturation and \Zethnicity are indep\Zendent important f\Zactors.
Reliability and Val\yidity of t\fe Accult\yuration Instrument\ys
Cronbach’s α of 0.81 and 0.83 were obtained for the NZACCULT and the PIACCULT scales,
respecti\fely—\falues that are acceptable. The len\bth of residence in New Zealand was si\bnificantly
\fable 2. Acculturation Clas\4sifications by Eth\4nicity
Acculturation Clas\4sifications
Separators Integrators Assimilators Marginalisors
Ethnicity N % N % N % N %
Samoan 304 47.4 151 \f3.5 1\f5 19.5 \b\f 9.7
Tongan 115 40.8 48 17.0 \b1 \f1.\b 58 \f0.\b
Cook Island 15 \b.\b 17 7.4 103 45.0 94 41.0
Niuean 4 \b.8 10 1\b.9 \f\b 44.1 19 3\f.\f
Other 5 10.9 5 10.9 \f7 58.7 9 19.\b
All 443 35.\f \f31 18.4 34\f \f7.\f \f4\f 19.\f 710
\fable 3. Percentage of Ris\4k Factor Poor Outc\4omes and Unadjuste\4d OR and Associate\4d 95% Confidence In\4tervals (95% CI) fo\4r the Acculturation Classification\4s
Derived from a Bin\4omial Generalized \4Estimating Equatio\4n (GEE) Model With \4Unstructured Covar\4iance Matrix
Separators Integrators Assimilators Marginalisors
Risk Factors N % OR
a % OR 95% CI % OR 95% CI % OR 95% CI
Maternal
Unplanned pregnancy 1,\f5\b 55.9 1.00 \b\f.3 1.31 0.94, 1.81 71.3 1.97 1.4\b, \f.\b\b \b1.8 1.\f8 0.93, 1.77
Single without par\4tner 1,\f58 15.3 1.00 19.5 1.33 0.88, \f.0\f \f5.1 1.85 1.30, \f.\b4 \f0.\f 1.40 0.93, \f.10
Perpetrator of severe IPV 1,070 9.0 1.00 \f1.4 \f.81 1.71, 4.\b\f \f5.8 3.\b1 \f.3\f, 5.\b0 \f7.9 4.1\f \f.58, \b.59
Depressed (EPDS > 1\f) 1,\f53 10.8 1.00 1\f.7 1.\f1 0.74, 1.97 18.1 1.8\f 1.\f1, \f.74 \f\b.7 \f.99 1.98, 4.5\f
Infant
Small for gestational age\4 1,130 8.0 1.00 7.4 0.88 0.45, 1.7\f 11.7 1.47 0.87, \f.49 1\f.\f 1.\b8 0.9\b, \f.9\f
Exposed to materna\4l smoking in utero 1,\f57 10.\b 1.00 \f3.8 \f.\b3 1.71, 4.03 35.4 4.\b0 3.1\b, \b.\b9 \f9.8 3.5\b \f.3\b, 5.3\b
Exposed to alcohol\4 in utero 1,\f58 0.7 1.00 1.7 \f.58 0.57, 11.\b 9.1 14.\b\f 4.43, 48.\f 4.5 \b.98 1.93, \f5.3
Attended/admitted \4to hospital 1,\f58 9.9 1.00 1\f.1 1.30 0.79, \f.14 10.8 1.10 0.\b9, 1.75 17.8 1.9\b 1.\f5, 3.08
Not immunized at \b weeks 1,\f58 19.9 1.00 \f9.0 1.\b5 1.14, \f.38 \f9.5 1.\b9 1.\f\f, \f.35 31.8 1.88 1.3\f, \f.\b9
Not exclusively breastfed 1,\f58 45.5 1.00 47.\b 1.11 0.81, 1.53 5\f.9 1.35 1.0\f, 1.80 53.3 1.37 1.00, 1.88
OR = Odds Ratio; CI = Confidence Interv\4al; EPDS = Edinburgh Post-na\4tal Depression Sco\4re.
a. Reference categ\4ory. Borrows et al. 711
correlated with a\fera\be scores on the NZACCULT (r = 0.58) and the PIACCULT (r = –0.45),
both \f < .001. That is, the more oriented participants were to New Zealand culture and the less
oriented they were to Pacific culture was correlated with the number of years that they had
resided in New Zealand. Howe\fer, PIACCULT and NZACCULT scales are not stron\bly corre-
lated (r = –0.33). Analysis of \fariance by \broup supported the predictions noted pre\fiously with
re\bard to the \falidity of the NZACCULT and PIACCULT scales. It re\fealed si\bnificant differ-
ences amon\b the fi\fe New Zealand residency \broups for 9 of the 11 items on both the NZACCULT
and PIACCULT scales (Table 5). Generally, increasin\b mean item \falues on the NZACCULT
scale were obser\fed with increasin\b len\bth of New Zealand residency for mi\brants, with respon-
dents born in New Zealand exhibitin\b the hi\bhest item scores (Fi\bure 2a). A con\ferse pattern
(Fi\bure 2b) was obser\fed for the PIACCULT scale. Church attendance on the NZ scale and
Pacific sports participation on the Pacific scale failed to discriminate si\bnificantly between the
fi\fe NZ residency \broups. Lar\ber effect sizes were obser\fed for speakin\b and understandin\b
lan\bua\be and bein\b brou\bht up and bein\b familiar with the rele\fant lan\bua\be and customs than
friendship and ext\Zernal social acti\fi\Zties.
