Country OPIC Fiji Report With Cover FINAL PDF

PACIFIC OBESITY PREVENTION
IN
COMMUNITIES PROJECT (OPIC)
FIJI COUNTRY REPORT
A collaborative project of: Fiji School of Medicine and Deakin University.

2004-2009
OBESITY PREVENTION IN COMMUNITY (OPIC)
PROJECT – FIJI REPORT 2004 - 8
Report prepared by Dr Timaima Tuiketei, Dr Wendy Snowdon, Gade Waqa, Dr Peter Kremer,
Jimaima Schultz and Nola Vanualailai, on behalf of the OPIC Team
August 2010
ISBN 978-982-515-057-2
1
Table of Contents
Foreword ............................................................................................................................................... 3
List of Tables ......................................................................................................................................... 4
List of Figures ........................................................................................................................................ 6
Abbreviations ........................................................................................................................................ 8
Acknowledgements............................................................................................................................... 9
Executive Summary ............................................................................................................................. 11
1.0 Objectives.............................................................................................................................................. 13
2.0 OPIC Methodology and Research design .............................................................................................. 15
3.0 The Healthy Youth Healthy Communities Intervention Study.............................................................. 17
4.0 Socio-cultural Component .................................................................................................................... 63
5.0 Policy Component ................................................................................................................................. 71
6.0 Economic Component ........................................................................................................................... 83
7.0 Conclusions and Recommendations ..................................................................................................... 88
References .................................................................................................................................................. 90
Annex 1: Background information on Fiji ................................................................................................... 92
Annex 2: Community and School interventions ......................................................................................... 99
2
Foreword
As the Dean of the Fiji School of Medicine (FSMed) and now the College of Medicine, Nursing and
Health Sciences, I am pleased to share a few thoughts in regard to the OPIC project.
Obesity is a major public health problem not only in Fiji but in the Pacific region as a whole. It is
responsible for significant social and economic costs to individuals, families, communities and
nations. Despite many local, national & regional prevention and control programmes, obesity-
related disorders continue to cause major challenges and more effective interventions are needed.
The Pacific Obesity Prevention In Communities (OPIC) Project which was implemented in four
countries: Fiji, Tonga, Australia and New Zealand, and was conducted as a collaboration between Fiji
School of Medicine, Deakin University (Melbourne/Geelong) and the University of Auckland
(Auckland). This was a challenging project to implement across four diverse sites, and involving
multiple components. It represents an important and unique study focused on the prevention of
obesity, and has the potential to help our understanding of the complex interplay between various
factors in the community. While unhealthy diets and reduced physical activity levels are well known
risk factors for obesity, there is limited information on the interactions between the various factors
which shape availability and choice of food, and opportunities for physical activity. Challenges within
the environment need to be better defined before effective interventions can be tested.
This Fiji report documents the main processes that were implemented within the four components
of the study, and their key findings, which have been compiled and consolidated from all the various
reports and documents that were made during the study period from 2004-8. The revelations from
this study provide some baseline information and insights specifically for obesity prevention in
young people at the different school and community settings in Fiji. Together with the findings of
other previous NCD and nutritional studies such as the 2002 NCD STEPS survey, the 2004 National
Nutritional survey and many others, these additional research outcomes will further consolidate,
advocate and strengthen the multisectoral response to NCD prevention and control strategies in Fiji.
Recommendations made in this report needs to be to be taken up and followed through by the Fiji
government through the Ministry of Health, Ministry of Education, Ministry of National Planning and
other government agencies. In particular, the 22 policies recommended will definitely provide an
appropriate framework for further policy development and decision making processes to improve
obesity prevention in Fiji to another level.
This study also provided an opportunity for capacity building and academic advancement for the Fiji
OPIC project team at the Fiji School of Medicine and those that were closely involved in the
execution of this research. I thank and commend all those who were involved in this Fiji OPIC
project.
Professor Ian Rouse

Dean - College of Medicine, Nursing and Health Sciences
August 2010
3
List of Tables
Table 1: Action Plan for the Fiji ‘Healthy Youth Healthy Communities ..................................................... 19
Table 2: Demographics of Intervention and Comparison groups ............................................................... 22
Table 3: Height, weight, fat percent, BMI and BMI-z score measurements by ethnicity ........................... 23
Table 4: Weight classification by gender .................................................................................................... 26
Table 5: Height, weight, fat percent, BMI and BMI-z score measurements by gender.............................. 27
Table 6: Waist circumference and waist-to-height ratio by ethnicity ........................................................ 28
Table 7: Waist circumference and waist-to-height ratio by gender ........................................................... 28
Table 8: Weight perceptions and weight control behaviours by ethnicity................................................. 29
Table 9: Weight perceptions and weight control behaviors by gender ..................................................... 30
Table 10: Breakfast consumption behaviours by ethnicity......................................................................... 32
Table 11: Breakfast consumption behaviours by gender .......................................................................... 34
Table 12: Morning tea consumption behaviours by ethnicity .................................................................... 35
Table 13: Morning tea behaviours by gender ............................................................................................. 36
Table 14: Lunch behaviours by ethnicity .................................................................................................... 36
Table 15: Lunch consumption behaviours by gender ................................................................................. 37
Table 16: Consumption of fruit, vegetables and takeaway foods by ethnicity ......................................... 38
Table 17: Consumption of fruit, vegetables and takeaway foods by gender ............................................ 39
Table 18: Soft drink consumption by ethnicity ........................................................................................... 41
Table 19: Soft drink consumption by gender .............................................................................................. 42
Table 20: Fruit drink consumption by ethnicity .......................................................................................... 42
Table 21: Fruit drink consumption by gender............................................................................................. 43
Table 22: After school snack consumption by ethnicity ............................................................................. 43
Table 23: After school snack consumption by gender ................................................................................ 44
Table 24: Snack food purchasing behaviours by ethnicity.......................................................................... 44
Table 25: Snack food purchasing behaviours by gender ............................................................................ 45
Table 26: Physical activities and television use by ethnicity....................................................................... 45
Table 27: Physical activities and television use by gender ......................................................................... 47
Table 28: Family meals and home availability of foods by ethnicity .......................................................... 49
Table 29: Family meals and home availability of foods by gender ............................................................. 52
Table 30: Parental support for healthy eating by ethnicity ........................................................................ 53
Table 31: Parental support for healthy eating by gender ........................................................................... 53
Table 32: Parental support for physical activity by ethnicity...................................................................... 54
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Table 33: Parental support for physical activity by gender ........................................................................ 54
Table 34: Home availability of televisions, video games and computers by ethnicity ............................... 55
Table 35: Home availability of televisions, video games and computers by gender .................................. 55
Table 36: School support for healthy eating and physical activity by ethnicity ......................................... 56
Table 37: School support for healthy eating and physical activity by gender ............................................ 56
Table 38: Neighbourhood and community factors by ethnicity ................................................................. 57
Table 39: Neighbourhood and community factors by gender.................................................................... 57
Table 40: Pediatric Quality of Life by ethnicity .......................................................................................... 58
Table 41: Pediatric Quality of Life by gender .............................................................................................. 59
Table 42: Awareness of OPIC messages...................................................................................................... 59
Table 43: Summary of Findings on the social cultural issues in schools ..................................................... 64
Table 44: Summary of interview results for gender & cultural differences in food & eating .................... 67
Table 45: Summary of findings in the cultural & gender differences in physical activity........................... 68
Table 46: Cultural & gender differences in body image ............................................................................. 68
Table 47: List of policies recommended ..................................................................................................... 77
Table 47: School participation for time trade-off ....................................................................................... 86
Table 49: Fiji’s key health indicators ........................................................................................................... 93
Table 50: Selected regional comparative indicators .................................................................................. 94
Table 51: The ten major causes of morbidity and mortality in 2007.......................................................... 95
Table 52: Action plan objectives for school and community ...................................................................... 99
Table 53: Action plan for the Fiji ‘Healthy Youth Healthy Communities ................................................. 102
Table 54: Interventions implemented in the 7 schools ............................................................................ 103
Table 55: Interventions in Communities ................................................................................................... 104
Table 56: Activities undertaken for social marketing ............................................................................... 104
Table 57: Activities undertaken for capacity building .............................................................................. 106
Table 58: Activities undertaken for nutrition objectives ......................................................................... 108
Table 59: Activities undertaken for physical activity objectives ............................................................... 109
5
List of Figures
Figure 1: Overall structure of OPIC project ................................................................................................. 15
Figure 2: Flow diagram showing participation in the Fiji, Healthy Youth Healthy Communities
intervention study....................................................................................................................................... 20
Figure 3a: Cumulative overweight and obesity – All ................................................................................. 24
Figure 3b: Thinness - All .............................................................................................................................. 24
Figure 4a: Cumulative overweight and obesity – Indigenous ..................................................................... 24
Figure 4b: Thinness - Indigenous ................................................................................................................ 24
Figure 5a: Cumulative overweight and obesity - Indo-Fijian ...................................................................... 25
Figure 5b: Thinness - Indo-Fijian ................................................................................................................. 25
Figure 6a: Cumulative overweight and obesity - Other .............................................................................. 25
Figure 6b: Thinness - Other......................................................................................................................... 25
Figure 7a: Cumulative overweight and obesity – Males ............................................................................. 26
Figure 7b: Thinness - Males ........................................................................................................................ 26
Figure 8a: Cumulative overweight and obesity - Females .......................................................................... 27
Figure 8b: Thinness - Females ..................................................................................................................... 27
Figure 9a: Proportion trying to lose weight – All ........................................................................................ 29
Figure 9b: Proportion trying to lose weight by ethnicity ............................................................................ 29
Figure 10a: Proportion trying to lose weight – Male .................................................................................. 30
Figure 10b: Proportion trying to lose weight - Female ............................................................................... 30
Figure 11: Proportion of adolescents who skipped breakfast – by group .................................................. 31
Figure 12: Proportion of adolescents reporting home as their source for breakfast ................................. 32
Figure 13: Proportion of adolescents who skipped breakfast – by ethnicity ............................................. 33
Figure 14: Proportion of adolescents reported having breakfast............................................................... 33
Figure 15a: Proportion who skipped breakfast - Males.............................................................................. 34
Figure 15b: Proportion who skipped breakfast – Females ......................................................................... 34
Figure 16a: Proportion who obtained breakfast from home- Males.......................................................... 35
Figure 16b: Proportion who obtained breakfast from home - Females ..................................................... 35
Figure 17: Proportion having recommended fruit and vegetable consumption by group......................... 37
Figure 18: Proportion having recommended fruit and vegetable consumption by ethnicity .................... 38
Figure 19a: Proportion having recommended fruit and vegetable consumption – Males ........................ 39
Figure 19b: Proportion having recommended fruit and vegetable consumption- Females ...................... 39
Figure 20: Proportion of frequent consumption of takeaway food consumption by group ...................... 40
Figure 21: Proportion of frequent consumption of takeaway food consumption by ethnicity ................. 40
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Figure 22a: Proportion of frequent consumption of takeaway food consumption - Males...................... 41
Figure 22b: Proportion of frequent consumption of takeaway food consumption - Females ................... 41
Figure 23: Proportion of adolescents reporting more than two hours total screen time/day according
to group....................................................................................................................................................... 46
Figure 24: Proportion of adolescents reporting more than two hours total screen time/day according
to ethnicity .................................................................................................................................................. 46
Figure 25a: Proportion of adolescents reporting more than two hours total screen time/day – Males ... 47
Figure 25b: Proportion of adolescents reporting more than two hours total screen time/day –
Females ....................................................................................................................................................... 47
Figure 26: Proportion of adolescents reporting having family meals on most days .................................. 48
Figure 27: Adolescent perceptions of availability of different foods and beverages in the household
according to group ...................................................................................................................................... 49
Figure 28: Family meals and home availability of foods by ethnicity ......................................................... 50
Figure 29a: Adolescent perceptions of availability of different foods and beverages in the household
– Indigenous ................................................................................................................................................ 50
Figure 29b: Adolescent perceptions of availability of different foods and beverages in the household
- Indo-Fijian ................................................................................................................................................. 50
Figure 30a: Adolescent perceptions of availability of different foods and beverages in the household
according to group – Males ........................................................................................................................ 51
Figure 30b: Adolescent perceptions of availability of different foods and beverages in the household
according to group - Females...................................................................................................................... 51
Figure 31a: Family meals and home availability of foods – Males ............................................................. 52
Figure 31b: Family meals and home availability of foods - Females .......................................................... 52
Figure 32: Awareness of OPIC messages .................................................................................................... 61
Figure 33: Problem tree for low vegetable intake ...................................................................................... 74
Figure 34: Solution tree for low vegetable intake ...................................................................................... 75
Figure 35: Map of Fiji .................................................................................................................................. 92
Figure 36: Distribution of deaths in Fiji by cause groups, 2007 .................................................................. 96
Figure 37: OPIC community interaction process model ........................................................................... 100
7
Abbreviations
AQOL Adjusted Quality of life

CEA Cost effective analysis
CUA Cost utility Analysis
DMO Divisional Medical Officer
Food Refers to all food and drinks
FPAN Fiji Plan of Action for Nutrition
FSM Fiji School of Medicine
MOH Ministry of Health
NCDs Non communicable diseases
OPIC Obesity Prevention in Communities project
PA Priority Area (s)
PedsQL™ Pediatric Quality of Life Inventory
Policy Laws & regulations, enforceable actions, precise policies which require action
QALY Quality adjusted life year
QoL Quality of Life
SDMO Sub Divisional Medical Officer
TTO Time trade off
UNDP United Nations Development Program
VAT Value added tax applied to all services and products in Fiji
WHO World Health Organization
WTO World Trade Organization
8
Acknowledgements
The Fiji OPIC component formed part of the Pacific Obesity Prevention in Communities project, and
was managed by the Fiji School of Medicine. The support and involvement of both past and present
members of the OPIC team is appreciated.
The research was funded by Wellcome Trust, the New Zealand Health Research Council and the
National Health and Medical Research Council of Australia. Funding contributions from the Ministry
of Health Fiji are hereby acknowledged. The involvement of the members of the following
government agencies, non-governmental organisations and the many stakeholder groups were
critical to the completion of the study and the following are acknowledged for their active
participation and contributions:
Ministry of Health: Permanent Secretary for Health, Medical Officer & staff Valelevu Health Centre,
SDMO Suva and team, DMO Central and staff, and staff of MOH HQ
Ministry of Education: The Permanent Secretary for Education, Director TVET. The Principals,
teachers, school project focal points, students and parents from the following: Assemblies of God
High School, Ahmadiyya Muslim College, Ba Provincial High School, Bhawani Dayal Arya College,
Central College Lautoka, Cuvu College, Drasa Secondary School, Lautoka Andra Sangam College,
Natabua High School, Nadi College, Nadi Muslim College, Nasinu Secondary School, Nakasi High
School, Nasinu Muslim College, Rishikul Sanatan College, Swami Vivekananda College, Sigatoka
Methodist College and St. Thomas High School
Community settings: Faith Base Organizations in Valelevu Medical Area: Assemblies of God; AGOFI,
Catholic; Hindu ; Methodist, ; Muslim; SDA; World Harvest Centre
Other public sector: Fijian Affairs Board, Fisheries Department, Department of Agriculture,
Department of Public health and Primary Care; Trading Standards, Ministry of External Trade and
Foreign Affairs; Ministry of Finance, Suva City Council, Ministry of Commerce and Industry
Private Sector: Ram Sami & Sons Fiji Limited Rooster Chicken; Rewa Corporative Dairy Company;
Acquifer Water company; Coca Cola Fiji Amatil Fiji; Nestle Fiji Ltd.
Other NGOs: Consumer Council of Fiji.
The OPIC Team:
Fiji: Jan Pryor, Graham Roberts, Sitaleki Finau, Jimaima Schultz, Gade Waqa, Anjileena Dev, Vani
Fifita, Nola Vanualailai, Anaseini Raikoti, Sunil Chand, Vula Utonivaya, Epi Coriakula, Andrew Prasad,
Joanna Kenny, Arleen Sukhu, Savaira Leweniqila, Wendy Snowdon
New Zealand: Sarah Carne, Ofa Dewes, Dudley Gentles, Shirin Foroughian, Gavin Faeamani, Maea
Hohepa, Fa’asisila Savila, David Schaaf, Robert Scragg, Lois Shaw, John Sluyter, Tasileta Teevale,
David Thomas, Jennifer Utter, Jody Warbrick
Tonga: Laukau ‘Aholova, Tilema Cama, Fatai Faingata’a, Hekisou Fifita, Kalesita Fotu, Popi Latu Fotu,
Litiola Kava, Ichikawa La’akulu, Lote Lautaimi, Fine Lolohea, Sisilia Moala, Nancy Palu, Siosifa
Pomana, Siosi Soakai, ‘Inoke Taufa, Paula Vivili
9
Australia: Colin Bell, Rob Carter, Anita Chia, Max de Courten, Jisheng Cui, Catherine Keating, Peter
Kremer, Mark Lawrence, Caryn Kave, Louise Mathews, Helen Mavoa, Marita McCabe, Lynne Miller,
Marj Moodie, Lina Ricciardelli, Mary Malakellis, Michelle Rowland, Andrea de Silva Sanigorski, Anne
Simmons, Wendy Snowdon, Boyd Swinburn, Anne-Marie Thow, Lauren Williams, Nadine White,
Laurie Meade, Kate Scalzo, Narelle Roberston.
10
Executive Summary
Background
The Pacific region including Fiji has the highest rates of obesity in the world. The Pacific OPIC
Project was established in 2004 to evaluate the effectiveness of whole-of community
obesity prevention programs for youth (ages 12-18 years) in New Zealand, Fiji, Tonga and
Australia. There is limited information on the lifestyle and obesity patterns among youth in
the South Pacific region. This Fiji report documents the main processes that were
implemented, and the key findings.
Methods
The quasi experimental design included several components: intervention and data
collection in schools, food policy analysis, socio-cultural studies and economic studies.
In the schools-based component of OPIC, information was collected from 17,150 high school
students from 7 different schools in Nasinu area alongside the Suva – Nausori corridor and
11 schools in the western division as a comparison group. The response rate for the 7
Nasinu Schools was 75% and the follow up rate was 32.7%. The response rate from the
comparative schools was 73% and the follow up rate was 45.1%.
The food policy component included an analysis of existing policies, along with the
identification of recommended policy changes to create a healthier food environment.
Utilizing participatory methods, along with informant interviews and economic modeling
this component worked with key sectors and agencies in Fiji.
The socio-cultural component included in-depth interviews with 48 students in the selected
schools. The interviews included collection of information on body image, physical activity
and diet.
The economic component of OPIC, included an assessment of the quality of life among
adolescents in the interview schools. Assessments of the cost-effectiveness of interventions were
also included.
Results and findings
• The prevalence of overweight/ obesity was 26% females and 17% males in the OPIC study
population.
• More than 30% of Indo-Fijian students were classified as thin.
• Approximately half of females and one third of males were trying to lose weight, while
13% of females and 24% of males were trying to gain weight.
• Approximately 30% of students drank soft drinks on 4 or 5 days in the past 5 school days.
• Multiple opportunities exist for increasing physical activity during the school day, yet less
than one-third of students played actively
• Less than 30% of students reported that food & drinks available at school were mostly
healthy.
The intervention resulted in no significant changes in the measures of overweight. While

there was some improvement in body fat % in the intervention group, this was not reflected
in the other anthropometric measures.
11
The food policy component identified considerable barriers to healthy eating in Fiji. The
existing mutton flap ban was having some effect on food supply, but was not sufficient.
Twenty-one policy change recommendations were identified by stakeholders focused on
reducing the cost of healthy foods and increasing the cost of less healthy foods, along with
reduced access to less healthy foods such as fatty meats and control of food advertising and
consumption of foods in schools and public buildings.
The socio-cultural component identified important influences on diet, physical activity and
body image. Indo-Fijians had a diet that was high in vegetables, while indigenous Fijians had
more complex carbohydrates. Many of the differences found in this study cut across
cultural group and gender. For example, Indo-Fijian females appeared to be less interested
in being physically active than either indigenous Fijians or Indo-Fijian males. Indo-Fijian
females also appeared to have fewer opportunities than indigenous Fijian girls to engage in
recreational physical activity. Indo-Fijian males wanted to increase weight and/or muscle,
while indigenous Fijian females wanted to lose weight.
The economic studied component of OPIC found a large variation in mean AQoL scores by
ethnic group. Quality of life decreased with excess weight for Indo-Fijians, but increased in
Indigenous Fijian adolescents. The Indo-Fijians experienced a bigger loss in quality of life
amongst the overweight (3%) than the obese group (1%). In contrast, both overweight and
obese Indigenous Fijian adolescents, experienced 2% higher quality of life scores than their
healthy weight peers.
Conclusions & Recommendations
Fiji now has extensive data on the diets, physical activity and weights of a large sample of
adolescents. This data highlights the considerable problems in this group with regard to
overweight, underweight, poor diets and low physical activity. The factors affecting diet and
physical activity levels in adolescents include multiple factors such as the school, home and
community environment, including sociocultural values and national policies. Improving the
health of adolescents is therefore unlikely to be a simple process.
The multiple planned actions that took place within the HYHC aspect of OPIC in Fiji delivered
few impacts on the intervention groups. This is a highly significant finding. It demonstrates
that multiple actions are likely required over sustained time periods to effect change. It also
demonstrates the importance of this type of research, and of programme evaluation. It is
essential that efforts to improve health are targeted and effective.
Recommendations are to:
1) Create supportive environments

2) Utilise multiple, sustained interventions and activities to target obesity.
3) Schools to adopt comprehensive health-promoting approach
4) Clear guidance on healthy eating, physical activity and body weight
5) More research, monitoring and evaluation to identify effective approaches to combat obesity
and NCDs.
12
Fiji OPIC Study
1.0 Objectives
1.1 AIM
The overall aim of the four-country Pacific OPIC Project (Obesity Prevention in Communities)
was to build the evidence for obesity prevention in young populations. The research
questions for Fiji were:
1. What is the overall impact (including cost-effectiveness) of comprehensive,
community-based programs on overweight/obesity prevalence in young
populations?
2. What is the feasibility of the specific intervention components and what are their
impacts on eating and physical activity patterns?
3. What are the socio-cultural factors (community attitudes, perceptions, beliefs,
values) that promote obesity and how can they be influenced?
4. What are the effects of national and international food-related policies and policy
changes on the supply of foods in Fiji that might influence obesity prevalence?
5. What is the overall burden of childhood obesity (including loss of quality of life,
disease impacts and health system costs) and how can resources be best allocated to
prevent obesity?
The research objectives were:
1. To develop, implement and evaluate the impact of comprehensive community based

programs in settings relevant to the identified target groups.
2. To compare the costs, impacts and outcomes of the programs with the comparison
communities.
3. To identify the reasons for the successes and failures of the individual intervention
components in each project using quantitative and qualitative methodologies.
4. To increase the capacity of health professionals and the community to plan,
implement and evaluate nutrition and physical activity programs
5. To link the intervention programs with monitoring programs (such as WHO STEPS
Survey)
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1.2 RATIONALE
Overweight and obesity are the seventh leading predicted cause of avoidable global disease
burden for 2010 and 2020 (WHO, 2002), with prevalence rates rapidly increasing in both
developed and developing countries. It is of serious concern that the Pacific region has the
highest rates of obesity in the world (Coyne, 2000). Chronic diseases contribute significantly
to the global burden of disease, and are particularly devastating for low and middle income
countries, both socially and economically (WHO 2005).
The Pacific region has the highest rates of obesity in the world. There is limited information
on the lifestyle and obesity patterns among youth in the South Pacific region. However, it is
only recently that governments have been seeking evidence on what does and does not
work for obesity prevention; and unfortunately this current evidence base is very limited.
The Pacific Islands Ministers of Health two yearly meetings resolutions were committed to
this initiative as such. This was reflected in the 2003 Tonga Commitment, 2005 Samoa
Commitment and the 2007 Vanuatu (WHO 2003, WHO 2005, WHO 2007) Commitment of
their governments’ undertaking.
Systematic reviews of the literature have identified less than 30 intervention studies to
prevent childhood or adolescent obesity (Summerbell et al., 2005). Most studies have been
conducted in primary schools, have been short term and have had modest results at best.
Much more intervention research is required, especially for highly susceptible populations.
For these reasons, the Pacific OPIC Project (Obesity Prevention In Communities) was
established to measure the effectiveness and cost-effectiveness of whole-of-community
obesity prevention programs for youth (ages 12-18 years) in New Zealand, Fiji, Tonga and
Australia.
The Pacific OPIC Project was funded for five years by three research funding bodies: the
Wellcome Trust (UK), the National Health and Medical Research Council (Australia), and the
Health Research Council (New Zealand) as part of an International Collaborative Research
Grants scheme.
14
2.0 OPIC Methodology and Research design
2.1 OVERALL PACIFIC OPIC PROJECT STRUCTURE
The overall structure of the project and the main inter-connections are shown in Figure 1.
Figure 1: Overall structure of OPIC project
Research Analytical Intervention Analytical Research

