Samoan Women Research Articles

A group prenatal care intervention reduces gestational weight gain and gestational diabetes in American Samoan women.

The objective of this study was to determine the preliminary effectiveness of an intervention to mitigate adverse pregnancy outcomes associated with pre-pregnancy obesity in American Samoa. We enrolled n = 80 low-risk pregnant women at <14 weeks' gestation. A complete case analysis was conducted with randomized group assignment (group prenatal care-delivered intervention vs. one-on-one usual care) as the independent variable. Primary outcomes were gestational weight gain and postpartum weight change. Secondary outcomes included gestational diabetes screening and exclusive breastfeeding at 6 weeks post partum. Other outcomes reported include gestational diabetes incidence, preterm birth, mode of birth, infant birth weight, and macrosomia. Gestational weight gain was lower among group versus usual care participants (mean [SD], 9.46 [7.24] kg vs. 14.40 [8.23] kg; p = 0.10); postpartum weight change did not differ between groups. Although the proportion of women who received adequate gestational diabetes screening (78.4% group; 65.6% usual care) was similar, there were clinically important between-group differences in exclusive breastfeeding (44.4% group; 25% usual care), incidence of gestational diabetes (27.3% group; 40.0% usual care), and macrosomia (8.3% group; 29.0% usual care). It may be possible to address multiple risk factors related to intergenerational transmission of obesity in this high-risk setting using a group care-delivered intervention.

O le Fau Gagana: A Samoan Mental Health Nurse in Aotearoa-New Zealand.

This article explores my journey as a Samoan woman who migrated as a young mother to Aotearoa-New Zealand, completed nursing qualifications, later specialising in mental health nursing, and eventually completed doctoral studies. Since July 2023 I have been a Lecturer in the Department of Nursing, Faculty of Health and Environmental Studies, Auckland University of Technology. This article uses autoethnographic and narrative methods to collect data from my own life, to explore the experiences of Samoan people in the mental health system of Aotearoa-New Zealand. Criteria for reporting qualitative research was used to prepare the paper. My story showcases the benefits of having both clinical and cultural understandings in the context of mental health care in Aotearoa-New Zealand. The gap between the rhetoric and the reality of the 'New Zealand dream' for Samoan people mirrors the gap between policy and practice in relation to Pacific strategy plans for mental health care. By writing about my experiences, I aim to support better understanding of core concerns for Samoan people when they are engaging with mental healthcare services.

Promiscuous Possibilities: Regenerating a Decolonial Genealogy of Samoan Reproduction

Most of the common ways of thinking about genealogical reproduction are influenced by colonialism and capitalism, which emphasize the importance of the nuclear family, heterosexuality and reproducing future citizens. Under colonialism and capitalism, Samoan women are disciplined into good reproductive laborers who reproduce the moral family and also wider society. This paper looks to Indigenous feminist discourse of regeneration to place Samoan reproductive labor outside of capitalism and within Indigenous feminist genealogies of world-building, asking what other promiscuous possibilities there are for Samoan regeneration. Here, we present a theoretical exploration: thinking with Indigenous feminism offers a decolonial intervention into Samoan reproduction, placing Samoan women’s labor into an alternative genealogy of Indigenous feminist world-building and outside of colonially imposed genealogies.

Pacific Leadership and Impact on the Samoan Woman

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“We are competing with culture” the chasm between healthcare professionals and Australian Samoan women in the prevention and management of gestational diabetes mellitus