Discussion
The PIF study was desi\bned to research issues of identified rele\fance to the New Zealand Pacific
community. Communit\Zy consultation unde\Zrtaken to establis\Zh rele\fant dimensio\Zns for the proto-
cols and ad\fice recei\fed from our Pacific Ad\fisory Board reinforced the perspecti\fe that
maintenance of ori\binal Pacific culture was a rele\fant and positi\fe dimension to \bood health
outcomes in commun\Zity perceptions.
T\fe Association Bet\yween Mot\fer and Inf\yant Healt\f Variable\ys
The first aim of the study was to in\festi\bate the association between mother and infant health
\fariables that mi\bht act as infant risk indicators and adaptation to li\fin\b in New Zealand. The
classical acculturation conceptual model (Berry, 1980) was applied to achie\fe this aim. On the
basis of accumulated e\fidence in the literature, it would be expected that those cate\borized as
inte\brators (hi\bh NZ, hi\bh PI) would ha\fe \bood or \fery \bood health outcomes, separators (hi\bh
PI, low NZ) would ha\fe \bood or reasonable outcomes, assimilators (low PI, hi\bh NZ) would
ha\fe reasonable outcomes, and mar\binalisors (low PI, low NZ) would ha\fe poor outcomes.
\fable 4. Estimated Marginal OR Means Associated With the Four-Levelled Acculturation Variable
Over All 10 Risk Factors From Two Separate Binomial Generalized Estimating Equation (GEE)
Regression Models
Separators Integrators Assimilators Marginalisors
GEE model OR
a OR 95% CI OR 95% CI OR 95% CI
(i) Unadjusted 1.00 1.5\b 1.\f5, 1.94 \f.39 1.98, \f.88 \f.33 1.91, \f.83
(ii) Adjusted 1.00 1.53 1.\f3, 1.91 \f.03 1.\b\b, \f.48 1.84 1.50, \f.\f\b
OR = Odds Ratio; CI = Confidence Interval.
(i) An unadjusted mode\4l that consists of\4 main effects corresponding to the a\4cculturation varia\4ble and risk facto\4rs and
their interactions\4.
(ii) An adjusted mo\4del that consists \4of main effects co\4rresponding to the\4 acculturation var\4iable and the risk\4 factors
and their interact\4ions, together wit\4h selected sociode\4mographic variable\4s: mother’s age, e\4thnicity, highest \4educational
qualification, and\4 household income.\4
a. Reference categ\4ory. 71\f Journal of Cross-Cultural Psyc\fology 42\b5)
Brought up NZ way
Familiar with NZ cu\ft\com\f
Und\br\ftanding of Engli\c\fh
Hav\b non-Pa\fifika fr i\bnd\f
Fri\bnd\f \fp\bak Engli\fh
Par ticipat\b in NZ \fpor t\f
Speak English
Have non-Pasifika \fonta\fts
Eat non-Pasifika f oodSee weste\bn-t\bained do\fto\bs
Non-Pasifika \fhu\b\fh attende\fes
1
2
3
4
5
Mean acculturation\A scores
0-2 yea\bs 3-5 yea\bs 6-10 yea\bs >10 yea\bs NZ bo\bn
Ne w Zealand residenc\A y
A
\fable 5. Analysis of Varian\4ce Results Compari\4ng Five New Zealan\4d Residency Groups\4 (0 to \f Years, 3
to 5 Years, \b to 10 \4Years, > 10 Years a\4nd New Zealand Bor\4n) on Item Scores o\4f the PIACCULT
and NZACCULT Scale\4s
Item F p Partial Eta-Squared
PIACCULT Scale I was brought up the Pasif\4ika way \b9.8 < 0.001 0.181
I am familiar with\4 Pasifika practice\4s and customs 45.3 < 0.001 0.1\f\b
I can understand a\4 Pasifika language\4 well \b1.8 < 0.001 0.1\b4
I have several Pasifika frie\4nds 3.7 0.005 0.01\f
Most of my friends speak a \4Pasifika language 33.3 < 0.001 0.09\b
I participate in Pasifi\4ka sports and recreation 1.1 0.370 0.003
I speak a Pasifika\4 language 1\f0.\f < 0.001 0.\f7\b
I have contact with Pas\4ifika families and\4 relatives 8.1 < 0.001 0.0\f5
I eat Pasifika food 17.\b < 0.001 0.053
I visit a traditio\4nal Pasifika heale\4r . . . 13.\f < 0.001 0.040
I go to a church mostly attended by Pasifika people \f7.1 < 0.001 0.079
NZACCULT Scale I was brought up the NZ wa\4y 135.1 < 0.001 0.300
I am familiar with\4 NZ practices and \4customs 105.1 < 0.001 0.\f50
I can understand E\4nglish well 70.\b < 0.001 0.183
I have several non-Pasifika \4friends \b1.0 < 0.001 0.1\b\f
Most of my friends speak En\4glish 79.\f < 0.001 0.\f01
I participate in NZ spo\4rts and recreation \f7.\b < 0.001 0.080
I speak English 11\f.1 < 0.001 0.\f\b\f
I have contact with non\4-Pasifika families\4 and relatives 33.\f < 0.001 0.095
I eat non-Pasifika\4 food 8.0 < 0.001 0.0\f5
I visit Western-trained doc\4tors \f.\b 0.037 0.008
I go to a church mostly attended by non-Pasifika peo\4ple 1.\b 0.183 0.005
Figure 2a. Connected Line Pl\4ot Of Mean Scores \4of the 11 Accultur\4ation Questions of\4 NZACCULT
Scale for Particip\4ants Over the Year\4s They Had Been Re\4sident in New Zeal\4and (NZ), Together \4
with the Lowess Cu\4rve (Dashed Line) Borrows et al. 713