Studies Studies Studies
Effects of Burden of
comprehensive childhood
Aus Economic
community obesity
interventions Studies
Allocative
Feasibility and
NZ 
efficiency for
effects of specific QoL interventions
interventions Fiji QoL in
*
* adolescen
Effects of policies
Socio- t obesity
and policy changes Policy * Tonga cultural
on food supply Studies S-C promoters
Studies
and protectors
for obesity
* Inform Interventions,  Cost effectiveness, QoL = Quality of Life
The rationale for the study designs was:

• The use of multiple intervention strategies across several settings to achieve a high
enough ‘dose’ of interventions to affect eating patterns and physical activity;
• The strong community focus and linkages with existing or proposed government and
NGO programs to increase the ownership and sustainability of the interventions;
• Linkages with monitoring and surveillance programs where possible to increase

sustainability and cost efficiencies (using monitoring data as the comparison
population);
• The use of community participation, including through ANGELO workshops, to

increase community engagement in the research process and outcomes and to
ensure the relevance and sustainability of the interventions;
• The analysis and incorporation of environmental factors (physical, economic, policy

and socio-cultural) into the intervention programs to address the underlying causes
of obesity;
15
• Measuring costs so that cost-effectiveness of the intervention programs can be
determined;
• Measuring the effects of the interventions on socio-cultural factors and quality of life
indicators so that these important program impacts can be documented;
• Maximising the opportunities to grow the research capacity through PhD and Masters
training programs linked with the research projects.
As shown in Figure 1, the OPIC study in Fiji had 4 different components which were:
1. Community and School Intervention Component (Intervention Study, known as
Healthy Youth Healthy Communities Study in Fiji)
2. Socio-cultural Component
3. Policy Component
4. Economic Component
The objectives, methods and findings for each component are detailed in separate sections
in this report.
16
3.0 The Healthy Youth Healthy Communities Intervention
Study
The Healthy Youth Healthy Communities (HYHC) study was the Fijian arm of the broader
OPIC intervention study. Details of the development, implementation and evaluation of the
HYHC component are detailed in this section.
Health promotion action at a community level needs to become embedded in the

organizations working in that community and need to ensure that the community owns and
embraces the action. The challenges are considerable, particularly in achieving a sufficiently
high and sustainable ‘dose’ of intervention and evaluating the process, impacts and
outcomes to a sufficiently high standard given all the constraints associated with such
projects. While these challenges are recognized, the problem of obesity, especially in Pacific
populations, needs to be addressed at all levels – community, national, and global. The
HYHC utilized a community-based approach which incorporated a health promotion
approach that aimed to build community capacity to change adolescent behavior and
reduce unhealthy weight gain.
3.1 METHODS
Study Design, Communities and Participants
The HYHC intervention study was based on a quasi-experimental study design, with
intervention schools chosen from the Nasinu community, and the comparison schools in the
west of Fiji. Specifically, seven intervention secondary schools in Nasinu were chosen based
primarily on the ethnic mix of students involving 67% indigenous Fijians and 33% Indo-
Fijians. Other criteria for selection include geographical locations, community setup and the
ease of access to carry out intervention activities. Similar criteria were used to select the
control schools from three areas in the west of Fiji, namely, Sigatoka, Nadi and Lautoka. In
these areas 11 schools that matched the profiles of the intervention schools were selected
from 35 secondary schools. Students between the ages of 13 and 19 in forms 3 to 7
participated in the study.
In the seven identified Nasinu schools, the total enrolment was 3530 of which 2670
consented to participate – giving the response rate of 75%. In the lost to follow up, 373
children were not available for their measurements to be taken and 1418 children moved
out elsewhere. Hence the follow up rate was 32.7%.
For the 11 Comparison schools in Sigatoka, Nadi and Lautoka, 6255 children were enrolled
and 4567 consented to the data collection. The response rate was 73%. In the lost to follow
up, 2 children refused, 431 children were not available for their measurements to be taken
and 2075 of them moved elsewhere. Hence the follow up rate for the comparison schools
was 45.1%
The overall follow-up rate was therefore 41%. The overall participation and follow-up rates
for the Intervention and Comparison groups are summarized in Figure 2.
17
The overall sample at baseline comprised more females (53%) than males (47%) and 84% of
students were between the ages of 13 and 16 years (41% aged 13 to 14; 43% aged 15 to 16).
Approximately 50% of students were in Year 9 and 35% of students were in Year 11 at
school. 43% of students identified their ethnicity as Indigenous Fijians, 52% as Indo-Fijian,
and 5% as other ethnicity (Other) group.
3.2 THE HYHC INTERVENTION
There were 2 phases in the HYHC Intervention:
a. Phase 1 – Preliminary assessment of socio-cultural factors

At each intervention site, preliminary interviews were conducted with the 12-18 year olds to
determine the perceptions of potential socio-cultural barriers related to three areas:
barriers that facilitate or hinder healthy eating, regular physical activity and a healthy body
size.
Findings from the interviews informed and shaped the community workshops and baseline
questionnaire and indicated that youth:
• knew about healthy food and drinks,
• often buy junk food with spending money that was not monitored by adults,
• identified mothers as a key messenger about food while fathers provided more
messages about exercise & physical activity,
• thought boys had more freedom than girls to exercise and in Fijians, Indo- Fijians
prioritize study over exercise,
• identified media, peers and sports stars as important messengers relating to body
size, shape and muscularity.
Overall they identified approximately 15-20 potential behaviors, knowledge and skills gaps,
and 10-25 environmental barriers in each of the settings. The findings of the socio-cultural
interviews were included in the materials developed for the community workshops.
b. Phase 2 – Community workshops to develop the draft action plans
The phase 1 findings were presented at a 2-day workshop with community stakeholders,
including the youth. The participants then prioritized the components to develop a draft
action plan which was later consolidated through further community consultation. The
community workshop used the ANGELO framework based on an Analysis Grid for Elements
Linked to Obesity.
Each action plan developed for the school and the community had two overall aims:
• to build community capacity
• to promote healthy weight through capacity building, social marketing messages,
evaluation and environmental change
The action plan developed is in Table 1.
18
Table 1: Action Plan for the Fiji ‘Healthy Youth Healthy Communities
Behavioral & Innovative Objectives Key Strategies
1. To significantly reduce the proportion of adolescents • Promote breakfast with students and
who skip breakfast on school days. parents – pamphlets & school assembly
morning talks
• School canteen providing breakfast
2. To improve the healthiness of food at school by • Develop school policies for canteens to
significantly decreasing the consumption of high sugar support water, fruit and vegetable
drinks and promoting the consumption of water and by consumption
significantly increasing fruit • Curriculum development with Home
and vegetable consumption Economics and Agricultural Science
3. To significantly decrease the consumption of energy • Social marketing [include fruits (&
dense snacks and significantly increase consumption of vegetables) for snacks and benefits
fruit as afternoon snacks of F & V; what constitutes healthy snack
• Student information on healthy snacks, F &
V snacks
4. To significantly increase the proportion of adolescents • “Walking buddies”
living within walking distance to school to walk to and • Road safety skills
from school with a sense of safety
5. To support physical education teachers to conduct • School policy on physical education classes
physical education classes effectively • Partnership with organizations to provide
sports equipment such as, hoops, ropes &
others
6. To significantly increase the amount of active play • House rules on screen time and outside
after school/ weekends; significantly decrease time play time
spent watching TV & playing computers or electronic • School walkathon
games
7. To develop a program for promoting healthy eating & Food Preparation Skills
physical activity within churches, mosques & temples • Budgeting skills
Further details regarding the interventions are provided in Annex Two.
19
Figure 2: Flow diagram showing participation in the Fiji, Healthy Youth Healthy Communities
intervention study
Intervention Comparison
Nasinu area selected as Three towns on western Viti

Enrolment
intervention region (target Levu (Sigatoka, Nadi,

group children 13-19 yo). Lautoka) selected as
Secondary schools (n=7) comparison region.
Secondary schools (n=11)
All children in Nasinu area Children from comparison

received intervention. towns received background
Allocation
2670 of 3530 children activities only.

consented to data collection 4567 of 6255 children
(response rate: 75%) consented to data collection
(response rate: 73%)
First exit survey: First exit survey:

440 children surveyed 644 children surveyed
Follow-up
Final exit survey: Final exit survey:

439 children surveyed 1425 children surveyed
Lost to follow-up: Lost to follow-up:

Child refused (n=0) Child refused (n=2)
Child not available for Child not available for
measurement (n=373) measurement (n=431)
Child moved elsewhere Child moved elsewhere
(n=1418) (n=2075)
Intervention analysed: Comparison analysed:

n=879; follow-up rate: 32.7% n=2069; follow-up rate: 45.1%
Analysis
Excluded from analyses: Excluded from analyses:

- All follow-up analyses - All follow-up analyses
because child moved into because child moved into
comparison area (n=5) intervention area (n=7)
- Anthropometric measures - Anthropometric measures
because of equipment because of equipment
problems, measurement or problems, measurement or
data entry error (n varies) data entry error (n varies)
- Knowledge, attitudes, - Knowledge, attitudes,
behaviours and quality of life behaviours and quality of life
measures because of measures because of
equipment problems (n varies) equipment problems (n varies)
20
3.3 SURVEY METHODOLOGY
In order to identify problems and also monitor the impacts of interventions, surveys were conducted
of the students involved. Students were surveyed in 2005 (baseline) and again in 2008 (follow-up).
Data were collected via paper questionnaires and Personal Digital Assistants (PDAs). Paper
questionnaires were used to record demographic information, and PDAs were used for
administration of the knowledge, attitudes and behaviours (KAB) survey. The KAB survey consisted
of items focusing on nutritional-related issues, with a total of 20 variables, physical activity issues
with 19 variables, and behavioral issues with a total of 42 variables.
A stadiometer was used to measure the height to the nearest 0.1 (cm), during which students
removed their socks and shoes. Weights to the nearest 0.05 (kg) were measured by feeding the
information, with no adjustment for clothing, into the Bioelectrical Impedance Analysis (BIA). A
Figure Finder tape was used to measure waist circumference at the level of umbilicus. Standardized
protocols were used to ensure consistency during recording and all research staff received training
in relation to measurement and sensitivity issues.
3.4 DATA TREATMENT
Anthropometric measures included: waist (cms), waist/height ratio (cms), body composition
(percentage body fat), as well as body mass index (BMI, weight in kg/height in m2) and standardized
body mass index (BMI-z score, calculated using the WHO Reference 2007 the Stata macro)
(www.who.int/growthref/en/). The WHO Reference 2007 age-specific BMI cut-offs were also used to
classify children’s weight status as either thinness grades 1-3, healthy weight, overweight or obese.
3.5 RESULTS
The results of the intervention study are reported according to key sections: demographics, body
size and attitudes, behaviors and perceptions and quality of life.
21
a. Demographics
Demographic information for the intervention and comparison groups across baseline and follow-up are summarized in Table 2.
Table 2: Demographics of Intervention and Comparison groups
Baseline Follow up Baseline Follow up
Fijian Indo- Other All Fijian Indo- Other All Fijian Indo-Fijian Other All Fijian Indo- Other All
Fijian Fijian Fijian
Total 174 680 20 874 174 680 20 874 775 1141 145 2061 775 1141 145 2061
Gender
Male 44.3 47.2 25.0 46.1 44.3 47.2 25.0 46.1 43.1 44.1 40.0 43.4 43.1 44.1 40.0 43.4
Female 55.8 52.8 75.0 53.9 55.8 52.8 75.0 53.9 56.9 55.9 60.0 56.6 56.9 55.9 60.0 56.6
Age
12 yrs & 0 0 0 0 0 0 0 0 0.1 0.1 0 0.1 0 0 0 0
<
13 to 14 24.1 39.0 30.0 35.8 0 0 0 0 45.0 50.4 54.5 48.7 0.1 0 0 0.1
yrs
15 to 16 62.6 58.4 70.0 59.5 14.4 26.5 15.0 23.8 47.5 48.5 43.5 47.7 35.7 40.8 40.0 38.9
yrs
17 yrs & 13.2 2.7 0 4.7 85.6 73.5 85.0 76.2 7.4 1.1 2.1 3.5 64.1 59.2 60.0 61.1
>
School year
Form 3 29.8 35.5 25.0 34.2 0 0 0 0 51.9 53.1 59.4 53.1 0 0 0 0
Form 4 54.6 44.1 55.0 46.3 0 0 0 0 0 0 0 0 0 0 0 0
Form 5 12.8 20.3 20.0 18.9 1.4 1.1 0 1.2 48.1 46.9 40.6 46.9 31.8 27.3 31.5 29.3
Form 6 2.8 0.2 0 0.6 72.3 64.6 70.0 66.1 0 0 0 0 46.2 43.2 42.0 44.2
Form 7 0 0 0 0 26.2 34.3 30.0 32.7 0 0 0 0 22.0 29.5 26.6 26.5
Living with one or two parents during the school week
78.9 98.3 77.8 94.2 77.3 97.6 88.9 93.6 81.5 97.4 94.3 91.5 78.9 96.2 91.9 89.6
Living with other adult relatives during school week
58.6 24.7 50.0 31.6 55.5 26.9 38.9 32.5 53.4 24.0 40.7 35.8 55.6 25.6 39.8 37.5
Number of people living at home
1 to 4 18.8 37.8 11.1 33.5 21.9 39.0 16.7 35.3 17.6 42.0 27.6 32.2 20.8 46.8 28.5 36.0
people
5 to 6 24.2 46.8 38.9 42.4 34.4 45.5 27.8 43.0 37.7 45.2 38.2 42.0 37.7 42.2 39.0 40.3
people
7 or > 57.0 15.5 50.0 24.1 43.8 15.5 55.6 21.8 44.7 12.8 34.2 25.9 41.6 11.1 32.5 23.7
people
The Intervention group had a higher proportion of Indo-Fijian and male adolescents than the Comparison group. Furthermore, the Intervention group had a
higher proportion of children who were older reflecting the different proportion of children sampled from each of the different year levels among the
22
Intervention and Comparison groups. There were few differences between the two groups for living arrangements; approximately equal proportions of
adolescents reported living with one or two parents, or with other adults during the school week, as well as numbers of other people living at home. At
follow up there were few differences between the two groups however again the distribution of year levels and ages varied, which is not surprising given
the structure of the two groups at baseline.
b. Body size and Attitudes