Objective: The Samoan community has a disproportionately higher incidence of gestational diabetes mellitus (GDM). We explored consumer and healthcare providers’ insight into perceptions of risk, attitudes to lifestyle behaviour change and experiences of GDM among Australian Samoan women in South Western Sydney. Methods: Semi-structured interviews and a focus group with Samoan women recruited through three churches, a diabetes and pregnancy clinic in South Western Sydney and via social media were conducted. Semi-structured interviews with healthcare providers’ were also conducted. Main themes were thematically analysed to identify recurring patterns using Quirkos software. Identified themes were framed against the constructs of the Health Belief Model. Results: One focus group (n=4) and 12 one-to one interviews were conducted among Samoan women. Eighteen semi-structured interviews with healthcare providers’ were also conducted. There was a high concordance between Samoan women and healthcare providers’ regarding perception of risk and barriers to maintaining a healthy lifestyle. However, Samoan women reported negative interactions with healthcare providers’ that hindered their behaviour change, while healthcare providers’ reported that normalisation of diabetes, confusion of GDM with type 2 diabetes and spiritual health beliefs were deterrents to behaviour change among Samoan women. Conclusion: Cross-cultural factors can influence the uptake of a healthy lifestyle. Future research should consider use of culturally tailored strategies when developing educational resources targeting Samoan women. Implications for research, policy and practice: The participants’ viewpoints expressed in this study suggest a critical need for the development of culturally-tailored health promotion strategies for Samoan women and cultural training for healthcare providers’, to improve GDM care and subsequent pregnancy outcomes.

Lessons learned from developing a Samoan health education video on pelvic organ prolapse

Pelvic organ prolapse affects an estimated 40% of parous women in developed countries, but there is no prevalence data in Samoa. The impacts of pelvic organ prolapse include urinary incontinence and bowel incontinence, with many women being asymptomatic. Samoan women have high prevalence of risk factors for pelvic organ prolapse, such as obesity and parity. There are non-surgical and surgical interventions for pelvic organ prolapse. Limited sexual and reproductive health education in Samoa hinders women’s knowledge of the pelvic organs and what is considered normal. This short report describes the process of developing and producing an educational video on pelvic organ prolapse in Samoan and English and the lessons learned from the process.

Disney, Little Women, and Me

AbstractThe search for identity, security, and recognition by the women of Samoa is both a cultural issue and a personal one. This article offers an analysis of the issues facing Samoan women, making use of both social science research and two popular Disney films—Lilo &amp; Stitch and Moana—that deal generally with Polynesian culture and specifically with the kinds of developemental issues facing women. Although Samoan women are facing the social dislocations caused by modernization, the mythic elements in movies that draw upon Polynesian legends can provide guidance. In addition, I draw upon one of my favorite films, Little Women, to reflect on how I continue to navigate emerging gender roles and expectations. As a woman living in Samoa, my own experience serves as a window into our culture, so I draw upon my own personal questions in reflecting on the material presented in fiction that helps us solve the problems that arise as cultures collide.

Visionary women: Sustaining the language and culture in Samoan early childhood centres

This article focuses on the powerful role of Samoan women sustaining the language and culture in Aotearoa. It presents findings from my Master’s thesis that explored the experiences of seven Samoan women who were involved in the establishment of three a’oga amata (Samoan early childhood centres) in Christchurch (Togiaso, 2017). This qualitative study had a conceptual framework of Pacific epistemologies including fa’a Samoa (a Samoan way of life) and teu le vā (to look after spaces). Questionnaires, semistructured interviews, and autoethnography were methods used. Findings revealed that Samoan women overcame major barriers and challenges in setting up unique spaces of learning that became places of belonging and cultural transmission for children, families, and the community. However, colonial incursions continue to be barriers in sustaining the Samoan language, culture, and fa’a Samoa.

Testing Women's Trust in Other Women and Same-Sex Attracted Males in Three Cultures.

Heterosexual women trust mating-relevant advice received from gay men more than that received from heterosexual women. This trust is predicated on women's perception that gay men lack ulterior sexual motives and romantically pursue other gay men. However, this trust may not hold in all cultures. For example, in both Samoa and the Istmo Zapotec of Southern Mexico, women take part in mate competition against feminine same-sex attracted males-referred to as fa'afafine and muxe, respectively-who regularly engage in sexual activity with masculine men. The present studies sought to replicate and extend research on women's trust in males who are same-sex attracted. Experiments were conducted in Canada, Samoa, and the Istmo Zapotec, with women randomly assigned to consider the likelihood of various mate-poaching behaviors performed by either a rival woman or a same-sex attracted male. In Canada, women were more trusting of cisgender gay men than other women. Similarly, Samoan women were more trusting of fa'afafine than other women. In the Istmo Zapotec, women were equally distrustful of women and feminine muxe gunaa, whereas more masculine muxe nguiiu were rated as more trustworthy than women and muxe gunaa. These results illustrate that women's trust in same-sex attracted males varies both between and within cultural contexts, perhaps impacted by the relative femininity of the male in question.