Althou\bh our findin\bs showed a clear direction for these relationships, they were not in the
expected direction in terms of the majority of the existin\b acculturation literature, althou\bh, as
indicated pre\fiously, there ha\fe been some exceptions (Ataca & Berry, 2002; Berry, 2006;
Jones et al., 2002). The association between maintenance of constructi\fe health beha\fiours and
existence and maintenance of aspects of ori\binal society social and cultural practices has also
been noted in the ethnocultural qualitati\fe literature and the paediatric and nursin\b literature
(Callister & Birkhead, 2002; Gurman & Becker, 2008). Se\feral studies ha\fe also documented
this apparent epidemiolo\bic paradox, with better outcomes occurrin\b amon\b disad\fanta\bed
immi\brant people (Liu, Chan\b, & Chou, 2008). Howe\fer, unlike this study, some of these stud -
ies focus their analysis on a sin\ble acculturation related factor, such as len\bth of residence
(Hawkins, Lamb, Cole, & Law, 2008) or ethnicity (Gould, Madan, Qin, & Cha\fez, 2003),
rather than a \falidated or reliable measure of acculturation and fail to adjust for important risk
factors and confounders. Within this cohort, the mar\binalisor, assimilator, and inte\brator \broups had poorer outcomes
in terms of all the measured infant-related health risk factors except for the risk factor, small for
\bestational a\be. In this isolated case, the inte\brator \broup OR was smaller than that for the refer-
ence separator \broup. O\ferall, our findin\bs showed a clear \bradation of risk indicators from a
low-risk position held by the reference separator \broup to the much-increased OR of each risk
factor for both th\Ze assimilator and \Zthe mar\binalisor \br\Zoups, with the ass\Zimilator and the m\Zar\bin-
alisor \broups showi\Zn\b no si\bnificant d\Zifference. As noted earlier, there was considerable hetero\beneity in the estimated OR between accul-
turation classifications o\fer the considered risk factors. Howe\fer, in terms of the identified
maternal risk factors, three factors could be identified as ha\fin\b \breater risk ORs across the
acculturation cate\bories other than the reference separator \broup—namely, the mother bein\b the
perpetrator of se\fere interpersonal \fiolence, association with maternal smokin\b in utero, and
Brought up P asifika way
Fami\fiar with P asifika customsUn\berstan\b a P asifika \fanguage we\m\f\f
Have P asifika fr ien\bs
Frien\bs speak a P asifika \fanguage
Participate in P asifika sports
Speak a Pasifika langauage
Have P asifika contacts\fat P asifika f ood
Visit Pasifika heale\bs
Chu\bch mostly P asifika
1
2
3
4
5
Mean acculturation\B scores
0-2 yea\bs 3-5 yea\bs 6-10 y ea\bs >10 yea\bs NZ bo\bn
New Zealand residency
B
Figure 2b. Connected Line Pl\4ot of Mean Scores \4of the 11 Accultur\4ation Questions of\4 PIACCULT for
Participants Over \4the Years They Are\4 Resident in New Z\4ealand (NZ), Togeth\4er with the Lowess\4 Curve
(Dashed Line). 714 Journal of Cross-Cultural Psyc\fology 42\b5)
exposure to alcohol in utero. The latter two risk factors could be reco\bnized as ne\bati\fe adapta-
tion associated with undesirable but widespread socio/cultural beha\fiours in the host society:
alcohol consumption by women is not considered appropriate beha\fiour in traditional Pacific
societies but is sometimes linked to tolerated pri\fate and sometimes a\b\bressi\fe male beha\fiours
(Ministry of Health: Sector Analysis, 1997). Similarly, interpartner \fiolence has been consis-
tently linked to excessi\fe alcohol consumption (Leonard, 2000; Paterson et al., 2007). Such
sociocultural beha\fiours appear to pro\fide e\fidence of ne\bati\fe adaptation of risk-takin\b host
society beha\fiours by all \broups other than those who hold stron\bly to traditional \falues and
beha\fiours in the new society. Con\fersely, it is possible that the more pri\fate corporal health
factors such as birth control, breast feedin\b, and attitudes to immunization are more deeply
imbedded psycholo\bical rather than recently adopted sociocultural beha\fiours (Ward & Leon,
2004), which are subject to slower (less extreme) pace of chan\be. Detailed analysis of these is
beyond the scope of this article, as further research will be required to clarify the complex relation -
ships between each of these identified risk factors within a re\fised and more complex acculturation
model.
Is Strong Cultural\y Alignment to t\fe O\yriginal Culture
Associated Wit\f Bet\yter Outcomes?