Information about body size and attitudes to body size are summarized in this section of the report.
Mean (and standard deviation, SD) values for the key anthropometric measures for the Intervention and Comparison groups at baseline and follow-up are
summarized in Table 3, and shown in Figures 3 to 6.
Table 3: Height, weight, fat percent, BMI and BMI-z score measurements by ethnicity
Fijian Indo-Fijian Other All Fijian Indo-Fijian Other All Fijian Indo-Fijian Other All Fijian Indo-Fijian Other All
Height
Mean 166.0 161.1 163.3 162.2 169.8 164.0 165.6 165.2 165.8 160.8 164.4 163.0 170.1 164.2 167.8 166.7
SD 7.1 8.2 4.6 8.1 8.0 9.1 5.1 9.1 7.7 8.5 7.6 8.5 8.1 9.1 8.6 9.1
Weight
Mean 62.5 51.1 57.6 53.5 69.0 55.4 61.2 58.2 62.2 50.7 61.1 55.8 69.2 54.9 66.4 61.1
SD 9.6 12.8 11.9 13.0 10.4 14.5 12.0 14.8 12.2 12.3 14.9 13.7 11.8 13.0 15.5 14.5
Fat percent
Mean 24.0 25.0 27.6 24.9 24.0 23.7 26.6 23.8 22.5 24.0 26.6 23.6 24.5 24.4 27.6 24.7
SD 10.6 10.5 8.3 10.5 12.0 12.3 11.3 12.2 9.9 10.6 9.9 10.4 11.8 12.0 10.7 11.9
BMI
Mean 22.7 19.6 21.5 20.2 23.9 20.5 22.3 21.2 22.5 19.5 22.5 20.9 23.9 20.3 23.5 21.9
SD 3.1 4.2 3.8 4.2 3.2 4.7 4.0 4.6 3.6 4.0 4.6 4.2 3.5 4.1 4.5 4.3
BMI-z score
Mean 0.59 -0.55 0.16 -0.32 0.67 -0.59 0.12 -0.34 0.62 -0.50 0.58 -0.02 0.69 -0.57 0.52 -0.03
SD 0.88 1.42 1.22 1.41 0.85 1.45 1.22 1.44 0.92 1.41 1.18 1.36 0.89 1.38 1.15 1.35
23
Figure 3a: Cumulative overweight and obesity – All Figure 3b: Thinness - All
Figure 4a: Cumulative overweight and obesity – Indigenous Figure 4b: Thinness - Indigenous
24
Figure 5a: Cumulative overweight and obesity - Indo-Fijian Figure 5b: Thinness - Indo-Fijian
Figure 6a: Cumulative overweight and obesity - Other Figure 6b: Thinness - Other
25
The same indicators are also shown by gender in Tables 4 and 5 and Figures 7 and 8. The combined overweight and obesity prevalence at baseline was
17.8% in the intervention group and 22.3% in the comparison group. At follow-up, the rates were 18.3% and 21.5% respectively.
Table 4: Weight classification by gender
Male Female All Male Female All Male Female All Male Female All
Weight Classification
Thin 13.3 9.4 11.2 14.3 11.6 12.8 11.5 4.9 7.7 10.8 6.0 8.1
Healthy weight 69.6 72.2 71.0 66.6 70.9 68.9 68.2 71.4 70.0 71.3 69.8 70.4
Overweight 9.6 15.0 12.5 12.1 14.1 13.2 14.1 18.1 16.4 11.5 17.7 15.0
Obesity 7.5 3.4 5.3 7.0 3.4 5.1 6.2 5.7 5.9 6.4 6.5 6.5
Figure 7a: Cumulative overweight and obesity – Males Figure 7b: Thinness - Males
26
Figure 8a: Cumulative overweight and obesity - Females Figure 8b: Thinness - Females
Detailed findings on anthropometric measures are given in Table 5.
Table 5: Height, weight, fat percent, BMI and BMI-z score measurements by gender
Height
Mean 167.3 157.8 162.2 172.3 159.1 165.2 167.8 159.2 163.0 173.8 161.2 166.7
SD 7.2 5.9 8.1 6.3 6.3 9.1 8.6 6.3 8.5 6.9 6.5 9.1
Weight
Mean 56.2 51.2 53.5 63.5 53.7 58.2 57.9 54.1 55.8 65.4 57.8 61.1
SD 13.8 11.9 13.0 15.0 13.0 14.8 14.8 12.5 13.7 14.8 13.4 14.5
Fat percent
Mean 18.4 30.3 24.9 14.6 31.5 23.8 16.5 28.6 23.6 13.8 32.2 24.7
SD 9.7 7.6 10.5 10.2 7.6 12.2 9.6 7.6 10.4 8.9 6.9 11.9
BMI
Mean 20.0 20.5 20.2 21.3 21.1 21.2 20.4 21.2 20.9 21.5 22.1 21.9
27
SD 4.2 4.2 4.2 4.6 4.6 4.6 4.2 4.1 4.2 4.2 4.3 4.3
BMI-z score
Mean -0.39 -0.26 -0.32 -0.37 -0.32 -0.34 -1.16 0.09 -0.02 -0.19 0.09 -0.03
SD 1.50 1.33 1.41 1.53 1.36 1.44 1.47 1.26 1.36 1.42 1.29 1.35
Information on the students’ waist circumference is given in tables 6 and 7. There are no specific cut-offs for adolescents.
Table 6: Waist circumference and waist-to-height ratio by ethnicity
Indigenous Indo- Others All Indigenous Indo- Others All Indigenous Indo- Others All Indigenous Indo- Others All
Fijian Fijian Fijian Fijian
Waist circumference
Mean 76.3 71.4 74.1 72.4 79.7 74.6 76.1 75.6 76.3 71.3 76.2 73.6 77.9 72.1 77.8 74.7
SD 7.0 10.3 7.1 9.9 7.6 11.0 8.3 10.6 8.6 10.1 10.7 9.9 7.9 9.8 10.7 9.6
Waist-to-height ratio
Mean 0.46 0.44 0.45 0.45 0.47 0.45 0.46 0.46 0.46 0.44 0.46 0.45 0.46 0.44 0.46 0.45
SD 0.05 0.06 0.04 0.06 0.05 0.06 0.05 0.06 0.05 0.06 0.06 0.06 0.05 0.06 0.06 0.06
Table 7: Waist circumference and waist-to-height ratio by gender
Waist circumference
Mean 72.7 72.3 72.4 77.0 74.5 75.6 73.8 73.4 73.6 75.7 73.9 74.7
SD 10.2 9.6 9.9 11.1 10.0 10.6 10.5 9.4 9.9 9.6 9.6 9.6
Waist-to-height ratio
Mean 0.43 0.46 0.45 0.45 0.47 0.46 0.44 0.46 0.45 0.44 0.46 0.45
SD 0.06 0.06 0.06 0.06 0.06 0.06 0.06 0.05 0.06 0.05 0.05 0.06
Information was also gathered on students’ perceptions of their own weight and body size. The findings are shown in Tables 8 and 9, and Figures 9 and 10
28
Table 8: Weight perceptions and weight control behaviours by ethnicity
Indigenous Indo-Fijian Others All Indigenous Indo-Fijian Others All Indigenous Indo-Fijian Others All Indigenous Indo-Fijian Others All
Weight Perception
Underweight 29.1 31.8 33.3 31.2 13.6 28.9 13.3 24.7 19.8 21.2 14.2 20.1 16.8 22.0 18.1 19.7
About the right 42.7 48.1 40.0 46.5 57.3 52.0 60.0 53.5 57.7 60.2 58.3 59.1 61.7 58.9 54.3 60.0
weight
Overweight 28.2 20.1 26.7 22.3 29.1 19.2 26.7 21.8 22.5 18.5 27.6 20.7 21.5 19.1 27.6 20.6
Body weight
Happy/very happy 44.7 42.9 33.3 43.0 36.9 41.2 26.7 39.7 52.2 46.0 42.5 48.1 52.2 48.5 41.7 49.4
Body shape
Happy/very happy 52.4 52.7 46.7 52.4 45.6 49.7 40.0 48.3 57.9 52.4 41.7 53.7 59.6 54.5 50.4 56.1
Weight control behaviours
Trying to lose 36.9 25.3 33.3 28.4 43.7 34.4 46.7 37.1 49.1 40.1 41.7 43.7 44.4 36.5 36.2 39.5
weight
Trying to gain 42.7 43.2 40.0 43.0 26.1 36.4 20.0 33.3 23.8 29.1 18.1 26.2 26.7 30.0 22.1 28.1
weight
Not trying to 20.4 31.5 26.7 28.6 30.1 29.2 33.3 29.6 27.2 30.8 40.2 30.1 28.9 33.6 41.7 32.4
change weight
Trying to gain muscle
43.7 52.3 66.7 50.7 48.5 49.7 60.0 49.8 63.7 55.0 64.6 59.1 54.2 52.1 59.1 53.4
Figure 9a: Proportion trying to lose weight – All Figure 9b: Proportion trying to lose weight by ethnicity
29
Table 9: Weight perceptions and weight control behaviors by gender
Weight Perception
Underweight 32.0 30.6 31.2 26.0 23.7 24.7 19.6 20.5 20.1 21.7 18.3 19.7
About the right weight 47.5 45.7 46.5 54.1 53.1 53.5 63.4 55.9 59.1 63.1 57.0 60.0
Overweight 20.4 23.7 22.3 19.9 23.3 21.8 17.0 23.6 20.7 15.3 24.7 20.6
Body weight
Happy/very happy 43.7 42.5 43.0 50.3 31.8 39.7 55.3 42.5 48.1 57.8 43.0 49.4
Body shape
Happy/very happy 55.6 50.0 52.4 57.3 41.7 48.3 59.1 49.5 53.7 60.9 52.5 56.1
Weight control behaviours
Trying to lose weight 23.8 31.8 28.4 27.1 44.5 37.1 34.7 50.5 43.7 28.5 48.0 39.5
Trying to gain weight 54.1 34.7 43.0 48.6 22.0 33.3 36.2 18.6 26.2 42.4 17.2 28.1
Not trying to change weight 22.1 33.5 28.6 24.3 33.5 29.6 29.0 31.0 30.1 29.2 34.8 32.4
Trying to gain muscle
Trying to gain muscle 77.9 30.6 50.7 87.9 21.6 49.8 85.4 38.9 59.1 84.2 29.8 53.4
Figure 10a: Proportion trying to lose weight – Male Figure 10b: Proportion trying to lose weight - Female
30
c. Eating and Diet
This section summarises information about adolescents’ behaviours – specifically pertaining to eating and diet. Physical activity and sedentary behaviours
and adolescents’ perceptions of their household, school, and community/neighbourhood environments are reported in sections after this.
The proportion of adolescents who skipped breakfast is summarized for the two groups in Figure 11. This indicates that nearly all adolescents reported
eating breakfast; only around 5 percent reported not eating breakfast. This was generally consistent for the Intervention and Comparison groups at both
baseline and follow-up.
Figure 11: Proportion of adolescents who skipped breakfast – by group
The proportion of adolescents who reported obtaining breakfast from home is summarized in Figure 12. This shows that of those adolescents who reported
eating breakfast, most indicated that this was obtained from home.
31
Figure 12: Proportion of adolescents reporting home as their source for breakfast
Table 10: Breakfast consumption behaviours by ethnicity
Source of breakfast
Home 93.9 94.2 85.0 93.9 94.7 91.0 95.0 91.8 89.5 92.5 89.0 91.1 92.6 91.8 89.0 91.9
School 0.8 1.0 0.0 0.9 0.8 2.2 0.0 1.9 3.4 1.5 2.4 2.3 1.9 1.0 0.8 1.3
canteen/tuckshop
Shop (outside school) 2.3 0.2 5.0 0.7 1.5 0.0 0.0 0.3 4.2 0.3 0.8 1.8 2.5 0.7 3.2 1.5
I don’t eat breakfast 3.1 4.7 10.0 4.5 3.1 6.8 5.0 6.1 2.9 5.7 7.9 4.8 3.1 6.5 7.1 5.3
Ate breakfast in past 5 school days
0 to 1 day 4.9 4.7 11.1 4.9 7.4 6.5 0.0 6.5 8.8 5.2 3.5 6.5 4.6 6.5 6.1 5.7
2 to 3 days 15.6 9.1 27.8 10.8 19.7 12.9 11.1 14.1 15.5 11.6 22.8 14.0 20.7 14.6 21.9 17.6
4 to 5 days 79.5 86.2 61.1 84.3 73.0 80.6 89.9 79.4 75.7 83.2 73.7 79.5 74.7 78.8 71.9 76.7
The proportion of adolescents who skipped breakfast is summarized for the two ethnicities in Figure 13. This indicates that higher proportions
(approximately double) of Indo-Fijian adolescents reported that they skipped breakfast when compared with Indigenous adolescents.
32
Figure 13: Proportion of adolescents who skipped breakfast – by ethnicity
The proportion of Indigenous and Indo-Fijian adolescents who reported obtaining breakfast from home is summarized in Figure 14. This Figure indicates
that of those Indigenous and Indo-Fijian adolescents who reported eating breakfast, most adolescents from both ethnic groups indicated that this was
obtained from home.
Figure 14: Proportion of adolescents reported having breakfast
33
Table 11: Breakfast consumption behaviours by gender
Source of breakfast
Home 95.5 92.5 93.9 93.4 90.4 91.8 94.1 88.7 91.1 94.1 90.2 91.9
School canteen/tuckshop 0.9 1.0 0.9 2.1 1.7 1.9 1.2 3.1 2.3 1.5 1.2 1.3
Shop (outside school) 0.3 1.0 0.7 0.3 0.2 0.3 1.9 1.8 1.8 1.2 1.8 1.5
I don’t eat breakfast 3.3 5.5 4.5 4.2 7.7 6.1 2.7 6.4 4.8 3.1 6.9 5.3
Ate breakfast in past 5 school days
0 to 1 day 5.8 4.1 4.9 9.3 4.1 6.5 6.0 6.9 6.5 6.7 4.9 5.7
2 to 3 days 8.0 13.2 10.8 9.0 18.4 14.1 10.6 16.7 14.0 12.9 21.4 17.6
4 to 5 days 86.2 82.7 84.3 81.7 77.5 79.4 83.4 76.4 79.5 80.4 73.7 76.7
The proportion of adolescents who reported skipping breakfast is summarized in Figures 15a and 15b. A higher proportions of females (approximately
double) reported that they skipped breakfast than their male counterparts. Again these trends were generally consistent across baseline and follow-up
surveys.
Figure 15a: Proportion who skipped breakfast - Males Figure 15b: Proportion who skipped breakfast – Females
34
The proportions of male and female adolescents who reported obtaining their breakfast from home is summarized in Figure 16. There was a small but
consistent trend for males to more often obtain their breakfast from home when compared with females.
Figure 16a: Proportion who obtained breakfast from home- Males Figure 16b: Proportion who obtained breakfast from home - Females
Table 12: Morning tea consumption behaviours by ethnicity
Source of morning tea
Home 22.1 44.8 30.0 40.4 13.7 19.6 10.0 18.4 18.1 37.5 23.6 29.0 13.6 23.0 11.8 18.6
School 73.3 49.9 45.0 53.9 74.8 74.5 60.0 74.2 70.8 52.2 59.8 59.9 70.7 63.9 55.9 65.9
canteen/tuckshop
Shop (outside 3.1 0.5 10.0 1.2 4.6 0.5 10.0 1.5 6.0 2.3 3.9 3.8 6.3 2.7 11.8 4.8
school)
I don’t eat 1.5 4.8 15.0 4.5 6.9 5.3 20.0 6.0 5.1 8.1 12.6 7.3 9.4 10.4 20.5 10.8
breakfast
Ate morning tea in past 5 school days
0 to 1 day 7.6 7.5 20.0 7.8 5.9 5.4 0.0 5.4 7.4 8.5 7.5 8.0 7.0 6.2 9.7 6.8
2 to 3 days 33.1 21.5 20.0 23.6 34.8 24.8 26.7 26.6 32.5 19.9 30.1 25.5 39.7 30.5 51.6 35.5
4 to 5 days 59.3 71.0 60.0 68.7 59.3 69.9 73.3 68.0 60.1 71.6 62.4 66.5 53.3 63.2 38.7 57.7
35
Table 13: Morning tea behaviours by gender
Source of morning tea
Home 46.9 35.3 40.4 19.4 17.5 18.4 33.8 25.3 29.0 19.8 17.6 18.6
Ate morning tea in past 5 school days
0 to 1 day 8.3 7.4 7.8 4.8 5.8 5.4 5.8 9.7 8.0 5.6 7.7 6.8
2 to 3 days 22.5 24.4 23.6 22.2 30.1 26.6 22.4 27.8 25.5 31.4 38.6 35.5
4 to 5 days 69.2 68.2 68.7 73.0 64.1 68.0 71.8 62.5 66.5 63.0 53.8 57.7
Data on lunch-related behaviour are provided in Tables 14 and 15.
Table 14: Lunch behaviours by ethnicity
Indigenous Indo- Others All Indigenous Indo- Others All Indigenous Indo-Fijian Others All Indigenous Indo-Fijian Others All
Fijian Fijian
Source of lunch
Home 85.5 89.9 85.0 89.0 77.9 84.7 60.0 82.9 86.3 86.7 83.5 86.3 86.3 85.6 75.6 85.1
School canteen 12.2 6.0 15.0 7.3 17.6 8.8 30.0 10.9 11.3 7.1 15.0 9.3 9.7 7.6 19.9 9.3
Shop (outside school) 2.3 1.0 0.0 1.2 3.1 1.7 10.0 2.1 1.2 0.9 1.6 1.1 2.9 1.2 3.9 2.1
I don’t eat b/fast 0.0 3.2 0.0 2.5 1.5 4.8 0.0 4.1 1.2 5.3 0.0 3.4 1.1 5.6 1.6 3.5
Ate lunch in past 5 school days
0 to 1 day 6.4 7.8 5.0 7.5 4.8 4.4 5.0 4.5 5.1 10.3 4.8 7.8 2.7 6.1 2.4 4.4
2 to 3 days 13.5 10.8 25.0 11.7 19.1 12.9 5.0 13.8 10.8 10.3 12.8 10.7 11.7 11.3 10.4 11.4
4 to 5 days 80.2 81.4 70.0 80.9 76.2 82.7 90.0 81.7 81.2 79.5 82.4 81.6 85.6 82.7 87.2 84.2
36
Table 15: Lunch consumption behaviours by gender
Source of lunch
Home 90.5 87.8 89.0 86.0 80.3 82.9 89.7 83.7 86.3 86.8 93.8 85.1
Ate lunch in past 5 school days
0 to 1 day 6.3 8.5 7.5 4.4 4.5 4.5 5.8 9.4 7.8 4.2 4.6 4.4
2 to 3 days 9.5 13.5 11.7 9.5 17.5 13.8 6.3 14.2 10.7 8.2 14.0 11.4
4 to 5 days 84.2 78.0 80.9 84.1 78.0 81.7 87.9 76.4 81.6 87.6 81.4 84.2
The recommendation for a healthy diet is to have at least 5 serves of fruits and vegetables (combined) a day. The findings of OPIC for this recommendation
are shown in Figure 17 and Table 16. The adolescents from the Comparison group were more likely to report meeting this target at both baseline and
follow-up surveys when compared with the Intervention group. There was no evidence of change in fruit and vegetable intake for either group.
Figure 17: Proportion having recommended fruit and vegetable consumption by group
37
Table 16: Consumption of fruit, vegetables and takeaway foods by ethnicity
Fruit/Vegetables
5 or more 24.4 19.6 40.0 21.0 21.4 21.1 25.0 21.3 27.6 20.9 33.9 24.5 27.0 21.2 37.0 24.6
servings per day
Takeaways
2 or more times 9.9 7.2 15.0 7.9 9.2 6.2 10.0 6.8 13.6 8.3 7.9 10.3 8.2 9.2 6.3 8.6
per week
Takeaways for dinner
More than once a 10.7 7.1 0.0 7.8 8.7 6.5 0.0 6.8 8.3 6.1 3.2 6.7 7.3 6.1 5.5 6.5
week
Consumption of recommended levels of fruit and vegetable intake by ethnicity is summarized in Figure 18. Generally there was a small but consistent trend
indicating that higher proportions of Indigenous adolescents consumed the recommended levels of fruit and vegetables.
Figure 18: Proportion having recommended fruit and vegetable consumption by ethnicity
38
Table 17: Consumption of fruit, vegetables and takeaway foods by gender
Fruit/Vegetables
5 or more servings per day 25.7 17.3 21.0 22.4 20.4 21.3 26.2 23.2 24.5 25.9 23.7 24.6
Ate takeaways
2 or more times per week 8.7 7.2 7.9 7.5 6.2 6.8 9.4 11.0 10.3 10.1 7.4 8.6
Ate takeaways for dinner
More than once a week 9.9 6.1 7.8 9.4 4.9 6.8 6.7 6.8 6.7 6.5 6.5 6.5
Consumption of recommended levels of fruit and vegetable intake for male and female adolescents is summarized in Figures 19a and 19b. Generally there
was a small but consistent trend indicating that there higher proportions of male adolescents consumed recommended levels of fruit and vegetables when
compared with their female counterparts.
Figure 19a: Proportion having recommended fruit and vegetable Figure 19b: Proportion having recommended fruit and vegetable
consumption – Males consumption- Females
High consumption of a take-away foods, is an indicator of a diet high in fat, sugar and salt, and therefore students were questioned on this. Frequent (≥
twice a week) consumption of takeaway food is summarised according to group in Figure 20. There were only slight differences between groups
(Comparison reporting higher proportion) for frequent consumption of takeaway. Generally, these levels remained consistent from baseline to follow-up.
39
Figure 20: Proportion of frequent consumption of takeaway food consumption by group
Consumption of take-away foods is shown by ethnicity in Figure 21. There is a small but consistent trend for Indigenous adolescents to more frequently
consume takeaway foods for dinner when compared with their Indo-Fijian counterparts.
Figure 21: Proportion of frequent consumption of takeaway food consumption by ethnicity
40
Frequent (≥ twice a week) consumption of takeaway food is summarised according to gender in Figure 22. This indicates that a small but significant (~6-
11%) proportion of both male and female adolescents reported that they consumed takeaway foods for dinner. There were no reliable differences between
males and females for frequency of takeaway food for dinner.
Figure 22a: Proportion of frequent consumption of takeaway food Figure 22b: Proportion of frequent consumption of takeaway food
consumption - Males consumption - Females
Soft drinks and fruit drinks are important contributors of sugar and energy in many diets, and the levels of intake in the study population is shown in Tables
18-21. Levels overall are high.
Table 18: Soft drink consumption by ethnicity
Regular (non-diet) soft drink consumption in past 5 school days
0 to 1 day 32.1 30.5 30.0 30.7 29.0 25.6 30.0 26.3 26.7 20.7 25.2 23.3 33.8 29.6 32.3 31.4
2 to 3 days 46.6 46.3 55.0 46.5 40.5 46.1 50.0 45.2 44.3 43.9 37.8 43.6 42.1 43.3 43.3 43.0
4 to 5 days 21.4 23.3 15.0 22.7 30.5 28.3 20.0 28.5 29.0 35.4 37.0 33.1 24.1 26.8 24.4 25.6
Soft drink consumption on previous school day
None 15.2 19.8 20.0 19.0 25.6 16.2 25.0 18.1 19.9 17.3 26.8 19.0 26.4 22.7 37.8 25.2
One can or less 46.4 47.8 50.0 47.6 40.0 46.6 25.0 44.8 44.4 47.8 37.0 45.7 42.4 44.0 29.1 42.3
Two cans or more 38.4 32.4 30.0 33.4 34.4 37.2 50.0 37.1 35.7 34.9 36.2 35.3 31.2 33.3 33.1 32.5
41
Table 19: Soft drink consumption by gender
Regular (non-diet) soft drink consumption in past 5 school days
0 to 1 day 26.0 34.5 30.7 16.7 34.1 26.3 21.4 24.8 23.3 26.2 35.5 31.4
2 to 3 days 48.7 44.8 46.5 46.6 44.1 45.2 43.9 43.4 43.6 43.2 42.9 43.0
4 to 5 days 25.4 20.6 22.7 36.7 21.8 28.5 34.7 31.8 33.1 30.7 21.7 25.6
Soft drink consumption on previous school day
None 15.6 21.9 19.0 14.1 21.4 18.1 17.9 19.9 19.0 23.3 26.7 25.2
One can or less 42.8 51.5 47.6 36.7 51.5 44.8 39.5 50.5 45.7 36.9 46.4 42.3
Two cans or more 41.6 26.6 33.4 49.2 27.1 37.1 42.7 29.6 35.3 39.8 26.9 32.5
Table 20: Fruit drink consumption by ethnicity
Fruit drink consumption in past 5 school days
0 to 1 day 46.6 49.9 50.0 59.3 47.3 43.8 35.0 44.2 36.7 37.4 31.5 36.7 46.0 44.8 34.7 44.5
2 to 3 days 43.5 38.1 35.0 39.0 38.9 42.6 45.0 42.0 40.0 40.6 10.2 40.3 38.0 38.3 44.1 38.6
4 to 5 days 9.9 12.0 15.0 11.7 13.7 13.6 20.0 13.8 23.3 22.0 28.4 23.0 16.1 16.9 21.3 16.9
Fruit drink consumption on previous school day
None 7.5 10.1 25.0 10.1 6.0 13.1 8.3 11.7 6.0 9.3 11.6 8.3 6.8 9.5 11.6 8.6
One glass 23.9 23.2 25.0 23.3 16.4 18.1 16.7 17.8 12.0 18.8 19.8 16.3 14.0 20.9 10.5 17.5
Two glasses or more 68.7 66.8 50.0 66.6 77.6 68.8 75.0 70.6 82.0 71.9 68.6 75.4 79.2 69.7 77.9 73.9
42
Table 21: Fruit drink consumption by gender
Fruit drink consumption in past 5 school days
0 to 1 day 48.7 49.9 59.3 43.3 44.8 44.2 36.8 36.6 36.7 40.5 147.6 44.5
2 to 3 days 40.0 38.1 39.0 42.1 42.0 42.0 38.3 41.9 40.3 38.7 38.5 38.6
4 to 5 days 11.3 12.0 11.7 14.6 13.2 13.8 26.9 21.5 23.0 20.8 13.9 16.9
Fruit drink consumption on previous school day
None 10.4 9.8 10.1 12.3 11.2 11.7 8.6 8.0 8.3 8.3 8.9 8.6
One glass 17.2 28.0 23.3 16.6 18.7 17.8 15.0 17.4 16.3 15.4 19.1 17.5
Two glasses or more 72.4 62.2 66.6 71.2 70.1 70.6 76.5 74.5 75.4 76.3 72.0 73.9
While snacking itself is not of concern, the types of snack chosen are often a problem in children. Results are shown in tables 22-25. Overall snacking is
common, with bread-based snacks the most popular, but biscuits, chips, noodles and chocolates/sweets are also common.
Table 22: After school snack consumption by ethnicity
Fruit after school
Most days/daily 23.7 33.3 10.0 31.0 24.4 32.1 15.0 30.3 31.6 44.3 51.2 40.0 27.5 38.7 44.9 34.9
Ate bread-based snack after school
Most days/daily 44.3 29.8 45.0 32.7 50.4 29.8 40.0 33.6 46.8 29.5 52.8 37.9 50.5 34.0 49.6 41.5
Ate biscuits, potato chips, noodles after school
Most days/daily 39.7 37.4 55.0 38.3 35.1 36.4 15.0 35.6 39.2 32.7 33.1 35.2 27.9 36.3 26.8 32.4
Ate pies, takeaways, hot chips after school
Most days/daily 12.2 10.7 10.0 10.9 9.2 11.7 20.0 11.4 9.9 10.4 7.1 9.9 8.8 13.1 10.2 11.2
Ate chocolates or sweets after school
Most days/daily 24.0 33.2 20.0 31.1 14.7 25.0 20.0 23.0 22.8 25.6 19.7 24.1 17.3 25.4 16.5 21.6
43
Table 23: After school snack consumption by gender
Fruit after school
Most days/everyday 34.0 28.5 31.0 33.7 27.6 30.3 40.9 39.3 40.0 37.7 32.6 34.9
Ate bread-based snack after school
Ate biscuits, potato chips, noodles after school
Ate pies, takeaways, hot chips after school
Ate chocolates or sweets after school
Table 24: Snack food purchasing behaviours by ethnicity
Bought snack food from shop/takeaway in past 5 school days
0 to 1 day 29.8 44.8 50.0 42.3 36.6 53.2 35.0 49.9 38.7 53.2 48.0 47.3 38.4 50.4 43.3 45.3
2 to 3 days 44.3 32.1 30.0 34.2 45.8 31.0 45.0 33.9 36.3 31.2 33.1 33.3 40.4 34.8 37.0 37.1
4 to 5 days 26.0 23.1 20.0 23.5 17.6 15.8 20.0 16.2 25.0 15.7 18.9 19.5 21.1 14.8 19.7 17.6
Money spent on food on last school day
None 17.1 19.8 15.4 19.0 17.1 16.9 15.4 16.9 14.8 22.1 35.4 20.3 15.3 18.9 29.9 18.3
$1 to 4 67.1 64.5 76.9 65.6 64.5 64.1 53.9 63.8 65.6 60.8 49.6 61.8 62.2 59.6 49.6 59.8
$5 to 9 13.2 11.3 7.7 11.6 14.5 14.9 23.1 15.1 14.8 12.6 11.0 13.4 17.3 15.3 12.6 15.8
$10 or more 2.6 4.4 0.0 3.9 4.0 4.0 7.7 4.2 4.8 4.5 3.9 4.6 5.3 6.3 7.9 6.0
44
Table 25: Snack food purchasing behaviours by gender
Bought snack food from shop/takeaway in past 5 school days
0 to 1 day 42.7 42.0 42.3 50.2 49.6 49.9 50.5 44.7 47.3 48.2 43.1 45.3
2 to 3 days 34.3 34.1 34.2 34.3 33.6 33.9 34.6 32.2 33.3 36.9 37.2 37.1
4 to 5 days 23.0 24.0 23.5 15.5 16.8 25.0 14.9 23.0 19.5 14.9 19.7 17.6
Money spent on food on last school day
None 15.3 21.8 19.0 9.7 22.3 16.9 20.4 20.2 20.3 18.3 18.4 18.3
$1 to 4 61.8 68.4 65.6 67.4 61.1 63.8 61.2 62.3 61.8 58.6 60.8 59.8
$5 to 9 14.6 9.3 11.6 16.7 14.0 15.1 12.9 13.7 13.4 15.0 16.5 15.8
