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Purpose: In New Zealand, Pacific immigrants are among the fastest growing ethnic minorities but, as a group, they are also at most risk of not realising their literacy and educational aspirations critical for achieving their human potential and wellbeing. This may be due, in part, to a misalignment in the shared understanding of academic success between students, parents and their teachers within largely non-Pacific school environments. This study aims to report levels of agreement in child-mother, child-teacher, and mother-teacher perceptions of Pacific children's academic performance at age 6 years., Method: A cohort of Pacific infants born during 2000 in Auckland, New Zealand, was followed as part of the Pacific Islands Families study. Maternal home interviews were conducted at 6-weeks and 6-years postpartum, together with separate child and teacher elicitations at 6-years. Pairwise agreement of academic performance responses was assessed using Cohen's weighted κ statistic, along with symmetry and marginal homogeneity tests., Results: At 6-years, information was available for 1,001 children and their mothers, and teachers' evaluations for 549 children. Negligible to slight agreements and significant asymmetry were found between the child-mother (κ = 0.03, 95% CI: -0.03, 0.09), child-teacher (κ = 0.04, 95% CI: 0.01, 0.08), and mother-teacher (κ = 0.07, 95% CI: 0.03, 0.11) pairwise assessments-with children and mothers more likely to rate Pacific children's academic performance higher than their teachers. Significantly higher concordances with teacher assessments were found among mothers with post-secondary education, proficiency in English, and stronger alignment with New Zealand culture and for children who performed strongly on a standardised measure of performance relative to their peers., Conclusion: Strategies are needed to align Pacific students' and parental perceptions with documented educational achievement outcomes and to facilitate more effective and timely feedback on achievement results and home-school communication. The importance of removing language, cultural and socio-economic barriers to achieving shared understanding of academic performance between teachers and families is highlighted., Competing Interests: The authors have declared that no competing interests exist.

Cigarette smoking continues to contribute to the adverse mortality and morbidity rates for Pacific people in New Zealand. Using a large cohort study of Pacific families, this paper investigates the prevalence of smoking amongst Pacific mothers and fathers over three time-points, up to six years after the arrival of their child, to determine the concordance of both partners' reports of that smoking. Moreover, the patterns of smoking between partners were investigated over the three major Pacific ethnicities that reside in New Zealand (Samoan, Tongan and Cook Island Māori). Maternal self-report prevalence of smoking estimates ranged from 29.8% (1-year) to 33.6% (6-years). Paternal self-reported prevalence of smoking estimates were higher, and ranged from 37.9% (2-years) to 45.2% (6-years). The prevalence estimates for smoking in both mothers and fathers over all three measurement waves were higher than the 26.9% reported for Pacific people in the 2006/07 New Zealand Health Survey. No significant change in fathers' smoking prevalence over time was observed (p = 0.37); however a significant increase in mothers' smoking prevalence over time was noted (p = 0.002). Significantly, for about 25% of Pacific children both their parents were current smokers. Reducing infant exposure to tobacco smoke, by encouraging parents to quit smoking or banning smoking in the home and local environment (such as vehicles), is likely to bring about improved health outcomes for many Pacific children. Findings suggest that the interaction between parents should be considered rather than focusing on mothers' or fathers' smoking behaviour in isolation.

Background: Childhood injury is one of the leading causes of morbidity and mortality worldwide. Many epidemiological studies use self-report injury data to understand the pattern of injury, and to identify risk factors and potential injury countermeasures, but the veracity of these data is not without question., Aims: To investigate the reliability and validity of the use of maternal recall of childhood injuries in a birth cohort study of Pacific mothers residing in New Zealand., Methods: As part of the Pacific Islands Families Study (PIFS), this study included 1,354 Pacific children born in Auckland in 2000 whose mothers completed a questionnaire at 6-weeks, 1-year, 2-years, 4-years, and 6-years postpartum. Maternal reports of child injuries and medical attendance events reported were matched to listings held within the National New Zealand Health Information Service's National Medical Discharge Summary (NMDS) database., Results: Overall, 120 child injury events were listed in the NMDS database and 139 in the PIFS questionnaires. Kappa statistics demonstrated a modest level of agreement between the NMDS database listings and the mothers reporting of childhood injuries over the six years postpartum. However, McNemar's test of symmetry revealed no systemic under-reporting by the mothers, suggesting that the use of maternal proxy reporting of childhood injuries is a valid measure in this population., Discussion: While maternal proxy reporting of Pacific childhood injuries was found to be a valid measure, some evidence of misinterpretation of questions was found; suggesting continued vigilance and development of maternal completed childhood injury questionnaires is warranted.

Background: The epidemiological investigation of acculturation has often been hampered by inconsistent definitions and measurement, and methodological short-comings. Adopting a bi-directional model, with good theoretical and psychometric properties, this study aimed to describe the temporal, ethnic and socio-demographic influences of acculturation for a group of Pacific mothers residing in New Zealand., Methods: Pacific mothers of a cohort of Pacific infants born at a large tertiary hospital in South Auckland in 2000 were interviewed at 6-weeks, 4-years and 6-years postpartum. At each measurement wave a home interview lasting approximately 90 minutes was conducted with each mother. Adapting the General Ethnicity Questionnaire, two scales of acculturation were elicited: one measuring New Zealand cultural orientation (NZAccult) and one measuring Pacific Islands cultural orientation (PIAccult). Acculturation scores were standardised and analysed using random intercept polynomial and piecewise mixed-effects regression models, accounting for the longitudinal nature of the repeated measured data. Mothers who immigrated to New Zealand and those who lived their lives in New Zealand were investigated separately., Results: Overall, 1276 Pacific mothers provided 3104 NZAccult and 3107 PIAccult responses over the three measurement waves. Important and significant differences were observed in both bi-directional acculturation measures between the two maternal groups studied. New Zealand cultural orientation increased, on average, linearly with years lived in New Zealand both for immigrant mothers (0.013 per year, 95% CI: 0.012, 0.014), after adjusting for maternal age, and for mothers who lived their lives in New Zealand (0.008 per year, 95% CI: 0.06, 0.010). Immigrant mothers maintained their Pacific cultural orientation for, on average, 12 years before it began to linearly decrease with each year lived in New Zealand thereafter (-0.009 per year, 95% CI: -0.010, -0.008), after adjusting for maternal age. Mothers who lived their lives in New Zealand had a Pacific orientation that was, on average, unchanged regardless of the number of years lived in New Zealand. Significant ethnic and socio-demographic variations were noted., Conclusions: Understanding the patterns and trajectories of acculturation over time, and its key determinants, is necessary for the development of appropriate targeted health policy and care in typically vulnerable and marginalised immigrant populations.