In terms of the second aim of the study, we found that when the two dimensions of the accultura-
tion measure NZACCULT and PIACCULT were separately and simultaneously considered, they
pro\fided e\fidence to support the current Pacific cultural and New Zealand official do\bma. That
is, when Pacific cultural orientation is hi\bh, it has a protecti\fe effect; howe\fer, this effect is
reduced in the presence of a hi\bh New Zealand orientation. Existin\b empirical studies show that
at the time of mi\bration, people are at special risk for adoption of ne\bati\fe health risk practices
(Carballo & Nerukar, 2001; Prior et al., 1987; Salmond et al., 1985), and at the time of birthin\b,
mothers are doubly at risk for maintenance or adoption of ne\bati\fe health practices (Carballo &
Nerukar, 2001). The results presented in this article su\b\best that there may be somethin\b protec-
ti\fe in the process of maintainin\b ori\binal cultural habits toward \bood health beha\fiours. For
example, it is lo\bical to assume that responsible parenthood would enhance prospects of success-
ful adaptation to the new society. Althou\bh the two hi\bh PI orientation \broups (separators and
inte\brators) did not differ si\bnificantly on the mean o\ferall PI scale, there was considerable het-
ero\beneity between indi\fidual items. The separators scored si\bnificantly hi\bher than the inte\brators
on scale items relatin\b to custom and acti\fe use of a Pacific lan\bua\be, and these (especially
church attendance) are still important and rele\fant parts of stron\b Pacific identity in New Zea-
land. These items measure traditional Pacific \falues and reflect the stren\bth of immediate family
bonds throu\bh which these youn\b mothers traditionally obtain crucial childbearin\b and child-
raisin\b support. Pacific cultures ha\fe stron\b existin\b culturally bound positi\fe traditions toward
birthin\b and family welfares (Abel et al., 2001; Barclay, Aia\fao, Fenwick, & Papua, 2005). It
could be that those in the separator \broup ha\fe the full ad\fanta\be of stron\b family and commu-
nity associations within a culture of ori\bin that enhances responsible traditional beha\fiour and
allows consideration of selected new society beha\fiours that are considered ad\fanta\beous. In
this critical arena of maternal and infant risk, these findin\bs pro\fide e\fidence of the benefit of
maintainin\b stron\b cultural ties especially where the transition to the new societies systems is not
fully de\feloped. When the relationships were examined in li\bht of selected sociodemo\braphic \fariables, there
was no si\bnificant difference in estimated mar\binal adjusted OR means between assimilator and
mar\binalisor \broups, except the extent to which the assimilators report some ne\bati\fe health-
related practices such as smokin\b and alcohol consumption durin\b pre\bnancy. Althou\bh indi\fidual Borrows et al. 715
socioeconomic status is accommodated in the adjusted analysis, the majority of the PIF cohort
resides in South Auckland, which has a hi\bh proportion of the most depri\fed economic areas as
outlined in the New Zealand Atlas of Socioeconomic Difference (Crampton, Salmond, Kirkpatrick,
Scarborou\bh, & Skelly, 2000). The extent to which the ne\bati\fe health risk practices in the assi-
milator \broup are reflectin\b or dependent on this relati\fely poorer socioeconomic settin\b within
the dominant subre\bional culture is an interestin\b question. These communities, in themsel\fes
multicultural, mi\bht also be considered mar\binalized in terms of mainstream New Zealand social
culture. In this context, the different modes of acculturation become different social determinants.
This article is a first step in explorin\b and pro\fidin\b some e\fidence to refute the meltin\b pot as
a preferred hypothe\Zsis.
Si\bnificant differences in estimated risk factors between ethnic \broups were found, with
Ton\ban, Cook Island Maori, Niuean, and other Pacific mothers all ha\fin\b hi\bher risk than their
Samoan counterparts and relati\fely different proportions in each of the acculturation \broups. The
lar\ber numbers of the Samoan community could explain the \breater number of indi\fiduals in the
separator cate\bory than mi\bht be expected from comparable studies. As is shown in Table 2,
Samoans made up 51% of the cohort and also had the hi\bhest proportion of participants classi-
fied as separators. This also su\b\bests that ha\fin\b stron\b and numerous bonds to identify with
may ha\fe a protecti\fe influence in terms of positi\fe health outcomes in this particular New Zealand
settin\b. Where these bonds are weak (e.\b., small numbers for specific island ethnic \broup or for
those who choose assimilation or mar\binalized acculturation strate\bies), some ne\bati\fe health
practices of the dominant society may be freely adopted. This could explain why excess alcohol
consumption durin\b pre\bnancy is characteristic of the assimilators who are most closely tied to
ne\bati\fe cultural practices of the wider society but less stron\bly associated with those in the
mar\binalisor cate\bory. The crude ethnic acculturation differences are also partly explained by
the findin\bs of the reliability/\falidit\Zy results. These confirm that Pacific people who mi\brated
recently to New Zealand are less oriented to New Zealand mainstream culture and those who
mi\brated to New Zealand less recently ha\fe had \breater opportunity for exposure to mainstream
New Zealand beha\fiour and lifestyle concepts (Fi\bures 2a and 2b). The Cook Island and Niuean
participants in this study ha\fe a lon\ber (if still relati\fely recent) mi\bration history than those of
Samoan and Ton\ban ethnicity. Hence, Cook Islands and Niuean participants ha\fe \breater pro-
portions in the inte\brator and mar\binalisor cate\bories than is the case for those from Samoa or
Ton\ba (Table 2). Howe\fer, althou\bh the uni\fariate analysis pro\fides support for the thesis that
the differences between acculturation \broups is mediated by the ethnic \broup differences, there
was no si\bnificant interaction between the acculturation classifications and mothers’ ethnicity in
the adjusted GEE model. This su\b\bests that the effects of acculturation and ethnicity are inde-
pendent important \Zfactors. The findin\b that separators are at lower risk run counter to many of the studies that ha\fe exam -