$10 or more 8.3 0.5 3.9 6.3 2.6 4.2 5.5 3.9 4.6 8.2 4.4 6.0
d. Physical activity and sedentary behaviours
Levels of physical activity are of interest, along with related variables such as television use. Findings on these indicators are provided in this
section.
Table 26: Physical activities and television use by ethnicity
Morning recess/interval
Mostly active 23.1 14.7 16.7 16.2 14.5 8.1 5.7 9.1 14.4 11.2 7.1 12.1 8.8 7.0 3.9 7.4
Lunch break
Mostly active 19.5 13.9 22.2 15.1 14.4 6.4 5.6 7.8 9.9 9.7 11.0 9.9 7.7 7.1 7.1 7.3
Did physical activities after school, past 5 school days
0 to 1 day 42.4 31.3 38.9 33.4 24.6 30.5 44.4 29.9 23.6 25.9 22.8 24.8 19.8 27.8 17.3 23.9
2 to 3 days 28.0 37.3 16.7 35.2 42.4 42.1 27.8 41.8 29.0 36.7 29.1 33.2 29.3 36.5 26.0 33.0
4 to 5 days 29.7 31.4 44.4 31.5 33.1 27.4 27.8 28.4 47.4 37.4 48.0 42.0 50.9 35.7 56.7 43.1
Total screen time (television and computer)
≤2 hours 42.9 28.2 12.5 30.3 40.5 28.6 38.5 30.6 37.5 37.8 44.3 38.2 45.2 37.0 34.6 39.4
>2 hours 57.1 71.8 87.5 69.7 59.5 71.4 61.5 69.4 62.5 62.2 55.7 61.8 54.8 63.0 65.4 60.6
45
The proportion of adolescents who reported high levels of screen time (> 2 hours) each day is summarized according by group in Figure 23. This indicates
that higher proportions of adolescents from the Intervention group reported higher levels of total screen time when compared with adolescents from the
Comparison group.
Figure 23: Proportion of adolescents reporting more than two hours total screen time/day according to group
The proportion of adolescents who reported high levels of screen time (> 2 hours) each day is summarized according to ethnicity in Figure 24. A higher
proportions of Indo-Fijian adolescents reported spending more time on screen based activities when compared with Indigenous adolescents.
Figure 24: Proportion of adolescents reporting more than two hours total screen time/day according to ethnicity
46
Table 27: Physical activities and television use by gender
Morning recess/interval
Mostly active 19.1 13.8 16.2 12.5 6.4 9.1 14.4 10.3 12.1 10.0 5.5 7.4
Lunch break
Mostly active 19.0 12.0 15.1 9.8 6.1 7.8 13.4 7.2 9.9 9.8 5.4 7.3
Did physical activities after school, past 5 school days
0 to 1 day 33.8 33.1 33.4 22.0 36.3 29.9 21.5 27.3 24.8 16.2 29.8 23.9
2 to 3 days 34.4 35.7 35.2 37.1 45.6 41.8 26.7 38.2 33.2 24.9 39.1 33.0
4 to 5 days 31.8 31.2 31.5 41.0 18.1 28.4 51.8 34.5 42.0 58.9 31.1 43.1
Total screen time (television and computer)
≤2 hours 26.1 34.4 30.3 27.1 34.4 30.6 35.0 41.2 38.2 35.0 43.2 39.4
>2 hours 73.9 65.6 69.7 72.9 65.6 69.4 65.0 58.8 61.8 65.0 56.8 60.6
The proportion of male and female adolescents who reported more than two hours screen time/day is summarized in Figures 25a and 25b. There was a
small but consistent trend where higher proportions of males spent more time on screen based activities when compared with female adolescents. There
was little evidence of change from baseline to follow-up survey for both males and females.
Figure 25a: Proportion of adolescents reporting more than two hours Figure 25b: Proportion of adolescents reporting more than two hours
total screen time/day – Males total screen time/day – Females
47
d. Perceptions of the household environment
The environment at home has important impacts on childrens’ attitude and behaviour. The proportion of adolescents reporting having family meals on
most days (ie. 4-5 days from the past 5 days) is summarized according to group in Figure 26. Just over 60% of adolescents from both the Intervention and
Comparison groups reported having family meals on most days and that there was a slight reduction in this proportion for both groups.
Figure 26: Proportion of adolescents reporting having family meals on most days
Adolescent perceptions of the availability of different foods and beverages in the home are summarized according to group in Figure 27. This indicates that
fruit was generally available in home of both Intervention and Comparison adolescents. Furthermore, this availability increased substantially for the
Intervention group at follow-up while the Comparison was unchanged. Adolescents from both groups also reported that chips, chocolates and soft drinks
were also generally available in the household (range: 27-52%).
48
Figure 27: Adolescent perceptions of availability of different foods and beverages in the household according to group
Table 28: Family meals and home availability of foods by ethnicity
Frequency of family meals in past 5 school days
0 to 1 day 8.7 12.6 16.7 12.1 8.7 13.7 5.6 12.7 13.0 11.2 15.8 12.2 11.6 14.1 18.1 13.4
2 to 3 days 22.1 22.6 16.7 22.3 16.4 26.4 22.2 24.7 204 25.0 15.8 22.5 21.6 25.8 18.1 23.6
4 to 5 days 69.2 64.9 66.7 65.6 75.0 59.9 72.2 62.6 66.7 63.8 68.5 65.3 66.8 60.1 63.8 63.0
Fruit available to eat at home
Most days/everyday 40.8 63.3 33.3 56.8 47.6 75.7 53.3 68.1 62.2 82.2 78.7 74.3 58.2 80.9 75.6 71.8
Potato chips available to eat at home
Chocolates available to eat at home
Soft drinks available to eat at home
49
The proportion of Indigenous and Indo-Fijian adolescents who reported having family meals on most days is summarized in Figure 28. This Figure shows
that there was a small but consistent trend for Indigenous adolescents to have family meals than their Indo-Fijian counterparts.
Figure 28: Family meals and home availability of foods by ethnicity
Adolescents from the two ethnic groups reported on availability of different foods and beverages in the household. These results are summarized in Figures
29a and 29b. There was considerable variation between food and beverage availability within the households by ethnic groups.
Figure 29a: Adolescent perceptions of availability of different foods Figure 29b: Adolescent perceptions of availability of different foods
and beverages in the household – Indigenous and beverages in the household - Indo-Fijian
50
The availability of different foods and beverages in the household is shown by gender in Figures 30a and 30b. Generally there were few reliable gender
differences in relation to perceived availability of different foods and beverages in the household.
Figure 30a: Adolescent perceptions of availability of different foods Figure 30b: Adolescent perceptions of availability of different foods
and beverages in the household according to group – Males and beverages in the household according to group - Females
51
Table 29: Family meals and home availability of foods by gender
Frequency of family meals in past 5 school days
0 to 1 day 12.8 11.5 12.1 13.1 12.3 12.7 11.2 13.0 12.2 11.6 14.8 13.4
2 to 3 days 22.6 22.5 22.3 25.5 24.1 24.7 21.0 23.7 22.5 23.0 24.1 23.6
4 to 5 days 65.1 66.0 65.6 61.4 63.6 62.6 67.9 63.3 65.3 65.4 61.1 63.0
Fruit available to eat at home
Potato chips available to eat at home
Chocolates available to eat at home
Soft drinks available to eat at home
The proportion of male and female adolescents who reported having family meals on most days is summarized in Figures 31a and 31b. About 2/3 of male
and female adolescents reported having family meals on most days and that there was no reliable gender difference.
Figure 31a: Family meals and home availability of foods – Males Figure 31b: Family meals and home availability of foods - Females
52
Table 30: Parental support for healthy eating by ethnicity
Maternal support for healthy eating
A lot 64.1 66.9 60.0 66.0 66.0 76.0 73.3 73.5 79.2 80.2 78.7 79.7 75.9 77.6 79.5 77.1
Some/a little 30.1 27.9 33.3 28.7 27.2 21.4 20.0 22.8 14.5 18.0 18.1 16.7 17.9 19.7 15.8 18.8
None 3.9 4.2 0.0 4.0 1.0 1.3 6.7 1.4 2.2 0.5 0.8 1.2 2.2 1.1 0.0 1.4
Don’t live with mother 1.9 1.0 6.7 1.4 5.8 1.3 0.0 2.4 4.2 1.3 2.4 2.5 4.0 1.6 4.7 2.8
Paternal support for healthy eating
A lot 54.4 52.0 66.7 53.1 56.3 62.0 73.3 61.0 70.8 66.8 63.0 68.0 67.8 66.9 61.4 66.8
Some/a little 29.1 34.1 20.0 32.4 28.2 30.2 13.3 29.1 19.6 27.7 23.6 24.3 22.2 26.0 22.8 24.3
None 7.8 7.5 6.7 7.5 1.9 3.6 0.0 3.1 2.2 1.9 5.5 2.2 2.5 2.5 3.9 2.6
Don’t live with father 8.7 6.5 6.7 7.0 13.6 4.2 13.3 6.8 7.4 3.7 7.9 5.4 7.6 4.6 11.8 6.3
Table 31: Parental support for healthy eating by gender
Maternal support for healthy eating
A lot 66.9 65.3 66.0 75.7 71.8 73.5 79.7 79.7 79.7 77.3 77.0 77.1
Some/a little 29.3 28.2 28.7 21.6 23.7 22.8 16.5 16.8 16.7 18.1 19.2 18.8
None 1.7 5.7 4.0 0.6 2.0 1.4 1.0 1.4 1.2 1.4 1.5 1.4
Don’t live with mother 2.2 0.8 1.4 2.2 2.5 2.4 2.9 2.2 2.5 3.3 2.4 2.8
Paternal support for healthy eating
A lot 53.6 52.7 53.1 61.3 60.8 61.0 68.5 67.7 68.0 68.1 65.8 66.8
Some/a little 36.5 29.4 32.4 32.0 26.9 29.1 24.9 23.7 24.3 23.6 24.9 24.3
None 3.9 10.2 7.5 1.7 4.1 3.1 1.6 2.7 2.2 2.2 2.9 2.6
Don’t live with father 6.1 7.8 7.0 5.0 8.2 6.8 4.9 5.8 5.4 6.1 6.4 6.3
53
Table 32: Parental support for physical activity by ethnicity
Maternal support for physical activity
A lot 35.4 47.0 35.7 43.8 48.5 48.3 42.9 48.2 50.2 58.5 54.3 55.0 51.7 55.1 45.7 53.1
Some/a little 54.6 46.6 57.1 48.9 42.4 46.0 42.9 45.0 41.5 38.5 39.4 39.7 40.6 40.4 46.5 40.9
None 6.1 4.7 0.0 4.9 3.0 4.7 14.3 4.7 3.6 2.1 3.2 2.7 3.7 2.9 3.9 3.3
Don’t live with mother 4.0 1.7 7.1 2.4 6.1 1.0 0.0 2.2 4.8 1.0 3.2 2.6 4.0 1.5 3.9 2.6
Paternal support for physical activity
A lot 47.4 51.0 61.5 50.6 44.7 54.2 30.8 51.2 54.6 65.0 49.6 29.9 55.1 60.6 53.5 57.9
Some/a little 38.2 37.8 23.1 37.3 34.2 35.3 53.9 35.8 34.1 29.2 40.2 31.9 32.9 31.1 31.5 31.8
None 7.9 4.4 7.7 5.3 4.0 6.8 7.7 6.2 3.4 2.0 2.4 2.5 4.3 4.6 4.7 4.0
Don’t live with father 6.6 6.8 7.7 6.8 17.1 3.6 7.7 6.8 7.9 3.8 7.9 5.7 7.7 4.8 10.2 6.3
Table 33: Parental support for physical activity by gender
Maternal support for physical activity
A lot 45.1 42.7 43.8 46.3 49.6 48.2 51.8 57.5 55.0 51.6 54.2 53.1
Some/a little 48.0 49.6 48.9 47.4 43.2 45.0 42.2 37.8 39.7 42.2 39.9 40.9
None 4.6 5.1 4.9 3.4 5.6 4.7 2.9 2.6 2.7 3.0 3.6 3.3
Don’t live with mother 2.3 2.6 2.4 2.9 1.7 2.2 3.1 2.2 2.6 3.1 2.3 2.6
Paternal support for physical activity
A lot 64.6 40.2 50.6 61.8 43.3 51.2 66.2 55.1 29.9 64.7 52.8 57.9
Some/a little 26.4 45.4 37.3 31.3 39.2 35.8 26.6 36.0 31.9 27.4 35.1 31.8
None 2.8 7.2 5.3 2.1 9.3 6.2 1.6 3.2 2.5 1.6 5.7 4.0
Don’t live with father 6.3 7.2 6.8 4.9 8.3 6.8 5.6 5.7 5.7 6.3 6.4 6.3
54
Table 34: Home availability of televisions, video games and computers by ethnicity
Has a television at home
Yes 84.7 94.8 100 92.6 89.4 96.8 92.3 94.8 92.3 97.1 96.1 95.2 96.0 97.5 97.6 96.9
Has a television in bedroom
Yes 21.1 21.0 16.7 20.9 11.3 21.9 25.0 19.6 13.8 21.5 18.2 18.4 12.8 21.8 22.3 18.5
Has video games, electronic games or computer at home
Yes 41.5 71.4 53.3 63.8 52.1 78.8 80.0 72.7 51.7 77.8 85.8 68.4 54.0 81.1 83.5 70.9
Parent limit television use
Strict limits 60.0 40.1 38.5 45.2 42.2 32.2 30.8 34.8 40.9 39.5 33.1 39.6 43.7 36.3 33.1 38.9
Table 35: Home availability of televisions, video games and computers by gender
Has a television at home
Yes 94.0 91.5 92.6 96.0 94.0 94.8 96.1 94.5 95.2 97.0 96.9 96.9
Has a television in bedroom
Yes 30.9 13.0 20.9 27.3 13.6 19.6 20.8 16.6 18.4 24.7 13.7 18.5
Has video games, electronic games or computer at home
Yes 69.8 59.5 63.8 79.3 67.9 72.7 71.5 66.0 68.4 71.8 70.2 70.9
Parent limit television use
Strict limits 47.3 43.7 45.2 34.9 34.7 34.8 40.3 39.0 39.6 37.1 40.3 38.9
e. Perceptions of the school environment
Similarly the school environment will impact on behaviours and attitudes. Perceptions of support are shown in this section. While many
students considered that their school was supportive of healthy eating, few felt that the canteen supported this. Support for physical activity
was seen to be quite low, although teachers were often seen as good role models in this area.
55
Table 36: School support for healthy eating and physical activity by ethnicity
School support for student’s healthy food choices
A lot 46.6 56.0 33.3 53.8 56.0 54.0 38.9 53.9 46.6 53.2 29.9 48.9 40.9 44.9 22.8 41.7
Food and drinks in the school canteen
Mostly healthy 9.4 9.4 16.7 9.6 12.0 11.4 0 11.2 15.6 13.3 4.7 13.5 11.0 9.5 2.4 9.5
Teachers as role models for healthy eating
Good/excellent 49.6 58.9 45.0 56.9 46.6 54.7 20.0 52.4 64.8 67.0 37.0 63.9 46.8 53.3 24.4 48.6
Teachers as role models for being physically active
Good/excellent 67.2 66.4 50.0 66.1 44.3 55.6 20.0 52.7 66.8 67.9 42.5 65.6 53.7 54.7 27.6 52.3
School support for all students to play organised sports
A lot 32.8 53.7 30.0 49.5 53.4 59.6 35.0 57.9 61.6 70.4 67.7 66.8 56.6 63.9 52.0 60.3
School encouragement for all students to be active at lunchtime
A lot 15.3 31.6 15.0 28.3 22.9 33.3 35.0 31.5 26.5 39.7 15.0 32.8 21.1 34.3 10.2 27.5
Table 37: School support for healthy eating and physical activity by gender
School support for student’s healthy food choices
A lot 48.0 58.5 53.8 50.0 57.1 53.9 47.1 50.3 48.9 40.9 42.3 41.7
Food and drinks in the school canteen
Mostly healthy 8.6 10.4 9.6 14.8 8.3 11.2 15.3 12.2 13.5 11.2 8.2 9.5
Teachers as role models for healthy eating
Good/excellent 53.1 60.0 56.9 52.2 52.5 52.4 63.2 64.4 63.9 48.2 48.9 48.6
Teachers as role models for being physically active
Good/excellent 61.2 70.0 66.1 53.7 51.8 52.7 61.3 68.8 65.6 51.8 52.7 52.3
School support for all students to play organised sports
A lot 41.2 56.1 49.5 48.7 65.2 57.9 59.7 72.3 66.8 54.8 64.4 60.3
School encouragement for all students to be active at lunchtime
A lot 20.3 34.8 28.3 28.1 34.3 31.5 30.8 34.3 32.8 25.2 29.2 27.5
56
f. Perceptions of neighbourhood and community
The wider environment and community will also impact on behaviour. Perceptions of key factors are shown in Tables 38 and 39.
Table 38: Neighbourhood and community factors by ethnicity
Neighbourhood at night
Safe 63.3 64.8 55.6 64.3 76.1 76.4 72.2 76.3 66.8 69.6 61.4 67.9 75.8 74.1 75.6 74.8
Parental perception of neighbourhood at night
Safe 45.3 38.9 16.7 39.4 44.4 54.7 55.6 53.0 43.7 42.5 28.4 41.9 50.6 48.6 37.0 48.5
Bothered by dogs when walking in neighbourhood
Somewhat/a lot 42.7 33.3 16.7 34.5 35.9 35.4 16.7 35.0 33.6 40.9 30.7 37.3 41.5 41.7 42.5 41.7
Bothered by traffic when walking in neighbourhood
Somewhat/a lot 37.6 25.1 27.8 27.3 31.6 30.9 22.2 30.8 27.6 26.1 17.3 26.1 30.4 25.7 24.4 27.4
Bothered by other people when walking in neighbourhood
Somewhat/a lot 43.6 23.9 16.7 27.1 35.0 28.4 27.8 29.5 29.8 26.4 18.1 27.1 31.3 26.9 24.4 28.4
Best friends provide support for physical activity
A lot 82.9 75.1 69.2 76.6 86.8 77.5 76.9 79.6 87.0 84.6 78.7 85.1 89.8 82.0 88.2 85.5
Table 39: Neighbourhood and community factors by gender
Neighbourhood at night
Safe 79.0 52.4 64.3 90.5 64.7 76.3 83.2 56.2 67.9 88.8 64.1 74.8
Parental perception of neighbourhood at night
Safe 50.3 30.5 39.4 69.1 39.8 53.0 56.4 30.8 41.9 63.9 36.7 48.5
Bothered by dogs when walking in neighbourhood
Somewhat/a lot 41.1 29.1 34.5 41.8 29.4 35.0 41.0 34.5 37.3 45.2 39.0 41.7
Bothered by traffic when walking in neighbourhood
Somewhat/a lot 27.0 27.5 27.3 34.9 27.5 30.8 26.8 25.4 26.1 28.1 26.9 27.4
Bothered by other people when walking in neighbourhood
Somewhat/a lot 24.0 29.7 27.1 29.9 29.1 29.5 24.5 29.0 27.1 24.9 31.1 28.4
Best friends provide support for physical activity
A lot 85.4 70.1 76.6 90.3 71.7 79.6 91.4 80.3 85.1 91.4 80.9 85.5
57
g. Quality of Life
This section summarises information for the assessment of quality of life (Pediatric instrument only). Again information is presented for both the
Intervention and Comparison groups at baseline and follow-up.
Table 40: Pediatric Quality of Life by ethnicity
Physical
Mean 77.3 81.5 82.2 80.7 82.4 82.0 80.9 82.0 77.7 79.9 83.9 79.4 83.2 82.8 85.6 83.2
SD 17.6 13.4 11.5 14.2 12.6 12.2 13.1 12.3 18.5 14.3 13.1 16.1 13.6 12.9 11.2 13.0
Emotional
Mean 64.2 66.7 67.0 66.3 62.1 63.3 60.8 63.0 64.7 65.2 67.5 65.2 64.1 65.5 67.4 65.1
SD 16.8 16.7 16.2 16.7 16.2 15.8 17.1 15.9 17.6 17.2 17.0 17.3 16.0 16.7 16.5 16.5
Social
Mean 73.7 83.9 76.8 82.0 76.1 85.3 78.0 83.5 74.3 82.1 80.0 79.0 77.6 86.1 82.4 82.6
SD 18.9 15.1 14.9 16.3 17.2 14.9 15.0 15.8 18.5 16.8 16.1 17.8 17.2 15.1 14.9 16.4
School
Mean 69.6 79.4 68.5 77.4 64.7 72.3 70.5 71.0 68.8 76.7 74.5 73.5 66.6 75.6 69.4 71.7
SD 16.1 15.6 18.4 16.2 16.1 14.9 14.2 15.4 16.5 15.6 14.9 16.3 14.8 15.2 16.1 15.7
Summary
Mean 72.0 78.2 74.7 77.0 72.8 76.5 73.6 75.8 72.2 76.5 77.4 74.9 74.2 78.2 77.5 76.6
SD 12.7 11.6 9.7 12.0 11.8 10.8 10.4 11.1 13.5 12.4 11.8 12.9 11.7 11.8 11.4 11.9
58
Table 41: Pediatric Quality of Life by gender
Physical
Mean 85.3 77.1 80.7 86.5 78.4 82.0 83.7 76.0 79.4 87.9 79.6 83.2
SD 13.5 13.8 14.2 11.0 12.0 12.3 15.1 16.0 16.1 11.1 13.2 13.0
Emotional
Mean 71.0 62.5 66.3 68.2 58.9 63.0 70.0 61.5 65.2 70.5 61.0 65.1
SD 16.4 16.0 16.7 15.3 15.2 15.9 16.7 16.9 17.3 15.6 15.9 16.5
Social
Mean 83.1 81.0 82.0 84.7 82.5 83.5 80.8 77.5 79.0 84.3 81.3 82.6
SD 15.8 16.7 16.3 15.4 16.0 15.8 17.7 17.8 17.8 15.7 16.8 16.4
School
Mean 77.2 77.5 77.4 71.1 70.9 71.0 73.9 73.2 73.5 72.1 71.5 71.7
SD 16.7 15.9 16.2 16.1 14.8 15.4 16.2 16.4 16.3 16.2 15.4 15.7
Summary
Mean 79.8 74.7 77.0 78.8 73.4 75.8 78.0 72.6 74.9 79.9 74.2 76.6
SD 12.0 11.5 12.0 10.7 10.8 11.1 12.6 12.7 12.9 11.3 11.7 11.9
4.7 AWARENESS OF OPIC KEY MESSAGES
The follow-up question had additional questions included to assess the awareness of adolescents of the HYHC key messages. A yes response indicated that
they were familiar with that message (although the message may not have originated from HYHC. This was included in both the intervention and
comparison schools. Table 42 and Figure 32. With the exception of fruits and vegetables, the awareness of HYHC messages was higher overall in the
intervention schools.
59
Table 42: Awareness of OPIC messages
Yes response
Drinking mainly water 86.1 79.2
Eating breakfast regularly 87.6 76.2
Walking/cycling to school 56.9 54
Eating plenty of vegetables 83.1 87.4
Not going on fad diets 52.7 49.1
Eating a healthy school lunch 82.8 79.2
Limiting television viewing time 70.2 69.1
Limiting electronics and television time 61.6 59.4
Limiting sugary drinks 77.7 73.5
Being active during recess/lunchtime 66.6 57.5
Eating plenty of fruit 92.5 91.3
Different body shapes can be healthy 57.2 52.7
Limiting high fat snacks 73.2 69.3
Being active after school/at weekends 75.5 77.1
60
Figure 32: Awareness of OPIC messages
4.8 CONCLUSIONS
The rates of overweight and obesity amongst the children surveyed were high, and combined with indicators such as diet, physical activity and
school and household environments, indicate substantial issues in Fiji which require action.
The plans of action for the identified sites of the OPIC project were developed within the context of the local communities. The action plans
are living documents to ensure ongoing feedback and participation of key community stakeholders.
The preliminary successes in engaging community members to support the OPIC project, development of the action plans and initial strategies
undertaken in the intervention communities have reinforced the community interaction process utilized by the project teams.
61
Despite the intensive activities in the Intervention sites, no significant impacts were seen for behavioural or health outcomes, with the
exception of the body fat measures and quality of life. Effects for the two ethnic groups were similar. The finding that the body fat percentage
was lower in the intervention group than the comparative group at follow-up may however indicate that the interventions did have some
impacts on the adolescents. The finding that measures of weight/height did not indicate change but that body fat did, is conflicting. While it
may be due to fat to muscle mass changes, this needs further research to understand more clearly the changes. The reported changes in body
fat should not be regarded as indicating that improvements were seen in health status of these adolescents, due to the need for more
research.
Findings for the behavioural and (perceived) environment measures generally indicated no group difference. With the exception of: ‘less than
or equal to one serve of vegetables/day’ and ‘average time spent watching TV/day’, and ‘potato chips/snacks available at home every
day/almost every day’. For each of these indicators, the results showed that there were more positive (healthier) changes in the comparison
group relative to the intervention group.
The perceptions of the environment failed to show any evidence for impacts on the household or school environments. There was however
quite high awareness of most of the HYHC messages, and the awareness was generally higher in the intervention schools.
The implementation of HYHC in Fiji had a number of limitations. The design was not based on the sociocultural data and baseline data
collected (due to timing issues), and as such targeted areas for action were not based on evidence. For example, intake of breakfast was
already quite high, and yet increasing this was a key objective for HYHC. Similarly interventions could not take account of the wealth of
sociocultural data which was developed which demonstrated considerable cultural influences on lifestyle. The implementation of HYHC also
had some limitations, including insufficient funds for all activities, insufficient intervention staff at times (as the same staff were also heavily
involved in data collection) and delays associated with the formalities of implementing the project. These limitations may have affected the
impacts of the interventions, and this needs to be considered when interpreting the results.
For further information on this aspect of the OPIC study, including published papers, please contact C-POND.
62
4.0 Socio-cultural Component
4.1 INTRODUCTION
The socio-cultural component of the OPIC study aimed to identify socio-cultural factors
experienced by adolescents that are related to food and eating, physical activity and
inactivity, and their ideas about body size. Socio-cultural factors that promote or protect
against obesity include community attitudes, perceptions, beliefs, values and practices.
It is difficult to change behavioral patterns without addressing underlying socio-cultural