Women's Reaction to Opposite- and Same-Sex Infidelity in Three Cultures : Data from Canada, Samoa, and the Istmo Zapotec.

Previous research indicates that Euro-American women are more upset by imagining their male partners committing homosexual infidelities than heterosexual ones. The present studies sought to replicate these findings and extend them to two non-Western cultures wherein masculine men frequently engage in sexual interactions with feminine third-gender males. Across six studies in three cultural locales (Canada, Samoa, and the Istmo Zapotec), women were asked to rate their degree of upset when imagining that their partner committed infidelity that was heterosexual in nature, as well as infidelity that was homosexual. In two Canadian undergraduate samples, women reported greater upset at imagining partner infidelity with a female, whereas a community sample of middle-aged women reported equal upset across infidelity types. Samoan women reported substantially less upset at the thought of partner infidelity with a third-gender male (fa'afafine) than with a female. Istmo Zapotec women reported equal upset toward infidelity with a female or a third-gender male (muxe), whereas a second Zapotec sample reported slightly greater upset at the thought of infidelity with a muxe. Results illustrate how cultural contexts moderate the degree to which same-sex infidelity scenarios are upsetting to women.

The role of Aotearoa New Zealand midwives as positive influencers on food literacy with Samoan families: Report on a small Auckland-based study

Background: Healthy eating is crucial for optimal development during all stages of life and most particularly during pregnancy. According to Stats NZ, Pasefika people make up 8.1% of the total Aotearoa New Zealand population. Information from the Ministry of Health suggests that Pasefika people have the highest level of food insecurity and the highest level of obesity. Women are more likely than men to be involved with food preparation; therefore, it is important to know to what extent women are aware of what healthy eating means for themselves and their families. Aim: This study aimed to explore an understanding of the levels of food literacy among representatives of three generations of women in five Samoan families; how each of the three generations ensured that their dietary intake contributed to their quality of health; and whether the extent of food literacy was influenced both within and between/across generations. Method: The study used a combined Delphi-Talanoa approach to interview 15 Samoan women about the levels of their understanding of food literacy. Findings: Midwives played an important role in helping pregnant Samoan women understand about healthy eating during pregnancy. Women shared with other female relatives what they had learned about healthy eating from their midwives. Learnings taken from midwives included the importance of choosing healthy foods, portion control and physical activity. Conclusion: All study participants who had received antenatal care in Aotearoa New Zealand mentioned the important role of midwives in increasing their understanding of healthy lifestyle choices. What the women learned from their midwives also informed their wider family or aiga.

Evaluating the feasibility and effectiveness of self-monitoring of health among Samoan women: a randomized trial

Objective: Self-monitoring technologies that help individuals track their health have proven effective in high-income countries but have not been widely tested or marketed in the Pacific islands. We conducted a pilot randomized controlled trial in Samoa to investigate the feasibility and acceptability of step-counters and digital scales.&#x0D; Methods: The trial enrolled 44 Samoan women (31-40 years), without previously diagnosed chronic conditions (hypertension, diabetes, etc.), who reported motivation to become more physically active. After measuring daily step counts for one week in the absence of feedback, participants were randomly assigned to one of three groups for a four-week intervention period: 1) FitBit Zip® step-counter, 2) digital BodyTrace© scale, or 3) both devices. Outcomes of interest were device use, psychosocial indicators of health, daily step counts, and body mass index, measured at baseline and post-intervention.&#x0D; Results: Participants who received scales used them a median of 5.5 times during the four-week intervention period. While FitBits were used a majority of days during the baseline period, there was significant decline in use during the intervention. In all groups, Health Locus of Control, Self-Efficacy for Exercise, and Weight Efficacy improved. However, while the Scale Only group reported improved health-related quality of life, the two groups that used FitBits either did not significantly change or significantly decreased in their assessments of this measure. No group demonstrated change in average daily step counts during the intervention; BMI increased among the two groups using the scales.&#x0D; Conclusions: Results suggest that self-monitoring technologies are acceptable in Samoa and generally improve psychosocial indicators of health. Further research is necessary to assess their effectiveness as an intervention tool and to determine how best to sustain device use over time. The significant increase in BMI over the relatively short intervention period highlights the importance of developing effective intervention approaches in this setting.