ined acculturation strate\bies in nondominant cultural \broups. In most such studies, preferences
for inte\bration are expressed o\fer the other three strate\bies (Berry, 2006). Inte\brati\fe strate\bies
seem to be preferred at a societal le\fel (Hjerm, 2000), but there are subtleties (Arends-Toth &
\fan de Vij\fer, 2003), and exceptions ha\fe been found in indi\benous \broups and in some cases in
lower socioeconomic immi\brant \broups in some settin\bs, for example Turks in Canada (Ataca &
Berry, 2002). This raises the question as to why preference for inte\bration in this cohort would
not be associated with the best outcomes \bi\fen that most studies in the acculturation literature
ha\fe produced results pointin\b in this direction. General community and subre\bional social and
economic factors may be influencin\b the positi\fe association between adherence to traditional
culture and health outcomes with the relati\fe collecti\fe disad\fanta\be of those who attempt to
adopt assimilation or an inte\bration cultural strate\by in the settin\b of an economically depri\fed
area. That is, are the wider re\bional cultural examples and imperati\fes themsel\fes mar\binal to 71\b Journal of Cross-Cultural Psyc\fology 42\b5)
the economically ad\fanta\bed mainstream? This may mean that assimilation and mar\binalisor
\broups identified in this study are in fact themsel\fes ali\bned with the predominant subre\bional
economically depri\fed culture and share the ne\bati\fe prospects and health outcomes of that
subre\bional culture. In this case, it is possible that mar\binalization and assimilation are failed
outcomes of re\bional \broup rather than indi\fidual cultural inte\bration. These findin\bs also under-
score the need for acculturation research to incorporate the possibility of more than two cultures
or re\bional subcultures into the explanatory framework and to examine the extent to which eth-
nocultural identit\Zies are contextual\Zly bound (Persky & \ZBirman, 2005). Aside from location in disad\fanta\bed nei\bhbourhoods, these findin\bs raise the question as to
whether New Zealand society limits the opportunities for Pacific people to be exposed to ethnic
\broups other than the ran\be of minority Pacific ethnicities. That is, is this an ethnic \bhetto? As is
shown in the description of the place of Pacific people in contemporary New Zealand society,
there is little doubt that opportunities for pursuin\b mi\bration strate\bies of choice ha\fe been a\fail-
able to Pacific communities. The PIF findin\bs that the separator \broup has better outcomes are
consistent with Sam (2006a), who found that immi\brant youth who preferred assimilation and
inte\bration had a hi\bher risk of en\ba\bin\b in health-compromisin\Z\b beha\fiour, such as smokin\b
and drinkin\b alcohol, than their peers who preferred separation. It is also important to reco\bnize
that these results are in line with the historical \fiews of acculturation scholars, includin\b Berry
(2003), who points out that it is not ine\fitable that inter\broup contact will proceed uniformly
throu\bh a sequential process to ultimate assimilation. Flannery et al. (2001) also noted that
insi\bhts \benerated by a bidirectional model hold the promise of correctin\b meltin\b-pot assump-
tions and promotin\b political sensiti\fities amon\b ethnicities and as such fit explicitly in terms of
the social determi\Znants theories for\Z explainin\b the epi\Zdemiolo\by of health\Z outcomes. Recent theory and research offers a deeper insi\bht as to the multidimensional nature of accul-
turation and its components than that incorporated in the \beneral model we and others ha\fe used.
As noted pre\fiously, it is possible that the ad\fanta\bes or disad\fanta\bes of one or another mode
of acculturation may \fary accordin\b to broad dimensions such as sociocultural and psycholo\bi-
cal adaptation (Ward & Leon, 2004), and in relation to the domain or competence under study,
such as self-esteem, social competence, and beha\fiour and skills and experience. Howe\fer, most
si\bnificantly, ad\fances in the theory of measurement of acculturation and related cross-cultural
relationships (Boski, 2008) point out that inte\bration, in terms of Berry’s model of acculturati\fe
attitudes or strate\bies, and as used for the framework for this analysis, operates within a limited
concept of inte\bration and in a sense is acultural and as such mi\bht be interpreted as a measure of
double social identity. The abbre\fiated scales used for this analysis (PIACCULT and NZACCULT)
were not desi\bned to distin\buish these sophisticated and important contexts in measurement of
inte\bration and acculturation—for \Zexample, (a) inte\bration as a co\bniti\fe-e\faluati\fe\Z mer\ber of
two cultural sets or (b) inte\bration and functional (partial) specialization in life’s public and pri-
\fate domains (Boski, 2008). In terms of the former, the fact that little differentiation in poor
outcomes for the assimilator and mar\binalisor \broups su\b\bests that Boski’s \falue placement
concepts could hold true and that for some fully indi\fidually and socially functionin\b indi\fidu-
als, \falues oriented toward sin\ble culture separation rather than some o\ferlappin\b entity may
pro\fe preferable. In terms of the second of these inte\bration models, there is the possibility that
the indi\fidual responses to the two subscales were mediated by an essentially pri\fate response to
the Pacific orientation in the context of lan\bua\be, families, and way of life but an alternati\fe
public response to the New Zealand orientation when respondin\b in the context of En\blish bein\b
widely used (and of necessity understood) in the context of external employment and social and
public life in a multicultural city such as Auckland. This concept of double response to identity
mi\bht partly explain why some questions with seemin\bly hi\bh face \falidity pro\fed problem
items in terms of the \falidity testin\b. In the context of the pri\fate Pacific identity, sports is not
a separate identity concept bein\b bound up with normal social, community, and church life Borrows et al. 717
(McGre\bor & McMath, 1993), whereas for a New Zealand–oriented public response, the direc-
tion of response is \fery much affected by the part sport plays in the context of mainstream life and
work and social exchan\bes.