factors. Yet, very little is known about socio-cultural values, attitudes and behaviors that
either promote or protect against obesity.
The socio-cultural data were collected from adolescents via (1) interviews, (2)
questionnaires, and (3) a computer programme to investigate perceptual distortion of the
body image.
4.2 METHODOLOGY
In addition to the measures conducted under the ‘intervention’ component of OPIC,

additional socio-cultural studies were included in OPIC. The in-depth interviews involved 24
males and 24 females from each cultural group, with equal representation across junior,
intermediate and senior students. Participants were from six (6) of the seven (7) secondary
schools in the study area, Amadhiya Muslim College, Assemblies of God High School,
Bhawani Dayal College, Nasinu Muslim College, Nasinu Secondary School and Rishikul
College.
The interview questions were developed from:

1) the OPIC goals,
2) two focus groups conducted in 2004, and
3) a pilot study that was conducted with six males and six females from each of two
main cultural groups in August 2004.
The interviews were semi-structured. All participants were asked the same questions but
not necessarily in the same order. Interviewers were the same sex as the participant and
spoke the same first language. Participants determined whether they were interviewed in
their first language, English, or a combination of the two. This interview protocol was
selected in order to create a relaxed environment where the youths would be more likely to
share their experiences and ideas.
The objectives of interviews were to determine youth’s impressions of:

i. Culture-specific values, ideas and practices that influence food, eating, physical
activity (PA) and body size.
ii. Important messages about food, eating, physical activity and body size (participants’
ideas and their explanations).
63
iii. Messengers – who provided the messages and who appeared to be most important
youth messengers (family, adults, older siblings, teachers, religious groups, peers,
media).
iv. Ways the messages were delivered (e.g. encouragement, rules, teasing, role
models).
v. Which messages/practices can be changed
• Interviews were recorded, transcribed and translated into English when necessary,
coded onto N6 software and put into categories or themes. Some categories were
predetermined by the specific research questions. Other themes were added as they
emerged from the transcripts.
• Data collected were co-analyzed so that local themes and nuances were identified.
4.3 RESULTS OF THIS ASPECT OF RESEARCH

4.3.1 Findings from the interviews were grouped under three main headings:
(1) “Food and Eating”,

(2)”Physical Activity”
(3)“Body Image”; and each with 3 subsections on:
(i) Messages – the messages that participants received, the ideas of

participants and their explanations for activities and body size.
(ii) Patterns – participants’ reports of their own patterns of eating and
physical activity and their body size, as well as the patterns and body size of
others.
(iii) Messengers - the key messengers (sources of messages) identified by
participants and their means of conveying messages.
4.3.2 The findings are summarized in Table 43.
Table 43: Summary of Findings on the social cultural issues in schools
Issues Food and eating Physical activity Body Image

Messages Many participants knew Participants were accurate in their Many participants
about healthy foods and explanations of the benefits of doing indicated that body
explained the value of a regular physical activity. The main reasons weight/size was the
balanced diet in terms of given were, in this order, to become fit, outcome of the balance
being fit, healthy & being be healthy, and to be alert at school. between food eaten &
able to concentrate at energy used.
school. Many participants observed that peers
who were overweight were unable to be Participants believed
One common physically active as their more normal size obese people could not
misconception: was that peers, and that overweight peers were do physical activities as
commercial fruit drinks less able to be skilled at physical activities. easily as people of a
were healthy. A number of participants suggested that healthy weight.
physical activity was for “kids”; this Many participants
64
A number of participants message appeared to be reinforced by suggested that it was
believed that their mothers parents. difficult for underweight
selected family food on the Male participants explained the purpose people to be physically
basis of health, and, in the of doing weights & training was to build active.
case of indigenous Fijians, up strength & fitness, respectively.
economics. Participants believed
Majority of males & females believed that they would be teased if
Most participants believed males had more opportunities to do their body size was
that the main meal of the recreational physical activities than outside the norm, that
day was either dinner or females. is, either too large or too
breakfast. small.
Eating Knowledge about healthy Patterns of physical activity Body change strategies
patterns food & eating patterns did There were culture-specific patterns of Many participants were
not always translate to physical activity, with indigenous Fijians not trying to use
practice. engaging in more physical activity than physical activity to alter
Indo-Fijians. their weight, size or
Many participants missed muscle tone.
breakfast, especially Indo- Participants from both cultural groups
Fijian females. suggested that indigenous Fijians were There were clear
physically active because, they were more differences in the body-
School canteens were the accustomed to physical activity and had a change strategies of
main source of food and healthier diet compared to Indo-Fijians. Fijians & Indo-Fijians.
drinks at recess time.
Twice as many Indo-Fijians as indigenous
More Indo-Fijians were
Fijians said that the need to study limited
The vast majority of youth actively trying to
their physical activities.
had “spending” money. increase their
There were also gender differences in
Spending money was used weight/size than were
physical activities, with males in both
to buy junk food, most indigenous Fijians.
cultural groups engaging in more physical
often from school canteens.
activity than females, both at home and at
No Indo-Fijian males
school.
Spending was not indicated that they were
Reasons given for this gender difference
monitored by adults. trying to lose weight.
were that males had fewer household
Food that was brought
chores than females, and were afforded
from home was not There were also gender
more freedom to play, especially in the
necessarily eaten only by differences in body
evenings when personal safety was a
participants. Food from change strategies; more
consideration.
home and spending money females were trying to
Participants suggested there were more
was often shared among lose weight than were
resources (facilities and sports) available
friends. males.
for males to do recreational physical
activity than females, both at school and
More males were doing
in the community.
weight training to
Some teachers discouraged Indo-Fijian
increase their muscles
girls from playing with boys. Many
than were females.
females said that males did more physical
activities than females because they were
more interested in sport.
Remarkably few participants said that
their families exercised together.
Messengers More mothers provided There was a wider group of messengers Many female
home messages about food for physical activity than for food and participants were
than did fathers. eating. influenced by family
However, friends members.
influenced at-school Fathers and older siblings/cousins
choices, in terms of shared influenced boys and girls, by teasing, role Friends and the media
65
buying and consumption. modeling and creating opportunities for also influenced ideas
physical activity. about actual and
While schools provided preferred body weight,
messages about food and Peers also influenced physical activity size, shape and
healthy eating via nutrition both positively (encouragement and being muscularity/tone.
curricula, the food and available to play) and negatively (criticism
drink reported to be about lack of skills). The media influenced
available at school canteens ideals about body
did not necessarily reflect Rugby stars had a major influence on the weight, size, shape and
those healthy eating physical activities of indigenous Fijian tone. Indigenous Fijians
messages. boys. were influenced by the
bodies of sports stars
Participants believed & more than Indo-Fijians ,
described how they had especially Fijian boys.
more control of their food
& eating outside the home. However, this influence
was more often
This increased control explained in terms of
translated into the sporting prowess rather
purchase of junk food. than good looks.
Religious beliefs & practices
determined food choices,
eating patterns at home &
at school, esp. for Hindu &
Muslim participants.
4.3.3 – For more detailed account of the findings on food and eating, physical activity and
body image – please refer to the detailed report in Annex 2
4.3.4 Cultural differences & gender differences in food and eating - The summary of the
findings is shown in Table 44.
66
Table 44: Summary of interview results for gender & cultural differences in food & eating
Issue Cultural Difference Gender Difference

Types & quantities All Indo-Fijians ate vegetables at least Peers appeared to be more likely
of food eaten twice a day. Fijians ate root crop daily to influence female participants
than the males
Breakfast Indo-Fijians had roti and one or more More than 66% of Indo-Fijian
curries with cocoa, Milo and milk. Fijians females did not have breakfast
had either bread or pancakes with tea & regularly
one to three teaspoons of sugar,
Servings Indo-Fijians have smaller servings than
Fijians
Sources of food for More indigenous Fijians than Indo-Fijians More females reported buying
lunch reported buying food from school food at school canteens at recess
canteens, especially at recess. Indo-Fij than did males
perceive that canteen food was not as
good as food prepared from home. Indo-
Fij mainly drank water
Evening meal Indo-Fijians have dinner immediately with
dessert after arriving home. Fijians ate
snacks & leftover bread & tea before
main evening meal later.
Meal regularity Indo-Fijians have less regular meals with Males had breakfast regularly
fasting 1-2 days /week & many females while 60% of female participants
skip breakfast. Fijians have regular meals skipped breakfast than did
males.
Food selection Depend on economy More female than male
participants indicated that adult
females in their families
influenced their eating patterns
esp. mothers, grandmothers &
aunts.
4.3.5 Physical Activity
Little is known about adolescents’ patterns of physical activity, their reasons for being
physically active and the socio-cultural factors that either support or limit these physical
activities. In order to gain the perspectives of Fijian youth, participants were asked about
their current patterns of physical activity, as well as about the physical activity patterns of
their male and female peers. Participants were also asked why they felt that physical activity
was important and what factors promoted or limited their own activities as well as those of
their peers.
67
4.3.6 Cultural & gender differences in physical activity – Summarized in Table 45
Table 45: Summary of findings in the cultural & gender differences in physical activity
Issue Cultural Difference Gender Difference

Constraint to Fijians cited chores as a constraint to Missing breakfast in Indo-Fijian females is
Physical physical activity compared to Indo- a constraint to be physically active.
activity Fijians.
More than twice as many Indo-Fijians Indo-Fijian females said that dress was a
as indigenous Fijians indicated that limiting factor for taking part in physical
the need to study was a major activities than indigenous Fijian females.
constraint to being physically active. Females indicated that they had more
More Indo-Fijians cited poor diet as a opportunities for physical activity at school
constraint on being physically active. than was the case at home
Appearance Fijians appeared to be much more
physically active than did Indo-Fijians
,
Positive More indigenous Fijians indicated Males did more recreational physical
influence to that parents were a positive influence activities than did females
physical on their physical activities than did
activity Indo-Fijians
Parental Indo-Fijian females suggested that
restriction parental restrictions on their daughters’
physical activities may have been related
to a concern for their daughters’ safety, a
number of indigenous Fijian females cited
personal safety as a constraint to
recreational physical activities, especially
in the evenings.
Males have more freedom to do sports
Interests Males more interested in sports
Health Females did less physical activity than
perception males because females were not as
interested in sport.
4.3.7 Cultural differences & gender differences in body image –summarized in Table 46
Table 46: Cultural & gender differences in body image
Issues Cultural Difference Gender Difference

Weight loss More Fijians wanted to decrease All Fiji females want weight loss. Very few
weight. More Fijians worked on females wanted to increase their muscle tone.
their muscle tone. Females thought overweight & underweight
will be teased by their peers.
Participating More Fijians took up sports for their The prediction of social commentary appeared
physique & their role models were to be a powerful mechanism for influencing
rugby players. Main role models for females. Media stars were role models for
Indo-Fijian were Bollywood stars. female participants than males.
68
Other findings include:
• 82% females and 89% males consume lunch prepared from home
• 50% females and 51% males ate fruit at least 2 -3 servings per day.
• 61% males ate 2-3 serves of vegetables than females (52%)
• 15% Indigenous Fijians have more take away food for lunch than Indo-Fijians and
other ethnic groups
• 30% of students consume soft drinks in schools and higher amongst males than
females.
• 25% of students bought after school snacks from shops everyday
• 80% of students spend between $1-$4 on food on the previous school day.
4.4 CONCLUSIONS
The participants in this socio-cultural component of the Healthy Youth, Health Community
project provided invaluable insights into their patterns of eating and physical activity and
their preferences regarding food, physical activities and body size and shape.
It was clear that participants had a good understanding of healthy food choices, although
their understanding of the importance of regular meals was not as clear cut. Sound
knowledge did not necessarily translate into good eating patterns. Participants often
received conflicting messages about healthy eating. This was highlighted in the frequent
opportunities that participants had to consume junk food and soft drinks. These
opportunities were facilitated by school canteens, and to a lesser extent, by families.
While the majority of participants took part in physical education at school, fewer
participants engaged in regular physical activities outside school. Females indicated that
opportunities for recreational physical activity were even more limited at home than they
were at school. While many participants wanted to lose weight, a few wanted to gain
weight and in the case of males, muscle bulk. A number of these respondents were making
active efforts to change their weight by eating a balanced diet and/or exercising.
The heterogeneity of adolescents living in peri-urban Suva was highlighted by contrasting

patterns and concerns for indigenous Fijians and Indo-Fijians, and males versus females.
In summary:
• Indo-Fijians had a diet that was high in vegetables, while indigenous Fijians had more
complex carbohydrates.
• Indo-Fijians were more likely to prioritize study over recreational physical activities
when compared to indigenous Fijians.
69
• Many of the differences found in this study cut across cultural group and gender. For
example, Indo-Fijian females appeared to be less interested in being physically active
than either indigenous Fijians or Indo-Fijian males. Indo-Fijian females also appeared
to have fewer opportunities than indigenous Fijian girls to engage in recreational
physical activity. Indo-Fijian males wanted to increase weight and/or muscle, while
indigenous Fijian females wanted to lose weight.
• The complex cultural and gender differences found in this study underscore the
heterogeneity of this peri-urban population in Suva, even within a relatively small
age range.
• It is also important that these findings be considered within the specific context of
the demographics of peri-urban Suva and not be generalized to other groups within
Fiji.
70
5.0 Policy Component
5.1 INTRODUCTION
There is long-standing global recognition that health promotion initiatives must include a
policy component (WHO 2005), and also that policies are an essential part of strategies to
improve diets and tackle the problem of obesity and chronic disease. Policy can be used to
create a supportive environment and also to reinforce healthy behaviors, radically change
food supply and ultimately diets (Lang & Rayner 2007). Throughout the Pacific Islands,
efforts are ongoing to improve both diet and lifestyles, these tend to focus on education,
rather than policy, despite recognition that both approaches are needed (Hughes &
Lawrence 2005), and that the lack of policy interventions are a key problem (Hughes 2002).
Policies relating to investment, agriculture, trade, urban design, transport, legislation,

regulation and money (fiscal policy) all impact on the food environment, and therefore any
efforts to tackle obesity, diabetes and other NCDs must include a focus on all of these.
Policies may have been developed for other reasons, eg raising revenue, meeting trade
agreements, encouraging commercial and economic development – without consideration
of their effects on diets and health. There may also be policy gaps where policy controls of
areas are not in place.
Changing the food environment will require more than one policy change to occur. Diets are
complex, and are affected by many factors such as access, availability, cost, preference,
attitudes, knowledge and values. In order to create a healthier food environment, actions
will be needed to affect all of these factors: lowering the price of healthier options,
increasing the access and availability of healthier options and improving understanding of
and attitudes to healthy eating. Therefore, a number of policy changes will be needed, and
must be supported by community-based and nutrition education initiatives. Educational
initiatives will never be enough by themselves, unless implemented alongside
environmental changes.
This project was intended to identify the priority policy changes needed to prevent and
control obesity & NCDs.
This project had two main components:
1. To identify the most effective, sustainable and feasible policy interventions to

prevent and control obesity & NCDs for Fiji. By the end of the research a
comprehensive list of possible policy interventions was developed (including those in
Fiji’s NCD strategic plan) along with projected health & economic impacts, from
which it can draw & select future interventions. This part of the research was also to
build the capacity of those involved in Fiji, to enable them to undertake similar work
in the future.
2. To contribute to local, regional and international understanding of the relationship

between macroeconomic policy and population nutrition, as well at the process of
developing and implementing cross-sectoral interventions. It focussed on
macroeconomic policy, examining historical trends in trade policy and nutrition, and
71
also evaluating previously implemented trade and fiscal policies with the potential to
improve population nutrition.
5.2 METHODOLOGY
5.2.1 The method for the identification of possible policy interventions was approached
using a participatory method. A multi-sectoral stakeholder group met over a year in a series
of five, one to two day workshop-style sessions. The group included policy makers, policy
advisers and technical staff from Government departments and Ministries (Finance,
Commerce, Trade, Education, Health, Agriculture, Fisheries, Prices and Income Board,
Council), the private sector (Nestle) and other non-Government groups (Consumers
Council). Contact between the research team and the stakeholder group members was
maintained throughout the process via email, letters, documents and phone calls.
The process was supported by information sourced from relevant departments and
agencies; Department of Statistics, published literature, reports and the internet. The results
and conclusions represented consensus decisions by the group members. Comments and
information included have not been attributed to any individual, but instead ‘belonged’ to
the group as a whole.
• The first step involved using problem trees to identify problem areas within policy
that could be contributing to an unhealthy food environment. Further information
was sought on these issues, to assess more carefully how much of a problem they
were.
• The second step identified potential solutions. Each solution was then carefully
assessed in step three. This include; scoring of probable effectiveness on NCD
problem, scoring of feasibility of policy change (including political and community
acceptability, technical and cost feasibility and trade-related feasibility), impact
assessment (consideration of side-effects of policy change), modeling (by research
team) of the expected impact of policy changes on NCD rates (only undertaken on
short-list of solutions, for practical reasons).
• In the final step, stakeholders reviewed all the information and categorized into
either: policies for action (most promising), possible policies (show some promise)
and policies not recommended for action (little promise).
• The final short-list of policies recommended for implementation, were expected to

be effective, cost-effective, targeted, beneficial overall and feasible.
5.2.3 The historical part of the project investigated the interaction between trade policy and
population nutrition to improve understanding of the economic and social/political context
in which food supply changes are occurring. Processes used included: literature review, data
collection, policy analysis methods (to evaluate existing policies, investigating the
origin/drivers, implementation & impact of the policies through semi-structured interviews,
policy documentation and related reports).
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The research in Fiji examined the genesis, development, implementation & perceived
impact of two soft drink taxes & the lamb flap ban. The other countries involved in this
comparative research project were Samoa, Tonga, Nauru & French Polynesia.
Interviews: Co-researchers in each country identified initial interviewees in government, the

non-government sector and industry, and additional participants were recruited based on
policy documents and using snowball sampling. Interviews were semi-structured and
tailored to the interviewees' area of expertise. They were kept to less than one hour, were
recorded (except for a few where permission was withheld), and summarised in detail and
summaries were sent to the interviewees to check. Interviewees were asked for any
available policy documentation, archival records and data relating to the policies. Themes
were identified using iterative analysis throughout the process of data collection, interview
data were triangulated using documented information, and any discrepancies were
investigated through additional interviews and locating further policy documentation.
Detailed chronological case studies were then constructed, describing the policy process
and impact using interview data, policy documents, media reports and available data
regarding policy impact. These detailed case studies were sent to the country co-researchers
for verification or correction. The impact of the two trade-related policies on consumers was
also assessed. These data had already been collected in Fiji by Gewertz and Errington
(2009).
5.3 RESEARCH OUTCOMES FROM POLICY PRIORITISATION COMPONENT
5.3.1 Policy problems and gaps
The process identified that policies across many sectors which could be contributing to an
unhealthy food environment. These included policies (and policy gaps) which affected: the
pricing of healthier and less healthy foods, advertising and information controls, production
levels of local foods and their export, access to healthier foods in different settings and the
quality of foods available locally.
The existing policies which were identified as problems included those related to taxation,
price control, production levels, agricultural and fisheries support. Overall, existing policies
(and policy gaps) were creating a situation where less healthy foods and drinks were widely
available, cheaper and more accessible than healthier options.
An example of a completed problem tree is shown in Figure 33.
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Figure 33: Problem tree for low vegetable intake
Blue indicates policy problem area
No govt
support
Transport
problems
FDB Policies/fund
No govt support shortage Land
policy Difficulty availability
for getting AMA
loans Shortage support
seeds etc Shortage Lack
Climate technical knowledge
Difficult Disinterest help quick
job in farming Exports cooking
high
No govt Tariffs mainly 3%
support Too
Local lazy to Alternative
Imports supply buy, foods
Storage Transport
difficult costs from Too lazy cook cheaper
farms to
Short plant/grow
Poor
supply Preference knowledge
No price Cost
control
Not eating No school food
policy or
Charge
enough gardens
for market vegetables
stalls
5.3.2 Potential solutions to policy problems

