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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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