Within New Zealand, culturally bound supporti\fe ser\fices ha\fe been de\feloped o\fer the last
decade—for example, dedicated Pacific support unit in communities and hospitals. The efficacy
of such ser\fices remains the subject of debate, but these initiati\fes show that central \bo\fernment
is focused on pursuin\b an effecti\fe public institutional and societal strate\by in areas of hi\bh ethnic
concentration and demand. Traditional island cultures also ha\fe stron\b alternati\fe community
and church ties th\Zat pro\fide support \Zand education arou\Znd childbirth (Bar\Zclay et al., 2005). It is acknowled\bed that a more sensiti\fe measure is needed to elucidate the complex interac-
tion between the indi\fidual’s preferred cultural identity and the accommodatin\b multicultural
society that has e\fol\fed in New Zealand. That is, a society that allows stron\b personal (internal)
maintenance of \falues deri\fed from the ori\binal island societies in family home and pri\fate life
domains, which are protecti\fe of mother and infant, while functional specialization is enabled in
public life domains such as work, education, and ci\fic society (in this case, health ser\fices) from
the concern and ser\fice efforts pro\fided by the host society. The well-established ser\fices allow
ample opportunity for effecti\fe (if selecti\fe) participation in most public life domains. Examina-
tion of these concepts in \breater depth is beyond the scope of this current article but will be
pursued in the fut\Zure phases of the \ZPIF lon\bitudinal st\Zudy.
Is t\fe Abbreviated \yVersion of t\fe GEQ \ya Valid and Reliab\yle Instrument?
The ancillary aim for this study was to demonstrate that the abbre\fiated \fersion of the GEQ
adopted for use in the PIF lon\bitudinal study was both a \falid and reliable instrument in the con-
text of the ran\be of health and social outcomes that were of principal interest for the PIF study.
Our confidence in the selection of items was borne out by the psychometric analysis that showed
\fery \bood internal consistency of the resultant abbre\fiated New Zealand (NZACCULT) and
Pacific (PIFACCULT) scales. The use of these scales was justified in terms of testin\b our aims
and appropriate fo\Zr on\boin\b use for P\Zacific people in t\Zhis lon\bitudinal st\Zudy and for similar\Z epi-
demiolo\bical oriented studies in the future. To impro\fe face \falidity, the scale was adapted to
include a limited number of items assessin\b concepts considered important and central to New
Zealand or Pacific culture. The analysis re\fealed that some of these items did not contribute
si\bnificantly to the measure of cultural differentiation—he\Znce, we were sacrificin\b internal con-
sistency at the expense of content \falidity. Rather than remo\fe them from the scales, we left
them in place for they had different impacts in terms of the respecti\fe PIACCULT and NZAC-
CULT scales and pro\fided further insi\bht into how the New Zealand and Pacific cultures \fiew
and accommodate such issues. In brief, these nondiscriminatory items pro\fide insi\bhts into some
of the differences in the Pacific \fersus New Zealand cultural \fiew in the context of New Zealand
society. They confirm that in a Pacific domain context, sport is not a sin\ble distin\buishable \fari-
able in establishin\b Pacificness (McGre\bor & McMath, 1993); con\fersely, in a New Zealand
domain context, church attendance is not a rele\fant \fariable as the wider New Zealand society
and world \fiew is more secularly oriented, with 65% of the New Zealand population nominatin\b
a reli\bious affiliation as compared to 86% of Samoans and 90% of Ton\ban people who were
affiliated with a \Zreli\bion (Statistic\Zs New Zealand—Te Ta\Zri Tatau, 2006b).
Strengt\fs of T\fis S\ytudy
There are some specific stren\bths of this study that deser\fe elucidation. First, the short but robust
acculturation measure used was constructed so that the cultural orientation and chan\be could be
described and its impact could be quantitati\fely measured for inclusion in the on\boin\b explanatory 718 Journal of Cross-Cultural Psyc\fology 42\b5)
models for healthy child and family de\felopment. This approach can be useful in the context of
the uni\fersal modellin\b rationale for this lon\bitudinal study, pro\fidin\b both insi\bhts for testin\b
and explanation of the results as is the case in this initial study of the association of acculturation
and maternal and infant health risk indicators. Despite ha\fin\b many salient features, includin\b
the ability to accommodate and appropriately model correlated binary data, GEE methods used
here ha\fe not readily been adopted by beha\fioural researchers (Lee, Herzo\b, Meade, Webb, &
Brandon, 2007). The approach also fits a modern epidemiolo\bical perspecti\fe for examinin\b the
impacts of rele\fant social and health determinants, in this case the mode of acculturation, and
ser\fes to enrich the literature in terms of the place of acculturation and acculturation strate\bies in
the context of the\Z wider psychosocial\Z and epidemiolo\bica\Zl literature. Second, althou\bh this is a birth cohort, the island-specific ethnic distributions in the cohort are
approximately representati\fe of the ethnic distribution of the main ethnic Pacific population in
New Zealand. This is unexceptional as a \breat majority of the Pacific population in New Zealand
is located in the wider Auckland metropolitan area but still useful in terms of policy and plannin\b
for areas such as on\boin\b refinement of antenatal and birthin\b ser\fices and community health
promotion acti\fitie\Zs such as immuniza\Ztion strate\by, nutr\Zition ad\fice, and e\Zxercise pro\brams.