After considering which policies were more significant problems, the group identified
potential actions (policy solutions) which would alter the current food environment to make
it more supportive of healthy eating. These policy solutions were changed to existing
policies or new policies where gaps existed. Over 100 potential policy solutions were
identified in total. These covered a diverse range of sectors including finance, trade,
commerce, agriculture, fisheries, health, planning and media.
Examples are:
- changing import and excise duties and VAT exemptions
- modifying price control list
- provision of subsidies and support to farmers and fishermen, including marketing
support, cool storage
- implementing quality controls on products to restrict fat content and type
- ban or limiting the import of certain items
- restricting marketing, sponsorship and advertising promotions
- labeling of foods
- controlling retail and vending opportunities
- improving school food environments
An example of a completed solution tree is shown in Figure 34
74
Figure 34: Solution tree for low vegetable intake
(blue indicate potential solutions to the red policy problems)
No govt
support
Subsidy More
Loans to transport support
get Transport
transport problems
FDB Policies/fund
No govt support shortage Land
policy Difficulty Provide availability
for getting free/subsidy AMA
loans Shortage seeds support
seeds etc Shortage Lack
technical knowledge
Difficult Disinterest Climate help quick
job in farming Exports cooking
Duty 0% high
No govt Import duty
support mainly 3% Local
Too
Storage lazy to Alternative
facility Storage Imports supply buy, foods
Transport
Price difficult costs from Too lazy cook cheaper
control farms to Poor
Short plant/grow knowledge
supply Preference School
No price Cost garden
control policy
Not eating No school food
policy or
Charge Bigger enough gardens School food
for market markets vegetables policy
stalls
5.3.3 Prioritising policy solutions
Implementing all these policy changes would not be possible, and would not be appropriate.
Further consideration was needed of which policy changes would have most health benefits,
have least negative impacts, be most cost-effective, be technically feasible and be
acceptable to the community, political leaders and others. By considering each of these
aspects, the group was able to develop a short-list of recommended actions. This process
was complemented by some cost-benefit modelling that was undertaken on some of the
policies (to predict benefits in terms of deaths averted from NCDs, and the costs of
implementation).
Policies were rejected from the short-list if they:
• were unlikely to affect NCD risk,
• costly compared to potential benefits (cost: benefit ratio),
• technically too difficult,
• likely to be rejected by the community and/or political leaders,
• have negative side-effects (such as affecting local businesses or the environment) or
• Were not in line with current national strategies (including membership of the World
Trade Organisation).
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The policies were sub-divided into three categories:
o Prioritised for action: Should be implemented as soon as possible

o Not prioritised for action: but could be considered for action at a later date, with
more assessment
o Not recommended for action: should not be used
The short-list of 22 prioritised policy actions were considered likely to be: effective, cost-
effective, feasible and acceptable. Some policy actions would ideally be implemented
together for maximum benefit and efficiency.
5.3.4 Recommendations for policy changes in Fiji
The policies summarised below have been recommended by the stakeholder group for
implementation. The recommended policy options are expected to be:
o Effective: They are likely to result in a change in the diets of the Fijian population,
and to reduce the risk of a range of non communicable diseases. They are cost-
effective. Effectiveness will be optimised if the policy is maintained and is full
implemented and enforced.
o Feasible: They are likely to be acceptable to a range of stakeholders including the
community and various government sectors. They are also practical in regards to
local technical capacity and costs.
o Targeted: They will have minimal negative side-effects on areas other than diet.
The stakeholder group discussed ways forward to ensure that the policy changes are
implemented as soon as possible. They agreed that multi-sectoral collaboration would be
essential to the process. This could be mediated via members of the group, and via relevant
multi-sectoral groups such as the Healthy food choices subcommittee and the NCD healthy
eating subcommittee of the Fiji National NCD Committee.
It is recommended that these policy changes be implemented as soon as possible, and

maintained. This will ensure maximum benefits to health in Fiji. They should be:
o incorporated into relevant sector and department strategic documents and action
plans
o incorporated into national strategic plans such as the Fiji Plan of Action on Nutrition
and the Fiji National NCD Strategic Plan 2004-8
o Communicated to the general community to ensure that they understand the
purpose and expected benefits.
5.3.5 List of Policies - The list of policies recommended are listed in Table 47 below.
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Table 47: List of policies recommended
Recommended policy change Expected dietary benefits
Reduce import duty on all vegetables to 0% (except Lowers the price of imports, enabling more
when an item is in season locally) people to buy. (Unlikely to affect local
sales).
Reduce import duty on all fruit to 0%.
Add VAT to less healthy oils* only Reduces the use of all oils, especially oils
high in saturated fats
5% import duty to be imposed on healthy oils,15%

import duty on less healthy* oils
Increase import duty dairy spreads to 15% Encourages shift to healthier margarines
Remove VAT from all bottled water (pure still water Reduces cost of water, so price competitive
only) with soft drinks.
All meats to have import duty 15% regardless of Increases the cost of high-fat processed
whether for local food processing (no concessionary meats compared to unprocessed meats, to
rate for processors) facilitate change to leaner meats.
Requirement for all drink vending machines in schools Reduces the intake of soft drinks by children
to include either water, unsweetened juice or a sugar-
free beverage, at a competitive price
All schools (government and non-government) to Improves diets, knowledge and attitudes of
implement school food and nutrition policy (including children
type of foods/drinks sold, pricing, marketing)
Policy for all schools to have garden by 2012
All divisions to have government F&V storage facilities Reduces waste due to spoiling, so increasing
local supply and intake
Cool storage facilities for fish in all divisions
Extend AMA role to include and support domestic Increases availability of local foods to locals,
supply which will increase intake.
Sponsorship sports events by any unhealthy* food or Reduces the exposure of children to
drink related company to be prohibited in events advertising and misleading information
involving children regarding less healthy foods and drinks.
Prohibit the use of children, cartoons and misleading
Resulting in healthier choices and
images in unhealthy* food and drink related preferences.
advertisements (all media)
Regulations revised to be clearer and more

enforceable regarding misleading advertising claims
(including use of words healthy and healthier)
Prohibit advertising unhealthy* food & drinks in

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Recommended policy change Expected dietary benefits
schools, hospitals & other public areas
Prohibit advertising of high fat/sugar/salt food and

drinks to children (children’s programmes, those of
interest to children) (definition of less healthy foods
as UK)
Enforcement of licensing for roadside vendors Reduce the number of vendors selling
unhealthy snacks on roadsides, so reducing
intake.
Regulation that processed meats sold contain no Reduce the fat content of meats sold locally
more than 20 % fat to be more consistent with other countries.
Reduction fat intake.
Sales ban on sale poultry > 15% fat, beef >25% fat,
pork > 35% fat, lamb>20% fat
Remove duty and VAT on pre-mix fuel for Reduces costs for small-scale fishermen,
fishermen enabling increased fishing, and increased
availability of fish to locals.
* Definition based on a nutrient profiling system.
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5.4 OUTCOMES FROM POLICY ANALYSIS COMPONENT OF RESEARCH
5.4.1 Trade and diet in the Pacific: There have been six key mechanisms through which
trade has affected dietary patterns in the Pacific during the past century. These six
mechanisms overlap, often reinforce each other, and all relate to specific trade-related
policy directions. The first three were initiated in late nineteenth century – the Pacific
region’s earlier (for some countries colonial) phase of integration into the global economy,
and have had significant and continuing effects on diet. The last three emerged during the
post-WWII period. The first factor was the shift from primarily subsistence agriculture to a
cash-based economy in response to market development and involvement in international
trade. This contributed to reductions in subsistence agriculture and increases in purchased
food. Second, the creation of administrative centres required to stimulate trade and
commerce in the Pacific Islands catalysed urbanisation, which also reduced capacity for
subsistence agriculture. Third, there was significant development of agricultural and fishery
commodity production and export, reinforcing the shift away from subsistence agriculture
and furthering the use of purchased (often processed) foods. In the post-WWII period, these
trade-related shifts in diet continued, and new implications of trade policy for diets
emerged. Food imports increased dramatically, facilitating marked dietary change through
increasing access to non-traditional foods. Financial integration and investment-related
policy liberalisation supported growth in ‘Western-style’ food service, food retail and food
processing. This increased the availability and convenience of ‘non-traditional’ foods. Finally,
the 1960s rise in development aid, particularly that in the form of food, has contributed to
dietary change through reducing the need for investment in local agriculture post-disaster.
A more detailed analysis of the recent period of trade liberalization in Fiji and Samoa
suggests that these ongoing policy changes have contributed to the availability of
transitional foods in four main ways. Policies of export promotion have reduced land and
resources available for production of root crops for domestic consumption. Reductions in
import tariffs have reduced the cost of importing transitional foods such as vegetable oil,
meat and cereals, likely changing the relative price of foods and energy according to source.
Encouragement of domestic meat production through protection has increased availability
of locally produced meat, and subsequent liberalization of meat imports has opened these
countries to cheap, fatty meat imports – particularly of chicken from the USA and sheep
meat from Australia and New Zealand. In addition, investment by multinational food
companies has increased availability and consumption of transitional foods. These pathways
have intersected at many points with socio-demographic changes including urbanization,
the growth of the cash economy, and changing work and leisure patterns. This has meant
that such dietary transformations once initiated tend to become embedded through
changes in food preferences and lifestyle.
5.4.2 Getting policies on the political agenda
Critical factors in the agenda setting process included advocacy, contextualisation of the
issue, and ownership by stakeholders. Advocacy by Ministry of Health staff can help to raise
awareness by politicians and staff in other (stakeholder) ministries about the importance of
nutrition and possible policy options. Contextualisation can be achieved by identifying
current policy debates that relate to food and health, and using these as forums for raising
79
the need to improve the food supply (for example, the linking of health concerns regarding
fatty meat consumption to concerns over dumping of fatty meats). Ownership can be
improved by discussing the benefits to all stakeholders, and by developing a clear
justification for the food targeted. Highlighting the benefit of the policy to the administering
agency can improve its acceptability.
5.4.3 Policy Implementation and administration
Much of the burden of implementation and administration of economic policies for

improving population nutrition falls outside of the Ministry of Health. The findings from the
comparative policy analysis suggest that health promotion practitioners can improve the
implementation of policies by reducing administrative costs, namely through proposing the
use of existing legislative mechanisms. The use of existing legislation also facilitated the
implementation of most of the policies in these case studies.
Active ownership by more than one stakeholder also appears to have been critical for policy
implementation. It is therefore important for the Ministry of Health to engage the
implementing agency and other stakeholders at an early stage. The development of policy
documents by the implementing agencies (trade or finance) can result in the selection of a
more acceptable and administratively feasible mechanism, which supports policy
implementation.
5.4.4 Policy outcomes
The trade and tax policies examined in these studies clearly reduced the supply of the
targeted food (trade) and raised significant amounts of revenue (tax). It is also likely that
consumers responded to the tax by reducing consumption to some extent. The policies
were also effective in raising consumer awareness of soft drinks and fatty meats as
contributors to poor health. The use of the lamb flap sales ban in Fiji as a springboard for
further public education through the media campaign was particularly effective, and served
to raise awareness of specific links between high fatty meat consumption and
cardiovascular disease.
However, it is difficult to tell whether these policy initiatives improved the healthfulness of
the food supply overall, due to the complexity of the food supply and the lack of time-series
dietary data. This highlights the usefulness of the modelling approach undertaken in this
study.
5.4.5 International trade law
Under ongoing World Trade Organization, regional and bilateral negotiations, trade
restrictions and tariffs (taxes on imports) are being progressively reduced as they form a
barrier to trade and discriminate between imported and domestically produced products.
Under the principle of ‘national treatment’, countries should not treat imports any less
favourably than the same or similar domestically-produced goods once they have passed
customs (WTO 2007). Trade restrictions and taxes that affect only imported foods do not
comply with this principle. A ban or tax that applies to both domestically produced and
imported foods is technically permissible because it is non-discriminatory, however, the
WTO requires evidence that it is the ‘least trade restricting measure’ that fulfils the
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objective. It is therefore important that trade restrictions or high taxes on certain foods be
clearly justified in order to be acceptable to trade policy makers.
Alternative mechanisms to restrict trade include a mechanism based on percentage of fat in

meat imports, or action taken under WTO regulation that allows for imposition of ‘anti-
dumping duties’ to bring the price of dumped goods up to an appropriate market value.
5.5 FUTURE ACTIONS
The recommended policy changes have the potential to have considerable impacts on diets
and the problems of NCDs in Fiji, through improving the food environment. Without these
policy changes, however, Fijians will continue to struggle to meet healthy eating
recommendations. Efforts are now needed to turn these recommendations into reality.
This will require the support of a wide array of government and non-government
departments and agencies. Preventing NCDs must be a priority across all sectors.
Analysis of the policy process behind cross-sectoral policy interventions to improve diets can
inform strategies to improve uptake and implementation of future policies. Policy
implementation depends on more than just evidence for effectiveness. It is also dependent
upon getting the policy intervention on the agenda of the relevant government agency,
development of appropriate policy documents or legislation, and provision of adequate
resources for implementation.
5.6 LIMITATIONS OF THE STUDY
• The use of only one stakeholder group for component one of the research may have
influenced findings, and it is possible that repeating the process would result in
slightly different results.
• The policy stakeholders who elected to participate in the study may also have been
biased due to self-selection; in particular, there was limited participation by private
sector stakeholders.
• The unavailability of data on population food and beverage consumption meant that
the impact of the policies on population health was only able to be determined using
modeling. The research was also relying on limited data, some of which was quite
outdated, for a number of its components.
5.7 CONCLUSION
This unique study has developed a clear picture of how policy has been and can be used in
the control of NCDs in Fiji. The in-depth analysis of the factors involved in policy-making
across different sectors, combined with the clear identification of specific preferred policy
81
changes offers health promoters in Fiji valuable information which they can use to improve
the health of Fijians.
It is clear from this research that there is a need for policy across sectors to support a
healthy food supply. In particular, trade and finance were highlighted as sectors that have a
significant impact on diet in the Pacific, and therefore have great potential to be used as
health promotion tools
Further information regarding this component of OPIC are available in a separate policy
report for OPIC, and in related journal articles. Please contact C-POND for more information.
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6.0 Economic Component
6.1 Objectives of the economic studies
OPIC included an economic studies component, the objectives of which were:

• To measure the net resource costs of the interventions in order to assess their cost-
effectiveness;
• To measure the impact of overweight and obesity on the quality of life of adolescents;
• To assess the disease and cost burden of overweight and obesity in Fiji.
6.2 Measurement of the intervention costs

The aim of this section was to determine the net cost of the intervention. Economic
evaluation entails an assessment of costs measured against those in the comparator area.
So the net costs of the intervention equal the costs in the intervention area minus those in
the comparator area.
In economic evaluation, it is quite to employ a health sector perspective when measuring

costs. However, in this instance, most of the intervention activities took place in sectors
other than health (primarily education). As a consequence, a societal perspective was
adopted to the measurement of costs, which means that all costs were measured
irrespective of who incurred them. The evaluation was also concerned to measure the full
economic costs of the intervention, rather than just the financial outlays incurred. This
meant that the costs of all goods and services incurred in the delivery of the intervention
activities were measured, even if the goods were not traded in the market. For donated
items such as parent and volunteer time or donated goods, a market value was imputed
based on current prices.
A data collection pro-forma covering data about the nature of the intervention activities (a
description of the activity), process (how the activity was conducted), dose (scale/duration
of the activity), reach (how many and type of people involved in the activity), frequency
(how often the activity was conducted) and associated resource use (for use in the
subsequent economic evaluation) was developed, and completed by intervention staff for
all activities related to intervention planning delivery. The process evaluation data was
supplemented by information drawn from the HYHC intervention reports, meeting minutes,
correspondence and communication with the research team staff and other personnel
involved in intervention delivery. The data was entered into an Excel database, and more
than 600 entries were recorded throughout the 2 year duration of intervention activities.
This information is summarised in Tables 56, 57, 58 and 59 .
Costs in the comparator area relate to the cost of ‘current practice’ which was defined as
any obesity-prevention activities undertaken in the schools over and above those conducted
in all schools in Fiji. Details on activities undertaken and associated resources were compiled
from interviews conducted in each of the comparator schools in 2007 and 2008. Generally
one person from each school was interviewed, including school principal or vice principal
(4), home economics teacher (5), physical education teacher (2), science teacher (1).
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Work to value the identified resources used in the delivery of the interventions or current
practice is still proceeding.
6.3 Quality of life analysis

The economic studies included the administration of two health-related quality of life (QoL)
measures in order to (i) describe the burden of overweight and obesity on the quality of life
of Fijian adolescents and (ii) as an outcome measure in a cost-utility analysis (CUA) of the
interventions.
Whilst the strong association between obesity and mortality and morbidity has been well
documented, much less is known about the impact of obesity on quality of life. The impact
is both substantial and multi-faceted covering both physical health and social and
psychological dimensions. At the broadest level, quality of life refers not only to health
status, but also to environmental and economic factors such as income and educational
attainment that can have a key influence on well-being.
One of the limitations of cost-effectiveness analysis (CEA), when health effects are
measured as survival gains, is that this measure does not take into account the quality of life
associated with such survival. Health economists have developed a measure, termed the
quality-adjusted life year (QALY) which captures both improvements in the length of life and
changes in the quality of those years. CUA is the form of economic analysis which expresses
outcomes as incremental costs per QALY gained. QALYs are estimated by assigning every
life-year a weight (or utility) between 0 and 1. A weight of 0 reflects a health status that is
valued as equivalent to death, with 1 equaling perfect health (Drummond et al. 1997). By
converting the effectiveness data to a common measure, the QALY, CUA facilitates
comparison of interventions both within and across disease areas.
6.3.1 Measuring quality of life for economic evaluation
A review of the published literature suggests significant cultural variations in health state
preferences. Adolescents are also likely to value their health differently to adults, given their
social values, support structures, lifestyles and experience. It was therefore important to
use adolescent rather than adult values and, more specifically, country-specific adolescent
values in the OPIC study. Therefore utility weights needed to be assessed and validated for
each site in the OPIC study. They will assess the burden of childhood obesity (in terms of
diseases and costs), and its impact on the quality of life of adolescents.
These economic studies are dependent on the use of an accepted, validated measure of
quality of life. Outcomes will be measured in a common metric of quality-adjusted life-years.
This entails individuals attaching a value to the ‘utility’ of any additional years of life gained
as a result of an intervention. (QALYs = number of years of life saved multiplied by the
‘utility’ value assigned to their particular health state.)
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6.3.2 Selection of quality of life tools
The starting point for this work was an existing quality of life assessment tool, The AQoL-6D
or Assessment of Quality of Life tool (Richardson et al 2004). This is what is termed a ‘utility-
based’ instrument suitable for use in an economic evaluation. This means it consists of a
generic descriptive questionnaire; plus a scaling system which assigns utility or preference
scores to every combination of health states. This provides each respondent with a health
state score ranging from 0 (death) to 1 (perfect health). The AQoL-6D consists of 20 items
grouped into 6 dimensions (independent living, relationships, mental health, coping, pain
and senses), each of which is separately modelled and then combined to obtain a single
AQoL-6D utility score.
The AQoL was pilot tested for cultural equivalence during two focus groups in Fiji.All
secondary students at both the intervention and comparator schools and participating in
the OPIC project completed the AQoL at both baseline and follow-up. The questionnaire was
self-administered and completed by students in a classroom setting.
In order to enhance the credibility of the QoL measurement in the OPIC study, a decision
was made to use the AQoL in conjunction with a second instrument, the PedsQL (Varni et al.
1999; 2001; 2002a). The PedsQL is a pediatric general health profile instrument, specifically
designed for use with adolescents and children. In the OPIC study, we will be using the
generic module for 13-18 year olds. It has been adapted for specific conditions (cancer,
asthma, diabetes etc; Varni et al. 2002b; 2003; 2004; Uzark et al. 2003, Laffel et al. 2003),
but not as yet for obesity. The questions, however, fit quite neatly with obesity, and we will
be using it as a proxy condition specific instrument.
6.3.3 Adapting the tools for Fiji
As the AQoL was originally calibrated with the utility weights or preferences of Australian
adults, it was necessary to recalibrate it for adolescents in each of the four countries. This
was done using the time trade-off methodology as was employed in the determination of
the original adult weights (Moodie et al 2009). AQoL utility scores and dimension scores
were calculated for each participant based on the recalibrated algorithm. The recalibration
was based upon country-specific time trade-off (TTO) data for 30 multi-attribute health
states constructed from the AQoL-6D descriptive system. Senior secondary students, in a
classroom setting, responded to 10 health state scenarios each.
A total of 70 individuals from the 6 different schools each completed 10 scenarios, making
for a total of 700 scenarios completed in Fiji. The scenarios were divided into three different
batches (or sorts). The table 47 below shows the school names, the sort number which each
school completed, number of students consented, number participated and the ethnicity
distribution.
85
Table 47: School participation for time trade-off
School Name Sort Number Number Ethnicity/Gender Ethnicity/Gender

number Consented Participated
Fijians Indians
Female Male Female Male
Rishikul S College 2 12 11 3 - 5 3
Amadhiya M College 2 11 11 3 1 4 3
Nasinu M College 1 13 13 1 1 5 6
Nasinu Sec School 3 13 13 7 6
AOG High school 3 12 11 3 3 3 2
Nakasi High School 1 11 11 6 1 2 2
TOTAL 72 70 23 12 19 16
The completed data was used to recalibrate the utility weights in the AQoL for use with adolescents
in Fiji.
 Six schools from the Intervention area were approached and the process of
developing new utility weights was explained.
 Eleven to thirteen of the senior (form 6) level students were selected by the focal
points from each school, in order to take part in the task. Only senior students were
selected given the cognitive complexity of the task.
 For the results to be reliable, the team considered ethnic distribution and gender
equity.
This instrument is now available for use in other economic evaluations conducted with the
adolescent group in Fiji.
6.3.4 Results
5,872 adolescents in Fiji completed the AQOL
Across the four OPIC countries, the average AQoL of the total sample was 0.74, ranging from
Australia 0.85 to Tonga 0.59. In Fiji, there was a large variation in mean AQoL scores by
ethnic group, with the Indigenous Fijians scoring 0.69, and Indo-Fijians 0.78. In general,
quality of life was shown to decrease in line with increasing weight status. In other words,
overweight or obese adolescents had poorer quality of life than their healthy weight peers.
The Indo-Fijians curiously experienced a bigger loss in quality of life amongst the overweight
(3%) than the obese group (1%). In contrast, the relationship did not hold for the Indigenous
Fijians, who enjoyed higher quality of life as their BMI increased. Both overweight and obese
Ethnic Fijian adolescents, experienced 2% higher quality of life scores than their healthy
weight peers.
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6.3.5 Conclusion
The economic studies have centered on the adaption of quality of life instruments for use in
Fiji and with adolescents, and their use in measurement the relationship between quality of
life and adolescent overweight and obesity.
Overall, girls were more sensitive to the effects of overweight and obesity on their quality of
life than boys. Amongst overweight adolescents, girls experienced a bigger loss than boys in
all ethnic groups. Losses ranged from 1% for overweight Indigenous Fijian girls to over 5%
for Indo-Fijians. Likewise Indigenous Fijians experienced quality of life gains except for the
overweight girls.
87
7.0 Conclusions and Recommendations
The OPIC project was a multi-faceted and complex research project, encompassing multiple
activities and areas of research. The project involved both dedicated staff, and the
involvement of multiple stakeholders, partners and students. Without the commitment of
all those involved, this project would not have been possible. This report has summarised
the activities of OPIC in Fiji, over its six years. More detailed reports, journal publications
and other materials are available for those who would like further information.
The design and implementation of OPIC in Fiji had limitations, as highlighted in this report,
across all the components. In particular, a number of aspects of the HYHC interventions
were less than ideal. Many lessons can be learnt from the process of implementing such a
complex research project in Fiji, and the research staff involved will ensure that these are
considered in future projects.
Fiji now has extensive data on the diets, physical activity and weights of a large sample of
adolescents. This data highlights the considerable problems in this group with regard to
overweight, underweight, poor diets and low physical activity. There are multiple factors
affecting diet and physical activity levels in adolescents, such as the school, home and
community environment, sociocultural values and national policies. Improving the health of
adolescents is therefore unlikely to be a simple process. The extensive and systematic
actions that took place within the HYHC aspect of OPIC in Fiji delivered few impacts on the
intervention group. This is a highly significant finding. It demonstrates that multiple actions
are likely required over sustained time periods to effect change. It also demonstrates the
importance of this type of research, and of programme evaluation. It is essential that
efforts to improve health are targeted and effective. More research is planned related to
obesity prevention, including on policy change and sociocultural impacts on behaviour
change.
Some specific recommendations that are clear from the project are
1. Creation of supportive environment: It is clear that multiple influences impact on

adolescent behaviour. Efforts are needed to ensure that these are supportive of a
healthy lifestyle. Supportive environments are needed in homes, schools and
religious organisations. Additionally higher-level policy change is required to ensure
that healthy diets are affordable and accessible; the food policy recommendations
made by OPIC are an important aspect of this. Other approaches to increase physical
activity are also needed.
2. Multiple, sustained interventions and activities: Unhealthy habits take time to
develop, and similarly developing healthier habits will take time, for all sections of
the population. Interventions therefore need to be sustained, rather than
implemented over short-time periods. Additionally multiple interventions are
88
needed across settings to ensure that the same messages are received from all
sources. Faith-based, community and school settings are particularly important areas
for interventions.
3. Schools need to adopt a comprehensive health-promoting approach: While the
contents of the curriculum are important in promoting healthy lifestyles, other
actions are needed in the school settings. This should include the health promoting
schools approach, student councils, peer support and role modeling. Curriculum may
need strengthening in terms of NCDs and healthy lifestyle.
4. Clear guidance on healthy eating, physical activity and body weight: The mix of
underweight and overweight present among adolescents is of concern, and
highlights the need for balanced approaches to healthy body weight. Guidelines for
schools and communities with regards to healthy body weight are needed.
5. Changing attitudes and norms: Attitudes, values and norms around physical activity
in girls, body size in girls and aspects of diet, are contributing to the growing health
problems seen in adolescents. Change in these areas is critical, and more
sociocultural consideration is needed of how to address these without undermining
important traditional values.
6. More research, monitoring and evaluation: It is clear that we do not have the
solutions to the problems of overweight and NCDs in adolescents, or the wider
population. Countries around the world continue to struggle with these problems.
Effective solutions are likely context-specific, and therefore it is critical that we
continue to work to assess ‘what works’ and ‘what doesn’t work’, and how to
improve the effectiveness of interventions. This requires research, along with strong
evaluation of activities. Additionally monitoring of obesity levels is needed, to assess
trends and factors involved.
Recommendations made in this report should be seriously considered by the Ministry of