Effect of maternal nutrient intake during 31–37 weeks gestation on offspring body composition in Samoa

Background Pregnancy dietary intake may be associated with newborn body composition, a predictor of future obesity. In Samoa, an energy-dense diet contributes to an alarming prevalence of adult obesity. Identifying associations between pregnancy nutrition and infant body composition in this setting may guide strategies to mitigate intergenerational transmission of obesity risk. Aim To examine dietary macro- and micronutrient intake of Samoan women during the third trimester of pregnancy and associations with infant body composition. Subjects and methods At 34–41 weeks of gestation, we measured dietary intake from the prior month using a Food Frequency Questionnaire (FFQ). Dual-energy X-ray absorptiometry (DXA) measured infant body composition at 1–14 days. We used multivariable linear regression models accounting for confounders to identify independent effects of nutrient intake on infant body composition. Results After adjusting for maternal body mass index, age, gravidity, infant age, and sex, a respective 0.2 g increase and 0.2 g decrease in infant bone mass was associated with fibre and saturated fat intake. Increased protein intake was associated with 0.02 g decrease in bone mass. Conclusions While maternal dietary intake was not associated with infant adiposity or lean mass, we observed an effect on bone mass whose role in regulating metabolic health is overlooked.

Abstract 3485: Body mass index and mammographic density among Native Hawaiians and Pacific Islanders

Abstract Background: Mammographic density is an important breast cancer risk factor, yet data on mammographic density is limited for some racial/ethnic groups, including Native Hawaiians and Pacific Islanders (NHPI). Obesity is highly prevalent in the NHPI population and prior work, primarily in non-Hispanic White (NHW) women, has reported that high body mass index (BMI) is inversely associated with mammographic density but positively associated with risk of breast cancer. We used data from the Utah Population Database (UPDB) to estimate the association between BMI and mammographic density in Utah's NHPI population and evaluate if the association differs for NHPI women compared to NHW women. Methods: We included women ages 18-79 years with at least one mammogram from 2005-2012 and no history of breast cancer. Data on BMI and race/ethnicity were collected from the UPDB, and mammographic density was evaluated using Breast Imaging Reporting and Data System (BIRADS) scores. We estimated the association between BMI and BIRADS using multinomial logistic regression adjusted for age and stratified at age 55 (a proxy for menopausal status). Heterogeneity by race/ethnicity was evaluated using likelihood ratio tests. Results: Our analyses included data from 102 Native Hawaiian, 112 Samoan, 344 other Pacific Islander, and 143,259 NHW women. High mammographic density (BIRADS=4) was less common among Samoan women (2.7%) and other Pacific Islanders (4.7%) compared to NHW women (5.8%), but more common among Native Hawaiians (11.8%). Age-standardized BMI was highest in Samoan women (mean=32.3, SD=6.3) followed by other Pacific Islander women (mean=31.2, SD=7.1) then Native Hawaiian women (mean=27.8, SD=6.4), and lowest among NHW women (mean=26.1, SD=5.4). Among women younger than age 55, a one-unit increase in BMI was associated with 0.76 (95% CI=0.69-0.84) times lower odds of high (BIRADS=4) versus low (BIRADS=1) breast density in NHPI women. The comparable odds ratio (OR) in NHW women was 0.66 (95% CI=0.65-0.66; p-heterogeneity=6.9 × 10^-10). For women age 55 and older, the association between BMI and mammographic density was stronger among NHPI women, OR=0.62 (95%CI=0.45-0.84), compared to NHW women, OR=0.70 (95%CI=0.69-0.72; p-heterogeneity=0.018). Discussion: Mammographic density differs among racial/ethnic subgroups of the NHPI population with Native Hawaiians having the highest mammographic density. Given the high prevalence of obesity in the NHPI population and evidence that the association between BMI and mammographic density may differ by race/ethnicity, more research is needed to understand how BMI and mammographic density influence risk of breast cancer in understudied racial/ethnic minorities, such as NHPIs. Citation Format: Mollie E. Barnard, Tarun Martheswaran, Jennifer A. Doherty, Karen Curtin. Body mass index and mammographic density among Native Hawaiians and Pacific Islanders [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3485.

