Cardiovascular disease is the leading cause of mortality in New Zealand. The most current evidence indicates that the burden of cardiovascular disease is greatest among Maori and Pacific peoples and Pacific peoples have the highest mortality rate for cerebrovascular disease [1]. There is substantial scientific evidence that cardiovascular disease has its origin early in life and that a person's risk of cardiovascular disease is determined by the synergistic effect of all the cardiovascular risk factors over time. The Auckland High School Heart Survey (AHHS) is an epidemiological survey designed to determine the prevalence of risk factors for cardiovascular disease in an adolescent high school population in New Zealand. It takes a 'lifecourse' and primary prevention approach to reducing the incidence of cardiovascular disease. The aims of the study were to determine cardiovascular risk factor levels in, and compare the cardiovascular and diabetes risk factor levels between, Pacific and European students and the main Pacific communities (Samoan, Cook Islands, Tongan, and Niuean). The AHHS was a school-based cross-sectional survey of 2,549 adolescent students, across 10 Auckland High Schools. A cluster sampling technique was used to obtain the target of 1000 Pacific participants, to enable Pacific ethnic-specific analysis. The study specifically aimed to determine ethnic-specific differences in lifestyle, intermediate and outcome variables that have been established as cardiovascular risks. Lifestyle variables included: smoking, alcohol consumption, leisure-time physical activity (LTPA), television exposure and sun exposure. The intermediate variables analysed included: body mass index (BMI), waist to hip ratio (WHR), percentage body fat (PBF) and physical work capacity 170 (PWC170). The outcome variables included: total cholesterol (TC), high density lipoprotein cholesterol (HDLC), ratio of total cholesterol to high density lipoprotein cholesterol (TC:HDLC), low density lipoprotein cholesterol (LDLC), triglycerides (TG), fasting blood glucose (FG), urinary micro albumin (UA), systolic and diastolic blood pressure (SBP & DPB). Demographic variables analysed included: sex, age, ethnic group, school, socio-economic status and growth development and maturation. The AHHS study results showed that demographic variables were strongly associated with both intermediate and outcome variables. The findings showed that there were significant ethnic variations between the four main ethnic groups (Pacific, Maori, Asian and European) in risk factors for cardiovascular disease. Pacific participants had the highest BMI and PBF. Pacific participants had the lowest levels of PWC170. With regard to outcome variables, Pacific adolescents had lower levels of TC, HDLC and LDLC compared to Europeans. However, Pacific participants had higher levels of TC:HDLC, FG, TG and DPB. To a lesser degree, lifestyle variables were also associated with other variables. However, the weaker association was likely due to measurement error. The findings of the AHHS study show that ethnic differences present in the adult population are already established among adolescents [2]. Some significant differences were also found between the Pacific ethnic groups (Samoan, Cook Islands, Tongan and Niuean). Among Pacific participants, Cook Islands participants also had the highest level of adjusted mean PWC170. With regard to outcome variables (lipids, fasting glucose and blood pressure), Tongan participants had lower TC, LDLC and TC:HDLC compared to Samoans. However, Tongan participants had significantly higher levels of TG compared to Samoans. For Pacific participants, Cook Islands participants significantly differed from Samoan in smoking, alcohol consumption and PWC170. Cook Islands participants were more likely to have tried smoking for the first time and at an earlier age. They were also more likely to smoke daily and to smoke higher amounts than the other Pacific ethnic groups. Cook Islands participants were more likely to have tried alcohol and at an earlier age. They were also more likely to be drinking alcohol weekly or more often when compared to Samoans. The AHHS study is one of the first pieces of epidemiological research undertaken in New Zealand that provides evidence that there are significant differences between Pacific ethnic groups for this age group. The AHHS study was also able to identify the determinant that explains ethnic differences in outcome variables. BMI was the most significant variable in determining the ethnic differences in outcome variables (lipids, blood pressure and fasting glucose). The AHHS study results showed that Pacific participants had the highest BMI levels of all the ethnic groups, followed by Maori. Television watching was the one lifestyle risk factor that was positively associated with BMI. The most effective variable in terms of decreasing mean difference in BMI was PWC170. PWC170 was significantly lower in Pacific, Asian, and Maori participants compared with European participants. Pacific participants had the lowest levels of PWC170 compared to all other ethnic groups. The AHHS findings support early interventions and programmes targeted to adolescents to reduce the incidence of cardiovascular disease. The findings which show that there are significant differences between Pacific ethnic groups for this age group, may warrant some specific public health initiatives being targeted directly to Pacific ethnic-specific groups. In addition, interventions and programmes that target reducing BMI and improving physical fitness should have an impact on a number of important cardiovascular risk factor outcome variables in adolescents, including: blood pressure, lipids and fasting glucose.
| Identifer | oai:union.ndltd.org:ADTP/274838 |
| Date | January 2005 |
| Creators | Schaaf, David |
| Publisher | ResearchSpace@Auckland |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated., http://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm, Copyright: The author |
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