Education, Ministry of Health, Ministry of National Planning and other government agencies.
89
References
Coyne T. (2000)Lifestyle Diseases in Pacific Communities. Noumea: Secretariat of the Pacific
Community; 2000.
Gewertz D, Errington F. (2007)The Alimentary Forms of the Global Life. American
Anthropologist;109(3):496-508.
Hughes R. (2003) Diet, food supply and obesity in the Pacific. Manila: World Health Organization
Regional Office for the Western Pacific;.
Hughes R, Lawrence M. Globalisation, food and health in Pacific Island countries. (2005) Asia Pacific
Journal of Clinical Nutrition;14(4):298-304.
Kremer K, Vanualailai N, Roberts G, Schultz J, Waqa G, Moodie M, Malakellis M, Pryor J, & Swinburn
B (2010). Reducing unhealthy weight gain in Fijian adolescents: results of the Healthy Youth Healthy
Communities project. Submitted for review.
Lang T, Rayner G. (2007) Overcoming policy cacophony on obesity: an ecological public health
framework for policymakers. Obesity Reviews;8(Suppl. 1):165-81.
McCabe M , Ricciardelli L, Waqa G, Goundar R, Fotu K (2009) Body image and body change
strategies among adolescent males and females from Fiji, Tonga and Australia. Body Image, 6: 299-
303
McCabe M, Ricciardelli L, Waqa G, Mavoa H, Rowland M, Chila A. (2009) Report on Sociocultural
Questionnaires and Perceptual Distortion Measures with Indigenous Fijian and Indo-Fijian Youth
Sociocultural Studies in the Healthy Youth Healthy Community Project. Unpublished
Ministry of Health (Fiji). (2002). Fiji Non-Communicable Diseases (NCD) STEPS Survey 2002. Suva, Fiji
Islands: Ministry of Health
Ministry of Health Annual Report (Fiji) 2006. (2006) Suva, Fiji Islands: Ministry of Health
Ministry of Health Annual Report 2007. (2007) Suva, Fiji Islands: Ministry of Health
Ministry of Health Annual Report 2008. (2008) Suva, Fiji Islands: Ministry of Health,
Ministry of Health Annual Report 2009. (2009) Fiji Islands: Ministry of Health
Ministry of Health (2004) National Non Communicable Diseases Strategic plan 2004-2008, Ministry
of Health (Fiji)
Moodie M, Keating C, Mavoa H, Fotu K, Waqa G Faeamani G, Swinburn G The impact of obesity on
the utility-based quality of life of adolescents from different ethnic groups in the Pacific: Obesity &
quality of life of adolescents.
Popkin B. (2001) Nutrition in transition: the changing global nutrition challenge. Asia Pacific Journal
of Clinical Nutrition;10 (Suppl.):S13-8.
Richardson J, Day N, Peacock S, et al. Measurement of the quality of life for economic evaluation and
the Assessment of Quality of Life (AQoL) Mark 2 instrument. The Australian Economic Review. 2004;
37(1): 62-88.
Roberts G, Lingham D. (2008) Fiji Health Situational Analysis Report 2008. Fiji School of Medicine.
Schultz J, Waqa G, McCabe M, Ricciardelli L, Mavoa H. (2008) Report on Interviews with Indigenous
Fijian and Indo-Fijian Youth Socio-cultural Studies in the Healthy Youth Healthy Community Project.
Unpublished,
Schultz J; Utter J; Mathews L; Cama T; Mavoa H; Swinburn B. (2007) The Pacific OPIC Project: Action
Plans and Interventions. Pacific Health Dialogue, 14;2:147-153
Summerbell CD, Waters E, Edmunds L, Kelly SAM, Brown T, Campbell KJ (2009). Interventions for
preventing obesity in children. Cochrane Library, 2009 issue 1
Thow, AM & Snowdon, W (2010) Policy interventions to tackle obesity & NCDs in Fiji: Findings from
local research. Unpublished
UNDP (2008) Human Dev. Report 2007/08, 2. UNICEF: http://www.unicef.org/info by country
90
Utter J, Faeamani G, Malakellis M, Vanualailai N, Kremer P, Scragg R, Swinburn B. (2008) Lifestyle
and Obesity in South Pacific Youth, baseline results from the Pacific Obesity Prevention In
Communities, (OPIC) project in New Zealand, Fiji, Tonga And Australia, University of Auckland
Varni J W (2007) PedsQLQuality of Life measurement in OPIC. Unpublished.
Waqa, G. (2007) Annual report Fiji Healthy Youth Healthy Community Project, Unpublished
Waqa, G. (2009) Baseline Study – Process Report for Fiji Healthy Youth Healthy Community Project,
Unpublished
WHO. The World Health Report 2002. (2002) Reducing risks, promoting healthy life. Geneva: World
Health Organization.
WHO (2003) Vanuatu Commitment 2003, SPC and WHO Pacific islands Ministers of Health meeting,
2003. Manila, WHO.
WHO. (2005) Preventing chronic diseases, a vital investment. Geneva: World Health Organization.
WHO (2005) Samoa Commitment 2005, SPC and WHO Pacific islands Ministers of Health meeting,
2005. Manila, WHO
WHO (2007) Vanuatu Commitment 2007, SPC and WHO Pacific islands Ministers of Health meeting,
2007. Manila, WHO
91
Annex 1: Background information on Fiji
Fiji - Demographic and Country overview.
Fiji is a small island state at the hub of the south-west Pacific midway between Vanuatu and the
Kingdom of Tonga. The 2007 Fiji population census 1 was 837,271 comprising 475,739 Indigenous
Fijians, 313,789 Indo-Fijians and 47,734 of other ethnic groups. Overall, the rural population was
49% and the urban 51% with urban growth rate being 1.7% 2. The average annual growth rate is 0.8%
(the natural increase of 1.2% minus migration) with crude growth rates being higher in the Fijian
than in the Indo-Fijian population. Areas with noticeably increased population over the past few
years are the Western Division (55,266) and Central Division, where the population of the Suva and
Nausori urban and peri-urban areas has increased by 32,300. Thirty nine percent of the population
is less than 20.
Figure 35: Map of Fiji
Fiji’s Economic Exclusive Zone contains 332 islands covering a total land area of 18,333 sq km in 1.3
million sq km of the South Pacific. It is a multi-cultural and multi-religious country where different
cultures meet and to some extent merge. Literacy rate is around 94%, with English being the official
language and Fijian and Hindi the languages of daily use.
Economic Situation.
Fiji’s housing and employment crises are pervasive and will be compounded over time by high rates
of school drop-out. As land leases expire and food costs rise, squatter settlements now number 200
with an estimated population of 100,000 people. Sixty eight percent of the workforce earns less than
$7,000 per year. Main sources of revenue are tourism, sugar, mining, agriculture and bottled water .
National GDP at constant price was $3.505 billion in 2000 and had grown to $5.826 billion in 2007.
The country has a relatively good infrastructure to support its development but the overall standard
of living is declining. It is rated on the UNDP Human Development Index (HDI) as being one of the
1
Fiji Islands Bureau of statistics Fiji MOH 2008 Annual Report
2
Roberts, Lingham; Fiji Health Situational Analysis report 2008
92
medium developed countries, being ranked 92nd among a listing of 177 nations in 2006. However
this represents a decline from position 46 in 1995. There is poverty, as reflected by the drop in
ranking on the HDI, but it is not overtly apparent as seen in Africa, and some other Melanesian
countries. The economy has become increasingly dependent on tourism, remittances from overseas,
gold and forestry exports.
The current Interim Government has been in place since December 2006. They have identified
certain conditions to be in place prior to Fiji proceeding to a general election. These include
adoption of the People’s Charter, within which Pillar 10 addresses issues of the health sector and
proposes to ‘increase the proportion of GDP allocated to health by 0.5% per annum for the next 10
years to achieve a level of 7% of GDP’. The achievement of this objective would result in significantly
increased funding for the health sector, this will require continued advocacy for health
developments in the face of competing demands; and the MoH to demonstrate that it uses its
resources effectively.
Estimates of poverty in Fiji are that 29% of the rural population and 40% of the urban population are
poor; and that poverty (35% of the overall population) is distributed across the nation. The poor
often live in unsafe and overcrowded houses in under-served peri-urban shanty towns where
exposure to pollution and other health risks are greatest. They are most likely to indulge in risky
behaviors out of circumstances rather than by choice, often going hungry or eating poor quality
foods, living stressful lives, indulging in personal habits such as drinking of kava and smoking tobacco
to obtain comfort and to socialize. It is estimated that by 2006 the Suva/Nausori corridor will have
15,000 squatter households with a population of 90,000-100,000 people. This will place a large
strain on the entire urban infrastructure, such as water supply, sewerage, electricity, roads, traffic
congestion and social services.
Key health Indicators

A comprehensive set of population health indicators is presented in Table 49 below. Overall the
Figures show no real improvement in the health status of the people of Fiji over the past 5 years,
although there have been some improvements in areas of post neonatal mortality and contraceptive
coverage rates.
Table 49: Fiji’s key health indicators
2003 2004 2005 2006 2007 2008
Population (Census estimates) 866,099 848,647 849,361 868,488 868,107 879,301
Total Live Births 17,910 17,714 17,826 18,394 19,298 18,944
Crude Birth Rate/1,000 Population 20.68 20.87 20.99 21.20 22.2 21.5
Crude Death Rate/1,000 Population 7.06 6.63 7.02 7.1 9.8 7.4
Rate of Natural Increase 1.36% 1.42% 1.4% 1.4% 1.2% 1.4
Under 5 Mortality Rates/1000 live 23.73 22.52 25.81 25.8 22.4 23.6
Births
Infant Mortality Rate/1000live Births 18.87 17.84 20.76 19.5 18.4 13.1
Perinatal Mortality (stillbirth and early 16.4 19.3 22.05 19.4 15.8 15.4
neonatal deaths/1,000Live Births)
93
Early Neonatal Deaths (0-7days)/1,000 7.54 8.13 10.43 8.0 N/A N/A
live Births
Neonatal Mortality (Deaths 9.27 10.05 15.37 11.3 11.9 9.0
0-28days) 1000 Live Births
Maternal Mortality Ratio/100,000 LBs 22.3 33.9 50.5 43.5 31.1 31.7
Source: Fiji MOH Annual Reports 2008
COMPARISON WITH PACIFIC NEIGHBORS.
Table 50 below presents comparative indicators for some pacific states and shows that the Fiji rank
in the UNDP Human Development Index, trails behind Tonga and Samoa. There are many other clear
differences for example Fiji exhibits double the rate of urbanization than its neighbors; its teenage
pregnancy rate (15-19) is high, partly accounted for by the young age of marriage of many Indo-
Fijian females.
Table 50: Selected regional comparative indicators
Indicator Fiji Samoa Solomon Is Tonga Vanuatu
Human Dev. Index Rank: 92 77 129 55 120
% population urbanised 51 23 17 24 24
Under 5 mortality rate 2006 18 28 73 24 36
Life expectancy at birth 2006 69 71 63 73 70
% of pop. using improved 47 88 70 100 60

drinking water sources 2004
% of pop. using improved 72 100 18 96 50

adequate sanitation 2004
Age specific fertility rate (15-19) 45 23 69 42 38

births per 1000 women
Sources: 1. UNDP Human Dev. Report 2007/08, 2. UNICEF: http://www.unicef.org/infobycountry
Morbidity and Mortality.

Table 51 reveals the triple burden of morbidity in Fiji stemming from injury, infectious diseases and
chronic non-communicable diseases. It also shows that non-communicable diseases account for the
greatest part of mortality.
94
Table 51: The ten major causes of morbidity and mortality in 2007
No MORBIDITY Cause MORTALITY Cause
1 Injury 1 Diabetes mellitus
2 Influenza and pneumonia 2 Other forms of heart diseases
3 Intestinal and infectious disease 3 Ischemic heart diseases
4 Infection of skin & subcutaneous tissues 4 Hypertension
5 Ischemic heart disease 5 Septicaemia
6 Other conditions originating in peri-natal period 6 Cerebrovascular Disease
7 Chronic lower respiratory disease 7 Other conditions originating in perinatal period
8 Other forms of heart diseases 8 Chronic lower respiratory disease
9 Hypertension 9 Renal failure
10 Diabetes mellitus 10 Influenza and pneumonia
Source: Fiji MOH - hospital admission Source: Fiji MOH -Death certificate
Non- communicable diseases such as diabetes, heart disease, high blood pressure and respiratory
diseases have now replaced infectious and parasitic diseases as the principal causes of mortality and
morbidity in Fiji.
Key Lifestyle and other issues impacting on health of the people
Lifestyle: The socio cultural differences on health, the migration to urban areas and the transition
from the consumption of local produce to imported refined food items, has resulted in an increase in
obesity and non-communicable diseases in recent decades. Secular fashion and behavioral trends
are powerful influences on young people while the breakdown of traditional social controls have
allowed behaviours such as binge drinking, cannabis consumption, an active nightclub scene, sexual
promiscuity and commercial sex, the consumption of ‘fast foods’ and the increase in street kids and
homelessness all of which are readily visible phenomenon of lifestyle change. The greatest
challenge is youth unemployment. Young people of productive working age are commonly seen on
the urban and suburban streets of Fiji during working hours.
Water and sanitation: Many of the rural water supply systems built during the colonial period are
now deteriorated to the degree that village water systems are sources of diarrheal diseases and
other water borne diseases.
NCD BURDEN IN FIJI

The obesity and non communicable disease problem in Fiji is a serious one. 82% of deaths are now
due to heart disease, heart failure, stroke and hypertension, and these have been recognized as an
important health problem 3. 10% of deaths are due to communicable diseases, maternal & prenatal
and 8% due to injury & poisoning.
3
Fiji Ministry of Health Report, 2007
95
Figure 36: Distribution of deaths in Fiji by cause groups, 2007
The last national NCD STEPS Survey 2002 4 found that of the 6783 individuals sampled:
The overall population of overweight (BMI 25-29.9) in the Fiji population between the ages of 15-64
years was 29% and for obesity 18%.
Generally the females had higher BMI than males (mean BMI 26.7 vs 24.2) Fijians more than Indo
Fijians
There is also a rapid increase in the proportion of overweight/obesity in both genders prior to the
age of 30years. By measurement of waist – hip ratio (WHR) there was a significantly higher rate of
high risk central obesity among females (45%) than males (4%).
The prevalence of diabetes in Fiji among 25-64yrs old was 16 %, & among them the proportion of
newly diagnosed cases was 53.2%.There is a much higher proportion of diabetes among the Indo
Fijians (21.2%) as compared with Fijians (11.5%) There is also difference in the overall prevalence of
diabetes by locality with a prevalence of 24.7% in the urban & 12.8% in the rural.
The prevalence of hypertension in the population 15-64years was 19.1% and 63% of them were
newly diagnosed. There is a higher proportion of hypertension among Fijians ((21%) as compared
with Indo-Fijians (16%) and the proportion of uncontrolled previously diagnosed cases is higher
among Fijians (81%) than among Indo-Fijians (58%).
There was generally low consumption of fruits and vegetables with 66% of survey participants eating
less than one serving of fruit per day and 26% eating less than one serving of vegetables per day.
Information from other surveys indicates the range of nutritional problems still being widely
experienced (such as iron and iodine deficiency). Reliance on imported foods, poor diet choices and
changing lifestyles, with reduced physical activity levels are the underlying problems, and are being
seen not only in Fiji but throughout the Pacific Island region.
• There was also a higher proportion of urban males (49%) in the high-risk triglycerides group
(>=1.70mmol/L) as compared to either rural males (24%) or urban females (28%). HDL
cholesterol levels were used to categorize individuals into a high risk group (<= 0.90
mmol/L) was 31% and for females was 35%, a difference that was not statistically
significant.
• 37% currently smoke tobacco,
• There is a low rate of physical activity (25%)
• A high rate of binge drinking (77.3% of current drinkers).
4
Fiji NCD STEPS Survey 2002 Report
96
The findings of the NCD STEPS Survey 2002 formed the basis of the development of the Fiji National
Non Communicable Diseases Strategic Plan 2004-8, which was formulated in 2003-4. The Ministry of
health then also reviewed, strengthened and consolidated its other existing strategies and activities
to address non communicable diseases interventions comprehensively as a united front. These
included the Fiji Plan of Action for Nutrition (FPAN), Fiji National Health Promotion Council Strategic
Plan 2004-8, Micronutrients Survey & Food Fortification of Flour, Food Safety Act 2003, Public Health
Act Review and Tobacco Control Act.
Interestingly, most of the strategies developed in this NCD Strategic Plan, such as Strengthening of
the Food safety Act 2003, Review the Food and Nutrition Policy, Finalise the School health and
nutrition Policy, Address non nutritious advertising, Advocate NCD friendly Accreditation of Food,
Advocate for taxation according to nutritious values, Advocate Price controls of Nutritious foods, and
other activities in Strengthen Community Action, Developing personal skills, Creating supportive
Environments and Reorienting health services; were followed through within the components of the
Fiji OPIC Research 2004-8. However, there was minimal tangible interaction at the policy level of the
Ministry of Health in relation to the implementation and processes taking place at the
implementation and intervention results of OPIC. These gaps could have strengthened the
implementation of the findings and results of the OPIC study.
The Fiji National NCD Strategic Plan is overseen by the national multisectorial NCD Committee which
is chaired by the Hon Minister of Health with membership from all stakeholders including
representatives from the 3 Divisions; Northern, Western and Central Eastern, who have their own
Divisional NCD Committees. The national NCD Committee meets once every quarter and monitors &
evaluates the progress of the implementation of this strategic plan at various levels. Following the
submission of the NCD Strategic Plan to cabinet in 2004, the Fiji Government also increased its
specific NCD budget allocation from 60,000 FJD in 2003 to 280,000 FJD in 2004 and continued
annually to date. This reflects the government commitment to address NCD issues and interventions
following the World Health Assembly Resolutions and the Pacific Island Ministers of Health meetings
culminating the 2003 Tonga Commitment, 2005 Samoa Commitment and the 2007 Vanuatu
Commitment.
Nutrition: An impressive quantity and range of traditional food such as root crops, fruits and
vegetables are grown throughout the country, and along with fish, and are identified as a “hidden
strength” of the economy. However it is estimated that only 40% of energy needs come from locally
grown food. Nutritional problems for weaning infants, undernourished children and adolescents
remain. Kumar (2006) found that one third of teenage schoolgirls in the Western Division were
anaemic and that many routinely miss breakfast.
The cost of food: Fiji is a net importer of food and its agricultural potential for food production is
largely underutilized. Much of Fiji’s arable land has been devoted to sugar production, but as land
leases expire land is left fallow without any plans for further development. For Fiji to develop a
viable food export sector, the quality of food produced will need to be increased to meet the
expectations of recipient markets. Available survey 5 information suggests that since the 1980’s
there has been increased intake of cereals (rice and wheat), animal fats and imported processed
foods. This is supported by importation data which reveals clear dramatic increases in the
importation of meats and meat products, along with vegetables oils. Overall the availability of
calories per capita has been gradually increasing. The contribution of fat to this calorie intake has
5
Roberts, Lingham (2008).
97
risen from 20% to 30% (from 1964 to 2000). Availability of fish per capita has been declining since
the late 1980s, whereas availability of meats has been increasing. Fruit and vegetable availability,
from both imports and local sources, has been steadily increasing over recent decades, but still falls
well short of the WHO guidelines for a healthy diet.
The main drivers of food choices have been found in a recent study to be cost and convenience.
Overall, the food environment is unsupportive of healthy eating for many, particular urban dwellers.
Prices for local foods such as fish and root crops are high compared to some meats and rice. There is
limited access to healthier options in settings such as restaurants and schools. Marketing is heavily
skewed towards the promotion of less healthy foods, and the resources available for health
promotion are far outweighed by those available to food manufacturers. While health promotion
and education efforts are critical to ensure that the public is well-informed about the importance
and constituents of a healthy lifestyle, they are unlikely to follow that advice if the environment does
not support them; if it’s difficult to access healthier food, too expensive or they have difficulty
identifying the healthier options in stores.
98
Annex 2: Community and School interventions
Introduction
Overweight and obesity is increasing in most countries but prevalence rates are particularly high and
increasing rapidly in Pacific populations. It is likely that socio-cultural factors playa large part in the
development of obesity. Any intervention programs, therefore, need to take into account the main
behaviors and underlying socio-cultural factors that are contributing to obesity. Health promotion
action at a community level needs to become embedded in the organizations working in that
community and to ensure that the community owns and embraces the action. The challenges are
considerable, particularly in achieving a sufficiently high and sustainable ‘dose’ of intervention and
evaluating the process, impacts and outcomes to a sufficiently high standard given all the constraints
associated with such projects. While these challenges are recognized, the problem of obesity,
especially in Pacific populations, needs to be addressed at all levels – community, national, and
global.
Development of Action Plans:

At each intervention site, preliminary interviews were conducted with youth to identify the potential
socio-cultural barriers that facilitators or hinder healthy eating and regular physical activity in order
to attain and sustain a healthy body size.
This and other information was presented at a 2-day workshop with community stakeholders,
including youth. The participants then prioritized the components for a draft action plan which was
later consolidated through further community consultation.
Action Plan objectives: Each action plan had two overall aims:
• to build community capacity and
• to promote healthy weight through capacity building, social marketing messages, evaluation
and environmental change.
The Action Plan Objectives that were developed for the school & community are listed in the Table
52.
Table 52: Action plan objectives for school and community
No. Topic Action Plan Objective

1 SOCIAL MARKETING To achieve a high awareness of the Healthy Youth Healthy Community
project’s key messages amongst youth and key stakeholders
2 BUILDING CAPACITY To build the Nasinu Community capacity to promote healthy eating and
regular physical activity in adolescents and youths
3 EVALUATION To evaluate the project, impact & outcomes of the Healthy Youth Healthy
Community Project
99
4 BREAKFAST To significantly reduce the proportion of adolescents & youths who skip
breakfast and lunch on school days
5 HEALTHINESS OF FOOD [a] WATER VS SWEET DRINKS - To significantly decrease the consumption of
AT SCHOOL high sugar drinks & to promote the consumption of water. [b] FRUIT &
VEGETABLES - To significantly increase fruit and vegetable consumption
6 AFTER SCHOOL SNACKS To significantly decrease the consumption of energy dense snacks and
significantly increase consumption of fruit
7 WALKING & CYCLING [a] To increase the proportion of school children living within the school area
to walk to and from school and have sense of safety for walking around the
neighborhood. [b] To significantly increase the healthiness of school food
8 SUPPORT PE CLASSES To support physical education teachers to conduct PE classes effectively.
9 GETTING ACTIVE To significantly increase the amount of active play after school & weekends
and significantly decrease time spent watching TV & playing on computers
or electronic games
10 GETTING THE To develop a program for promoting healthy eating & physical activity within
COMMUNITY INVOLVED churches, mosques, and temples
Developing the draft action plans

Figure 37 describes the model of the OPIC community interaction process. The steps taken to
develop the action plans were conducted within the context of the communities; key community
members and stakeholders were involved in all aspects of the process.
Figure 37: OPIC community interaction process model
In Depth
COMMUNITY Interviews
ACTION Intervention
PLAN Strategies
Preliminary
Preliminary
Interviews ANGELO
Interviews Workshop
Community
Readiness
100
Phase 1 – Preliminary assessment of socio-cultural factors
Preliminary interviews were conducted to determine the perceptions of 12-18 year olds in terms of
three themes: food and eating, activity and inactivity, and preferred body size. Findings from the
interviews informed and shaped the community workshops and baseline questionnaire and
indicated that youth:
• knew about healthy food and drinks,
• often buy junk food with spending money that was not monitored by adults,
• identified mothers as messenger about food while fathers provided more messages about exercise
& physical activity,
• thought boys had more freedom than girls to exercise and in Fijians, Indo- Fijians prioritize study
over exercise,
• identified media, peers and sports stars as important messengers relating to body size, shape and
muscularity. The findings of the socio-cultural interviews were included in the materials developed
for the community workshops.
Phase 2 – Community workshops to develop the draft action plans

Once the community consultations and preliminary socio cultural studies took place, each site
organized a community workshop with key stakeholders to develop a draft action plan. The
community workshop used the ANGELO framework based on an Analysis Grid for Elements Linked to
Obesity. The original ANGELO framework centered on obesogenic environments but this was
augmented by identifying potential behaviours for targeting, knowledge and skill gaps to fill, in
addition to environmental barriers in the homes, schools, churches and communities that needed to
be addressed. All the elements were informed by the preliminary socio-cultural interviews prior to
each workshop (approximately 15-20 potential behaviors, knowledge and skills gaps, and 10-25
environmental barriers in each of the settings). The environmental barriers were classified as:
• physical (what is or isn’t available),
• economic (what are the financial factors),
• policy (what are the rules); and
• socio-cultural (what are the beliefs, values, attitudes, perceptions & community
practices).
Healthy Youth Healthy Communities’ - A 2-day ANGELO workshop was conducted in August 2004 to
develop a plan of action for intervention within the Nasinu community. The students, teachers, and
people from the communities and related organizations were updated on the issues related to
obesity and available local data on the problem. The participants were then taken through a process
of prioritization of the various elements. Individuals first checked, and altered the elements if
necessary, and then scored each element for importance and changeability. Group aggregate scores
were combined to identify the priority behaviors, knowledge and skill gaps, and environmental
barriers that relate to obesity. From these priority elements, a draft action plan was developed.
The strategies were congruent with the stage of readiness and were culturally appropriate (the latter
was addressed through the in-depth socio-cultural interviews). The draft action plan and behavioral
objectives to guide the interventions at was developed for the Fiji Healthy Youth Healthy Community
project is described in the Table 53 below:
Aim: To improve the health and wellbeing of individuals and strengthen the Nasinu Community
through healthy eating and physical activity
101
Table 53: Action plan for the Fiji ‘Healthy Youth Healthy Communities
Ion
Behavioral & Innovative Objectives Key Strategies

1. To significantly reduce the proportion of • Promote breakfast with students and parents
adolescents who skip breakfast on school days. – pamphlets & school assembly morning talks
• School canteen providing breakfast
2. To improve the healthiness of food at school by • Develop school policies for canteens to
significantly decreasing the consumption of high sugar support water, fruit and vegetable consumption
drinks and promoting the consumption of water and • Curriculum development with Home
by significantly increasing fruit Economics and Agricultural Science
and vegetable consumption
3. To significantly decrease the consumption of • Social marketing [include fruits (& vegetables)
energy dense snacks and significantly increase for snacks and benefits of F & V; what
consumption of fruit as afternoon snacks constitutes healthy snack
• Student information on healthy snacks, F & V
snacks
4. To significantly increase the proportion of • “Walking buddies”
adolescents living within walking distance to school to • Road safety skills
walk to and from school with a sense of safety
5. To support physical education teachers to conduct • School policy on physical education classes
physical education classes effectively • Partnership with organizations to provide
sports equipment such as, hoops, ropes &
others
6. To significantly increase the amount of active play • House rules on screen time and outside play
after school/ weekends; significantly decrease time time
spent watching TV & playing computers or electronic • School walkathon
games
7. To develop a program for promoting healthy eating Food Preparation Skills
& physical activity within churches, mosques & • Budgeting skills
temples
These names were reviewed by community members during focus groups to identify the most
commonly selected one. The choice of name and logo: Healthy Youth Healthy Community
participants was developed by the participants during the focus group discussion in the social
marketing workshop.
Community Engagement and Intervention Strategies

The initial behavioral objective targeted by the Healthy Youth Healthy Community intervention
addressed the issue of students missing breakfast. Key stakeholders were again consulted to
determine the types of strategies that were important and appropriate for their communities in the
Action Plan and two working groups were formed to implement the action plan:
(1) first group - Local Steering Committee whose membership comprised of representatives
of all major stakeholders at Ministerial levels (Health, Education, Women), school focal points for the
Healthy Youth Healthy Communities project, local town council, and health centers in the
intervention area. The terms of reference for this committee were to advise and support the project
team with implementation and act as a link between their respective organizations and the project
staff.
(2) second group - comprised of the individual School Implementation Committees for each
of the intervention schools which included teachers, students, school administration, and canteen
managers. The Committee’s terms of reference supported the project by implementing the action
102
plan in their school setting. The Committees met fortnightly to plan and monitor project activities.
The behavioral objective targeted by the Healthy Youth Healthy Community intervention addressed
the issue of students missing breakfast. Schools used multiple strategies to encourage students and
to eat a healthy breakfast. Intervention strategies included social marketing through pamphlets
targeting students & parents; promotion of breakfast by students during parent interview days;
school canteens opening early to sell breakfast before school starts; and education through skills
development for students in time management.
• School Intervention - A snapshot of interventions implemented in the 7 schools in 2007 is shown
in Table 54.
Table 54: Interventions implemented in the 7 schools
Intervention objectives Implementation by schools & no. of times
Breakfast: To significantly reduce Ahmadiyya M College: 3; AOG High School: 3; Bhawani D A College:
the proportion of 3; Nakasi High : 3; Nasinu M College: 2; Nasinu Secondary : 2;
adolescents/youths who skip Rishikul S College:2;
breakfast on school days
Lunch: To significantly reduce the Ahmadiyya M College: 1; AOG High School: 2; Bhawani D A College:
proportion of adolescents/youths 2; Nakasi High: 1; Nasinu M College: 1; Nasinu Secondary: 1;
who skip lunch on school days Rishikul Sanatan College: 3
Water vs. sweet drinks: To Ahmadiyya M College: 6; AOG High School: 3; Bhawani D A College:
significantly reduce consumption 2; Nakasi High: 5; Nasinu M College: 5; Nasinu Secondary: 2; Rishikul
of high sugar drinks & promote Sanatan College:- 5
consumption of water
Fruit and Vegetables: To Ahmadiyya M College: 3; AOG High School: 1; Bhawani D A College:
significantly increase fruit and 3; Nakasi High: 4; Nasinu Muslim College: 3; Nasinu Secondary: 2;
vegetable consumption Rishikul S College: 2
After school snack: To Ahmadiyya M College: 1; AOG High School: 1; Bhawani D A College
significantly decrease the :2; Nakasi High: 1; Nasinu M College ; Nasinu Secondary :1; Rishikul
consumption of energy dense S College: 1
snacks & significantly increase
consumption of fruit
Physical activity: To significantly Ahmadiyya M College: 1; AOG High Sch: 1; Bhawani D A College: 2;
increase the no. of students Nakasi High: 2; Nasinu M College; Nasinu Secondary :1; Rishikul S
engaged in active play after school College:4
& weekends
Community Intervention: A total of 1000 people participated in these community activities during
the year within faith based organization in the following intervention strategies in Table 55.
103
Table 55: Interventions in Communities
Intervention Objectives Implementation by schools & no of times
Breakfast: To significantly reduce the proportion of Assemblies of God: 3; Catholic – 1; Hindu ;

adolescents/youths who skip breakfast on school Methodist Church: 3; Muslim: 1; SDA: 3; World
days Harvest: 2
Lunch: To significantly reduce the proportion of Assemblies of God: 1; Catholic: 1: Hindu: 1;

adolescents/youths who skip lunch on school days Methodist Church: 3; Muslim: 2; SDA:- 3; World
Harvest: 1
Water vs. sweet drinks :To significantly reduce Assemblies of God ; Catholic; Hindu; Methodist
consumption of high sugar drinks & promote Church: 1; Muslim; SDA ; World Harvest: 1
consumption of water
Fruit and Vegetables: To significantly increase fruit Assemblies of God: 2; Catholic; Hindu; Methodist
and vegetable consumption Church : 3; Muslim; SDA ; World Harvest: 2
After school snack: To significantly decrease the Assemblies of God ; Catholic; Hindu; Methodist
consumption of energy dense snacks and Church ; Muslim; SDA ; World Harvest
significantly increase consumption of fruit
Physical activity: To significantly increase the Assemblies of God ; Catholic; Hindu; Methodist
number of students engaged in active play after Church : 1; Muslim; SDA; World Harvest: 1
school and on weekends
Table 56: Activities undertaken for social marketing
Objective code: M - Multiple objectives, W - Water, FV - Fruits & Vegetables, L - Lunch, B - Breakfast,
PA - Physical Activity
Category Description Objective Comments

Code
Media reports and promotions
Television 1x 30 sec TV advertisement, PA Multiple sponsors, shown live

screened 6 times during Fiji-Hong Kong Rugby
Sevens match
9 TV news items B - 7, PA - 2 Featured programs at schools;
involved 4 teachers and 3 students
2 live TV interviews M-2 Local church TV station aimed at
adolescents and parents; involved
project staff and dietician
Radio 10 minutes talk back show, M-3 On Fijian and Hindi Radio stations;
repeated twice involved 3 project staff
2 x 5 minute Sunday Health M -3 Project staff on Fijian Radio station
Programs
104
Code
4 live radio interviews with Fijian B- 2, M- 2 Project staff

Radio station, replayed 3 times
3 live radio interviews with Radio M - 2, PA - 1 1 student, 2 with project
New Zealand coordinator
Print 10 newspaper articles, 30,000 B - 3, L - 1, M Targeting whole community and
daily distribution – 4, PA - 2 adolescents special newspaper
Developed materials
Printed 60 copies DVD on HYHC Jump PA Produced by Ministry of Health
Jam aerobics instructors training distributed to schools and faith
based organizations schools
3 sets posters posted for 3 PA - 1, FV -1, Attached on power poles at 3
months W -1 different settings
1 set HYHC logo stickers, 2000 W-1 To all schools
copies distributed
1 project newsletter, 100 copies M-1 To stakeholders
distributed
1500 water bottles distributed to M Personalized with school logos
7 schools
3000 copies of annual school M-2 3 term calendar, including
calendars, produced for 2 years intervention photos and health
messages; distributed to all
stakeholders;
Articles in school magazines, 4 M Pages devoted to HYHC articles;
schools for 2 years 2,000 copies distributed
100 certificates of appreciation M Prize giving ceremonies for 2 years,
awarded to HYHC champions
3000 project leaflets distributed M-1
to students
3000 copies of breakfast B-2 Separate pamphlets for students
pamphlets and parents
Other 4 billboards erected at 3 different B - 2, PA – 2 Roadside billboards, featuring local
locations students as actors
4 project banners displayed PA- 1,B -1,M - Displayed at workshops, sports
during promotions 2 events
Logos on 2 project vehicles M
1000 T-Shirts with project logo M Distributed to students
7 School health notice boards M Distributed to 7 schools for project
health messages
One school billboard with project M Project of the School Health
logo Committee
Sourced materials
Printed 1 Fat kit and set of posters M Sourced from New Zealand Heart
Foundation
Other 1000 Posters and pamphlets for M Sourced from National centre for
105
Code
distribution Health Promotion

5000 bottles of water distributed W Compliments of local water
to students and staff company distributed at special
events.
70 crates eggs, 26 tins of Milo, 26 B Donated by local business partners
bars of cheese, 30 crates of milk
used in event catering
Table 57: Activities undertaken for capacity building
Abbreviations: FT - Full Time, M - Multiple objectives, W - Water, FV- Fruits & Vegetables, L - Lunch,
B - Breakfast, PA - Physical Activity
CSC Community Steering Committee; LSC Local Steering Committee; SSC School
Steering Committee; SHC Student Health Committee
Categ Description Objective Distribution and comments

ory Code
Additional Resources
Funds $45,000 procured in 3 small M-2, PA -1 Multiple funding sources
grants.
Additional funds procured by 2 W-2 Successful submissions to fund water
schools tanks/fountain
Person 2 consultants for Jump Jam PA Conducted one week program for 30
nel Training hired teachers and community reps
Leadership
Student 200 champions trained in 7 M Student members of Student Health
s schools x 2 years Committee (SHC)
168 SHC meetings chaired by M At least monthly meetings
students
Commu 60 women attended two 3 day M 10 faith-based organisations represented
nity workshops
leaders
30 members attended monthly M Few members presented in
CSC meetings conferences/meetings as heath champions
30 members of CSC attended M Project proposal completed with budget.
training
Workforce Development
Student 48 students attended 1 day M Social marketing workshop conducted by
s training HYHC and National Centre for Health
Promotion
24 students attended half day M Poster making workshop conducted by
training HYHC
30 students attended 3 days M Conducted by HYHC and National Centre for
training on COMBI Health Promotion.
3 attended 5 day Health M 3 students and 1 community representative
Ministers Forum, NZ
106
Categ Description Objective Distribution and comments
ory Code
1 student attended OPIC M Helped coordinated Fiji displays
satellite in NZ
3 persons attended 3 day M 2 students, 1staff presented to 500
workshop participants at Youths Conference
Other 14 school canteen staff B, L, FV,S Food handlers workshop organized by
Persons attended 2days training HYHC and Ministry of Education
14 canteen managers B, L, FV,S Canteen managers workshop organized by
attended 1 day training HYHC and Ministry of Education
40 participants attended 2 x 5 PA Aerobics training for Physical Education
days training teachers and health staff
30 women attended 3 days B, L, FV, S Healthy lifestyle workshop organized by
training HYHC and a church group
25 women attended 3 days FV, PA Pot planting workshop organized by HYHC
training and Ministry of Agriculture
30 participants attended 3 M Pastors and representatives of women’s
days training and youths group; conducted by Health
Promoting Churches
Staff 2 staff attended 5 days training M Attended by Project Coordinator and other
and meetings members
5 HYHC staff attended 5 days M Social marketing workshop organized by
training HYHC
Partnerships and Collaborations
Govern 700 attended 10 x 30 minutes M Multiple presentations on project to
ment presentations stakeholders
Coordinator attended 14 M Committees jointly organized by Ministry of
committee meetings Education and Ministry of Health
Non- 25 members attend 6 monthly M Chaired by HYHC
Govern LSC meetings
ment
Organiz
ations
20 members of SSC attend 7 M Chaired by Ministry of Education
monthly meetings
30 members of CSC attend 3 M Chaired by local church Pastor
bi- monthly meetings
55 presentations delivered by B, L, S Attended by 60 leaders and 300 church
HYHC staff members
Organizational Development
Schools 5 schools changed menus of B, L, FV, Improved school food services for collegial
school catering services lunch/tea or teachers meetings
Church 2 church groups improved B, L, FV, More vegetables incorporated into lunch
catering services menu
107
Table 58: Activities undertaken for nutrition objectives
Objective code: M - Multiple/combination of nutrition objectives, W - Water, FV- Fruits &

Vegetables, L- Lunch, B - Breakfast S - Snacks, F – Fruits
Category Description Objective Distribution and

Code comments
Policies 2/7 schools developed and M Whole school community
implemented school food policy advised of new policy
3 churches, 5 women’s groups, M Church members advised of
piloting food policy the new policy
7/7 schools implemented fruit policy F Children required to bring
on Fridays own fruit each Friday
2/7 schools implemented school W Children allowed to bring
water policy bottled water to class
Programs 26 breakfast activities in schools, 28 B More than 9000 serves of
in community healthy breakfast provided
29 lunch activities in school, 6 in L ~4000 serves of lunch
community provided to both school and
community
36 water activities conducted in W Bottled water provided as
schools, 8 in community incentives during programs
25 fruit and vegetable activities in FV Demonstrated multiple ways
schools, 3 in community of using fruit
Activities 5/7 schools organized programs an M A variety of activities during
annual OPIC day lunch, before or after school
7/7 schools had OPIC information M Events such as career days,
booth at school events parent interview days
2/7 schools organized essay M Conducted at class level
competitions around obesity
7/7 schools organized assembly All Up to 6 talks per term per
talks by SHC members school
1/7 schools, student survey of foods B, L, S New school food policy
sold in canteen mandated as a result
7/7 schools participated in World FV Seeds, manure and technical

Food Day advice provided; students
showcase school garden
produce
3/7 schools performed plays at non- M 30 students from 3 schools
OPIC schools performed, > 1000 students
watched
1 faith based organization organized M Incentives provided. Sunday
oratory contest school children participated.
Infrastructure 4/7 schools installed new water W SHC prepared and submitted
tanks budget proposal
1/7 schools installed new water W SHC prepared and submitted
fountains budget proposal
108
Category Description Objective Distribution and
Code comments
7/7 schools planted a vegetable FV Produce used by school
garden canteen or hostel
2/7 schools built/renovated M
canteens
Table 59: Activities undertaken for physical activity objectives
Abbreviations: PE Physical Education; MoE Ministry of Education; MoH Ministry of Health
Category Description Distribution and

comments
Programs 15 physical activity programs organized in Included walking,
the 7 schools traditional dances
and aerobics
10 PA programs, >1000 members of Included walking,
religious organizations attended aerobics and soccer
Annual events, > 200 students, 2 new Tadra Kahani, cultural
schools joined dances, Bollywood
dances etc
Activities > 2000 students attended International
Walk to School Day
Infrastructure and More than 200 netballs, rugby balls, Distributed at annual
equipment volleyballs and net were awarded to winning award nights
schools for winning PA prizes during Award
Nights organized for OPIC schools.
Organisational 3 PA workshops organized for PE teachers Jointly organized with
Development and selected health workers MoE and MoH
109
Report produced August 2010
For information please contact:

C-POND (Pacific Research Centre for the Prevention of Obesity
and Non-communicable Diseases)
Fiji School of Medicine, Tamavua Campus
Suva, Fiji
Telephone 3233255

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PACIFIC OBESITY PREVENTION

FIJI COUNTRY REPORT

A collaborative project of: Fiji School of Medicine and Deakin University.

Professor Ian Rouse

AQOL Adjusted Quality of life

Other NGOs: Consumer Council of Fiji.

The OPIC Team:

Results and findings

The intervention resulted in no significant changes in the measures of overweight. While

Conclusions & Recommendations

Recommendations are to:

1) Create supportive environments

The research objectives were:

1. To develop, implement and evaluate the impact of comprehensive community based

2.1 OVERALL PACIFIC OPIC PROJECT STRUCTURE

Figure 1: Overall structure of OPIC project

Research Analytical Intervention Analytical Research

The rationale for the study designs was:

• Linkages with monitoring and surveillance programs where possible to increase

• The use of community participation, including through ANGELO workshops, to

• The analysis and incorporation of environmental factors (physical, economic, policy

Health promotion action at a community level needs to become embedded in the

Study Design, Communities and Participants

3.2 THE HYHC INTERVENTION

There were 2 phases in the HYHC Intervention:

a. Phase 1 – Preliminary assessment of socio-cultural factors

b. Phase 2 – Community workshops to develop the draft action plans

Behavioral & Innovative Objectives Key Strategies

Further details regarding the interventions are provided in Annex Two.

Nasinu area selected as Three towns on western Viti

intervention region (target Levu (Sigatoka, Nadi,

All children in Nasinu area Children from comparison

2670 of 3530 children activities only.

First exit survey: First exit survey:

Final exit survey: Final exit survey:

Lost to follow-up: Lost to follow-up:

Intervention analysed: Comparison analysed:

Excluded from analyses: Excluded from analyses:

3.4 DATA TREATMENT

Table 2: Demographics of Intervention and Comparison groups

b. Body size and Attitudes

Detailed findings on anthropometric measures are given in Table 5.

Table 6: Waist circumference and waist-to-height ratio by ethnicity

Table 7: Waist circumference and waist-to-height ratio by gender

Figure 11: Proportion of adolescents who skipped breakfast – by group

Table 10: Breakfast consumption behaviours by ethnicity

Figure 14: Proportion of adolescents reported having breakfast

Table 12: Morning tea consumption behaviours by ethnicity

Data on lunch-related behaviour are provided in Tables 14 and 15.

Table 14: Lunch behaviours by ethnicity

Figure 21: Proportion of frequent consumption of takeaway food consumption by ethnicity

Table 18: Soft drink consumption by ethnicity

Table 20: Fruit drink consumption by ethnicity

Table 22: After school snack consumption by ethnicity

Table 24: Snack food purchasing behaviours by ethnicity

d. Physical activity and sedentary behaviours

Table 26: Physical activities and television use by ethnicity

Table 28: Family meals and home availability of foods by ethnicity

Figure 28: Family meals and home availability of foods by ethnicity

Table 31: Parental support for healthy eating by gender

Table 33: Parental support for physical activity by gender

e. Perceptions of the school environment

Table 38: Neighbourhood and community factors by ethnicity