Chick-Lit Pasifika-Style or How to B(l)end the Formula: Lani Young’s Scarlet Series

Abstract This article focuses on Scarlet Lies (2015), Scarlet Secrets (2015), and Scarlet Redemption (2019), the popular romance series by Samoan writer Lani Wendt Young. The novels deploy the recognizable chick-lit formula to narrate the predicaments and romantic adventures of a young Samoan woman in what could be defined, following Selina Tusitala Marsh, as “‘Chick Lit’ Pasifika-style” (“Aotearoa Reads”). My main argument is that Young b(l)ends the conventions of chick lit both by hybridizing some of its defining features and by repoliticizing the formula. While dealing with commonplace preoccupations of chick-lit heroines, the novels serve as effective tools for social commentary as they raise criticism toward both Samoan and western societies, reflect on the neocolonial and neoliberal structures affecting the lives of her young Samoan characters, and introduce discussions on culturally specific issues.

Evaluation of a PGP3 ELISA for surveillance of the burden of Chlamydia infection in women from Australia and Samoa.

ABSTRACTSerological assays can be used to investigate the population burden of infection and potentially sequelae from Chlamydia. We investigated the PGP3 ELISA as a sero-epidemiological tool for infection or sub-fertility in Australian and Samoan women. The PGP3 ELISA absorbance levels were compared between groups of women with infertility, fertile, and current chlamydial infections. In the Australian groups, women with chlamydial tubal factor infertility had significantly higher absorbance levels in the PGP3 ELISA compared to fertile women (P < 0.0001), but not when compared to women with current chlamydial infection (P = 0.44). In the Samoan study, where the prevalence of chlamydial infections is much higher there were significant differences in the PGP3 ELISA absorbance levels between chlamydial sub-fertile women and fertile women (P = 0.003). There was no difference between chlamydial sub-fertile women and women with a current infection (P = 0.829). The results support that the PGP3 assay is effective for sero-epidemiological analysis of burden of infection, but not for evaluation of chlamydial pathological sequelae such as infertility.

Associations between sociodemographic and behaviour factors, and dietary risk factors for overweight and obesity, in Samoan women

Adults in Samoa have the third highest obesity prevalence in the world, and the prevalence is higher in women than men. The nutritional status of a household in most low- and middle-income countries is positively influenced by the level of control women have over financial resources. Our analysis examined how consumption of specific dietary groups was associated with different sociodemographic and individual health risk factor groups for women who participated in the 2014 Samoa Demographic and Health Survey.Our research question was explored through multivariate analysis of the 2014 Samoa Demographic and Health Survey dataset. The sociodemographic and health behaviour groups included in our analysis were: urban vs. rural residence, wealth quintile, education level, participation in physical activity program, lives with husband/partner, household size, parity, age, smoking, and alcohol consumption. The following diet variables were included: fruit, vegetables, seafood, high-fat food, sugary drinks, high-salt food, and high-sugar food consumption.There was a high prevalence of unhealthy food consumption and unhealthy dietary patterns among a) a large proportion of the population, and b) across sociodemographic and health behaviour groups, with a higher prevalence of particular at-risk patterns in some specific groups including women of younger age and women of higher wealth.Our analysis highlighted some specific opportunities for policy action, including the need to create an enabling environment for healthier food consumption for Samoan women.