Aim: To objectively assess physical activity (PA) and body size in 6-year-old children and their mothers participating in the Pacific Islands Families (PIF) cohort study, and to identify factors potentially related to PA and body size in Pacific children., Methods: The PIF cohort was drawn from live births at Middlemore Hospital (South Auckland, New Zealand) in 2000. Information has been collected at birth, 6 weeks, 12 and 24 months, and 4 and 6 years postpartum. At 6 years, the Child and Parental Physical Activity and Body Size (PIF:PAC) study was simultaneously conducted and measures of child and mother PA (8-day accelerometry), body size (waist circumference, body mass index), and PA supports and barriers (questionnaire) taken., Results: 254 mothers and their children took part in the PIF:PAC study. Usable accelerometer data were gathered for 173 mothers and 199 children over an average of 3-4 days. High levels of overweight and obesity were found in boys, girls, and mothers (62%, 58%, and 97% overweight or obese, respectively)., Conclusion: Strategies for obesity reduction in Pacific populations are urgently required. Combined, the PIF and PIF:PAC studies will provide vital information for understanding and targeting the obesity epidemic in Pacific children.

Objectives: To present current breast-feeding rates for Pacific infants resident in New Zealand. Reasons for the introduction of complementary liquid foods were also explored., Design: A longitudinal study using hospital discharge summary records and maternal home interviews undertaken at 6 weeks, 12 and 24 months postpartum. Turnbull's non-parametric survival analysis was used to model exclusive breast-feeding rates., Setting: Auckland, New Zealand., Results: The cohort comprised 1376 infants at 6 weeks, 1223 infants at 12 months and 1142 infants at 24 months. Exclusive breast-feeding rates at hospital discharge, 6 weeks, 3 and 6 months postpartum were 84% (95% confidence interval (CI): 80-88%), 49% (95% CI: 43-55%), 37% (95% CI: 32-42%) and 9% (95% CI: 7-11%), respectively. Significant ethnic difference existed, with Samoan mothers having higher exclusive breast-feeding rates than Tongan mothers (P = 0.002). The percentage of infants receiving any breast milk at hospital discharge, 6 weeks, 12 and 24 months was 96% (95% CI: 94-97%), 95% (95% CI: 94-96%), 31% (95% CI: 28-34%) and 15% (95% CI: 13-17%), respectively. Again ethnic differences emerged. Common reasons cited for discontinuation of exclusive breast-feeding included uncertainty of breast milk supply (56%), problems with breasts (30%) and difficulties breast-feeding in work or educational environments (26%). However, 691 (50%) mothers sought no advice about their breast-feeding concerns within the first six weeks of life., Conclusions: Exclusive breast-feeding rates for Pacific infants are ethnically heterogeneous, have declined since the 1990s and fall short of the World Health Organization recommendations. The principal reasons cited for exclusive breast-feeding discontinuation echo those reported over a decade ago.

Objective: To examine whether permanent domicile change of the mother, thence the infant, or temporary relocation of the infant away from his or her usual place of residence affects the risk of sudden infant death syndrome (SIDS)., Design: A case-control nation-wide epidemiological study., Setting: New Zealand between the years 1987-90., Participants: From the 485 SIDS diagnoses over this time, parents of 393 (81%) SIDS infants consented to participate and these comprise the cases. Controls were selected by randomly sampling 1800 infants from all babies born over 78% of the country. Parents of 1592 (88%) control infants participated., Results: Infants away from their usual address were 1.70 (95% CI: 1.09, 2.66) times more likely to die from SIDS than infants sleeping at home, after controlling for likely confounding factors. A partial explanation for this finding was that SIDS infants were less likely to have been mainly breast fed in the last two days and were less likely to have shared a room with at least one adult at the nominated sleep/death. Infants of mothers who shifted house after their birth, infants having mothers who shifted house within a year prior to the study interview date, and infants who slept at numerous different houses were associated with an increased relative risk for SIDS at the univariate level, but not after adjustment., Conclusions: Infants are less likely to die in their accustomed residential environment. This finding needs confirmation by other studies.

Objective: To describe the current timing of the introduction of solids in infancy and the factors influencing the decision to introduce solids., Methodology: Eighteen hundred infants were selected randomly as part of the New Zealand Cot Death Study. Of these, 88% of the parent/caregivers were interviewed when their infant was aged between 1 and 12 months. They were asked when solids were first introduced into the diet., Results: By 12 weeks of age more than 20% of infants had been given solids; by 16 weeks and by 6 months 50 and 90% of babies, respectively, had been given solids. Maternal smoking, low educational achievement and not being breast-fed exclusively to 4 weeks of age were factors which were strongly associated with the early introduction of solids., Conclusion: Half of New Zealand infants are being started on solids earlier than is presently recommended. More education is needed to promote the later introduction of solid foods into the diet.