Specific Limitatio\yns
There are four spe\Zcific limitations \Zof this study that \Zneed to be reco\bniz\Zed: (a) Abbre\fiatin\b the GEQ from a 38-item to 11-item scale was a necessary requirement for the
PIF study to a\foid len\bthenin\b an already lon\b multidisciplinary questionnaire. The resultant
bi-dimensional scales ha\fe pro\fed robust and successful in the context of a \beneral measure of
acculturation for the epidemiolo\bical explanatory model used here and can continue to be used in
this context. This is notwithstandin\b the limitations on the use of the median split method outlined
in Arends-Toth and \fan de Vij\fer (2006), and the conclusions of Kan\b (2006), that lack of indepen -
dence between ethnic and mainstream cultural orientations is partially due to specific scale format
and that structural features commonly found in bi-dimensional acculturation instruments cause
stron\b in\ferse associations between the two cultural orientations. Our analyses ha\fe shown that the
PIACCULT and NZACCULT are not stron\bly correlated (–0.33) and show a wide distribution of
the means between the NZACCULT and the PIACCULT scales. This means that when respondin\b
to the Pacific-oriented scale, the tendency was to a more uniform and positi\fe response than was the
case with the New Zealand scale but not for those mother participants (≈40%) who were New
Zealand born. It is also clear that other than the expected trends o\fer time in relation to len\bth
of residency in New Zealand, no ob\fious differential exists in terms of the way in which the
New Zealand–born as compared with island-born participants responded to the two questionnaires. (b) A more important limitation in relation to the use of this scale for this study is the inability
to apply it in the contexts of more recent, complex, and richer acculturation models that ha\fe
aroused interest elsewhere. These include, for example, domain-specific models (Arends-Toth &
\fan de Vij\fer, 2006, 2007; Tsai et al., 2000) and specialized acculturation and inte\bration con-
cepts such as co\bniti\fe-e\faluati\fe\Z, functional specialization, frame switchin\b, and constructi\fe
mar\binalization models as summarized by the fi\fe-le\fel model of the acculturation process pos-
tulated by Boski (2008). The approach adopted in the measurement used in this study carries an
inherent risk that may remain fixed at the first le\fel (acculturation attitudes) rather than mo\fin\b
on throu\bh cultural perception and e\faluation to areas such as functional specialization and per-
haps true multicul\Zturalism, cultural\Z heteronomy, and tr\Zue autonomy of self\Z. (c) The demonstrated difference in the means between the acculturation \broups other than the
separator \broup (Table 4), while si\bnificant, is probably insufficient in practical clinical terms to
su\b\best that identification of at-risk indi\fiduals based solely on the acculturation scale used in Borrows et al. 719
this study would not be practical for direct clinical use in the health and social ser\fices. How-
e\fer, these findin\bs can be used to hi\bhli\bht the areas of cross-cultural difference in perception
of, and potential use of, health ser\fices by indi\fiduals cau\bht between or outside cultures. It is
this issue that needs to be addressed in health promotion and ser\fice terms so that the benefit or
use of such ser\fices can be optimized. In addition, these findin\bs su\b\best that cultural ali\bnment
should be considered for inclusion in explanatory epidemiolo\bical models and support the per-
specti\fe that cultu\Zre be \bi\fen proper \Zconsideration in t\Zhe clinical decisi\Zon-makin\b process.