Pelvic Organ Prolapse Symptoms in American Samoan Women

American Samoa has one of the highest rates of obesity worldwide, making it a population at high risk for pelvic organ prolapse (POP). The primary objective of this study was to describe the presence of POP symptoms and associated degree of bother in American Samoan women. The secondary objective was to determine which characteristics are associated with POP symptoms in this cohort. We performed a cross-sectional survey of women presenting to the waiting room of the emergency department of the Lyndon B. Johnson Tropical Medical Center in Faga'alu, American Samoa from February to March 2017. Questions included self-described characteristics and the Pelvic Organ Prolapse Distress Inventory 6. Univariate distributions were described and comparisons of social and health characteristics were made between women without POP symptoms and those with at least 1 POP symptom. Two hundred eighty-four women were approached and 225 women completed the survey (79% response rate). The mean (SD) age was 40.5 (14.7), the mean (SD) body mass index was 36.4 (8.7), and the median (range) number of vaginal births was 2 (0-14). A total of 44.2% endorsed at least 1 POP symptom, most commonly pelvic pressure (29.9%) and feeling of incomplete bladder emptying (26.7%). The number of vaginal births was associated with lower abdominal pressure (P = 0.04) and hysterectomy was associated with pelvic heaviness (P = 0.05). This is the first study investigating POP in American Samoa. Almost half of women reported at least 1 pelvic floor symptom, demonstrating the need for further research on pelvic floor disorders within this high-risk population.

Reproductive health, obesity, and cardiometabolic risk factors among Samoan women.

Obesity leads to deleterious effects on not only cardiovascular health but also on the reproductive health of women. We estimate the prevalence of menstrual irregularity and of polycystic ovarian syndrome (PCOS) in Samoan women, among whom obesity prevalence is extremely high. We explore the association of these reproductive health conditions with adiposity, cardiometabolic risk factors, and androgen levels. A cross-sectional sample of Samoan women 25-39 years of age (n = 470) from a larger population-based genome-wide association study of adiposity and cardiometabolic disease was assessed for the prevalence of oligomenorrhea/amenorrhea (OM/AM) using a self-reported questionnaire. Serum androgens and anti-Müllerian hormone levels were assayed to determine hyperandrogenemia and presence of polycystic ovaries (PCO), respectively, using criterion values. PCOS was classified using NIH guidelines of having at least two of the three conditions: menstrual irregularity, hyperandrogenism, and PCO. We contrasted socio-demographic, reproductive health, and cardiometabolic risk factors between those with and without OM/AM and similarly for PCOS. The prevalence of OM/AM was 7.4% (95% CI: 5.1, 9.8), and women with OM/AM had significantly higher central adiposity. PCOS was estimated at 6.8% (95% CI: 4.5, 9.1), and those with PCOS were younger but had higher overall and central adiposity measures, higher triglycerides, and higher prevalence of insulin resistance than women without PCOS. The prevalence of menstrual irregularity and PCOS are less than hypothesized given the high levels of adiposity in this population. Nevertheless, Samoan women with menstrual irregularity and other features of PCOS have significantly poorer metabolic health.

Caesarean section wound infection surveillance: Information for action.

Surgical site infection (SSI) following caesarean section is common, resulting in significant morbidity. Several factors are known to contribute to wound infection, including maternal, procedural and antibiotic factors. We sought to clarify these issues and sought opportunities to make improvements. A retrospective cohort study was performed assessing all women who underwent caesarean section in 2014 and 2015 at Wellington Hospital. Any women with culture-positive wound samples within 30days of surgery were identified, and clinical notes reviewed. Odds ratios (OR) were calculated for available maternal, procedural and antibiotic risk factors. Two simplified surveillance techniques were also tested for their abilities to identify significant trends. The study included 2231 women, of whom 116 (5.2%) were identified as having SSI. Maternal obesity (body mass index (BMI) ≥30) was associated with significant SSI risk (OR 4.1, P<0.001). The pathogen distribution was significantly different between women with BMI<30 and BMI≥30 (P<0.001). Increased cefazolin dose based on BMI (3g dose for BMI≥30) was associated with a significant reduction in SSI (OR 0.309, P<0.001) and was administered in 74.1% of obese women receiving cefazolin. Māori women had an increased SSI risk (OR 2.1, P=0.019), as did Samoan women (OR 3.0, P=0.002). The study reinforces other studies showing that raised BMI is the single biggest risk factor for surgical site infection post-caesarean section. Surveillance using simplified techniques appears to be adequate to identify trends. We believe that concentrating on appropriate antibiotic dosing and targeting special wound care measures will be pivotal interventions in improving outcomes in high-risk groups.