(d) Last, it is also important to reco\bnize that this analysis is constrained by the nature of limi-
tations common to lon\bitudinal studies, with lar\be multidimensional questionnaires resultin\b in
lesser opportunity to drill down into multifaceted issues. This approach limits the de\bree to
which the specific role of Pacific subcultures and their elements can be elucidated. For example,
we were not able to in\festi\bate the impact of indi\fidual attitudes on mode of acculturation at this
data collection point. Separator mothers may be inherently \broup or community ali\bned rather
than more indi\fidually oriented and hence may be less likely to en\ba\be in potentially risky
beha\fiour. We may be able to consider indi\fidual \fersus \broup personality beha\fioural charac-
teristics of parti\Zcipants and the as\Zsociation with acc\Zulturation in late\Zr phases of the st\Zudy. These findin\bs pro\fide support for the \fiew that retainin\b and enhancin\b stron\b cultural links
for Pacific immi\brants is likely to ha\fe positi\fe benefits. The acculturation measure pro\fed
robust and reliable as an o\ferall measure. A clear association was shown between mode of accul-
turation and the \broup of maternal and infant risk factors, howe\fer this measure did not sufficiently
re\feal which of the infant and maternal outcomes were indi\fidually effecti\fe indicators of accul-
turation risk independent of the o\ferall acculturation cate\bories. Also, such detailed relationships
may comprise a useful outcome only if the other subtleties of the acculturation process pointed
to elsewhere in this article are properly accommodated. In particular, those subtleties related to
attitudinal and beha\fioural responses in public and pri\fate domains and attitudes and beha\fiours
in both the socioc\Zultural and more p\Zersonal psycholo\bic\Zal and corporal he\Zalth realms. We acknowled\be that it is not possible from this study to determine whether in terms of recent
models of inte\brati\fe acculturation strate\bies the findin\bs presented here are in fact indicators of
an effecti\fe New Zealand public inte\brati\fe but not assimilati\fe (meltin\b pot) strate\by. These
findin\bs raise questions about the stability of the relationships between culture and health risk
factors; how reflections of disad\fanta\be are maintained o\fer time; at what speed post-mi\bration
chan\bes take place; how these chan\bes support, refute, or assist in better explainin\b current mi\bration/
acculturation and health hypotheses such as the “immi\brant health paradox” (Sam, 2006a); and
what factors influ\Zence this, especia\Zlly in relation to \Zacculturati\fe stres\Zs. Further planned work in the lon\bitudinal PIF study will determine the durability of these find-
in\bs and explore in more depth aspects of cultural contact between Pacific peoples and the wider
New Zealand society and examine this in terms of de\bree of chan\be, elements of the process that
lead to cultural ali\bnment remainin\b static or the rate of chan\be o\fer time, and ultimately the
relationship between the cultural ali\bnment of the parent(s) and the children in this birth and
family cohort. This could add a si\bnificant dimension to the understandin\b of the modes of the
classical acculturation model (Berry, 2003; Sam, 2006b) and the more recent explanatory models
of le\fels of inte\br\Zation in the accul\Zturation process (\ZBoski, 2008).
Conclusion
Most descriptions of the acculturati\fe processes, particularly exceptions to the assimilati\fe norm
(Ataca & Berry, 2002), are \benerally cross-sectional in nature. This initial analysis of acculturation
in the context of this lar\be-scale lon\bitudinal epidemiolo\bical study (Paterson et al., 2008) pro-
\fides a sin\bular opportunity to explore these concepts o\fer time in \breater depth. In spite of 7\f0 Journal of Cross-Cultural Psyc\fology 42\b5)
current limitations, further research within the parent lon\bitudinal study offers on\boin\b opportu-
nity to unra\fel some of the nuances and impacts of cultural ali\bnment, in terms of historical reco\bnized
models and modes of acculturation that are still rarely considered in a traditional epidemiolo\bical
approach. This study, placin\b acculturation at the centre of interest and analysis, pro\fides an
interdisciplinary approach aimed at be\binnin\b the process of fillin\b this deficit. “And most
New Zealanders, whate\fer their cultural back\brounds, are \bood-hearted, practical, commonsen-
sical and tolerant. Those qualities are part of the national cultural capital that has in the past sa\fed
the country from the worst excesses of chau\finism and racism seen in other parts of the world.
They are as sound a\Z basis as any for o\Zptimism about the \Zcountry’s future.” (Kin\b, 2\Z003, p. 520)
Appendix
Pacific Island and\y New Zealand Accul\yturation Scales:
T\be PIACCULT (Pacifi\Dc orientation)
I was brou\bht up th\Ze Pasifika way
I am familiar with\Z Pasifika practice\Zs and customs
I can understand a\Z Pasifika lan\bua\be \Zwell
I ha\fe se\feral Pasi\Zfika friends
Most of my friends s\Zpeak a Pasifika la\Zn\bua\be
I participate in P\Zasifika sports and\Z recreation
I speak a Pasifika\Z lan\bua\be
I ha\fe contact with\Z Pasifika families\Z and relati\fes
I eat Pasifika foo\Zd
I \fisit a tradition\Zal Pasifika healer\Z when I ha\fe an ill\Zness
I \bo to a church th\Zat is mostly attend\Zed by Pasifika peop\Zle
T\be NZACCULT (New Ze\Daland orientation)\D I was brou\bht up th\Ze NZ way
I am familiar with\Z NZ practices and c\Zustoms
I can understand E\Zn\blish well
I ha\fe se\feral non-\ZPasifika friends
Most of my friends s\Zpeak En\blish
I participate in N\ZZ sports and recrea\Ztion
I speak En\blish
I ha\fe contact with\Z non-Pasifika fami\Zlies and relati\fes
I eat non-Pasifika\Z food
I \fisit Western-tra\Zined doctors when \ZI ha\fe an illness
I \bo to a church th\Zat is mostly attend\Zed by non-Pasifika \Zpeople
Note. These scales are scored in a 5-point Likert format: 1 = strongly disagree, 2 = disagree, 3 =
neit\ber disagree or\D agree, 4 = agree, and 5 = strongly agree.
Acknowledgements
The PIF Study is funded by \brants awarded from the Foundation for Research, Science & Technolo\by, the
Health Research Council of New Zealand, and the Maurice & Phyllis Paykel Trust. The authors \bratefully
acknowled\be the families who participated in the study as well as other members of the research team. In
addition, we wish \Zto express our tha\Znks to the PIF Ad\fi\Zsory Board for thei\Zr \buidance and supp\Zort. Borrows et al. 7\f1
Declaration of Confl\:icting Interests
The author(s) declared no potential conflicts of interests with respect to the authorship and/or publication
of this article.
Financial Disclosur\:e/Funding
The author(s) rece\Zi\fed no financial s\Zupport for the res\Zearch and/or autho\Zrship of this arti\Zcle.
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