Previous qualitative research with Pacific families has highlighted the lack of "fit" between the state housing stock and its occupants. The housing conditions of Tokelauan people living in New Zealand have a significant impact on their wellbeing and health. We carried out qualitative research in partnership with the Wellington Tokelau Association to highlight the impact of the built environment on extended-family living, and in particular the impact on young people in the household. We sought their views by carrying out 20 in-depth interviews with young people, born in New Zealand, who live with their Tokelauan-born parents and grandparents. In this paper we discuss their views of health and the serious difficulties created by inappropriately sized and configured housing, but also highlight what the young people see as the many advantages of extended family living: a strong sense of cultural identity, enhanced fluency in the Tokelau language and strong social support, even if some risky behaviours are the source of arguments. Almost all the young people saw the advantages of living in their extended family as outweighing the evident disadvantages and hoped to repeat the pattern when they had children, but in better-designed houses.
Migration is a brave personal experiment, one that helps researchers understand the social impact of different physical and cultural environments. It also highlights housing differences and the effects on extended-family living (Howden-Chapman et al. 2000). For migrants, extended family living is often an important cultural and economic strategy to facilitate their adaptation to a new country. In the case of Pacific peoples, it also reflects the realities of the norm of lives in villages, where land is limited and owned collectively by families.
Tokelau is New Zealand's sole remaining colony, which places Tokelauan people living in New Zealand in a unique position of being both New Zealand citizens and migrants. The citizens of Tokelau, the Cook Islands and Niue have access to New Zealand citizenship, which allows them a level of choice and not only encourages migration but--aside from the difficulties of direct travel to Tokelau--also makes for an easy flow of movement of people to and from the islands to New Zealand.
Tokelauan people have a unique relationship with researchers, having collaborated generously over many decades (Wessen et al. 1992, Huntsman and Hooper 1997, HowdenChapman and Woodward 2001). In this qualitative study we explore the impacts of extended-family housing on young people's wellbeing at a time of a unique cultural and historical nexus. All the young people we interviewed had the fortune of living with a generation of grandparents, who, having spent the greater part of their life in Tokelau, were the first generation to migrate to New Zealand but retained Tokelauan as their mother tongue. As the Western world encroaches on the way of life in Tokelau, exemplified by such changes as an improved transport system and internet access, this situation is unlikely to recur.
Tokelauan people are the sixth largest Pacific ethnic group in New Zealand (Statistics New Zealand 2007b). The atolls, Nukunonu, Atafu and Fakaofo, were colonised by different religious groups, which affected their culture and customs (Huntsman and Hooper 1997). While outsiders might consider "Tokelauan" to be an adequate description, insiders would want to know which of the three atolls an individual Tokelauan is from in order to place them.
The Yokelauan community in New Zealand is centred in the Hutt Valley, where some of the earliest post-war state houses were built in Petone, Taita and Naenae (Viggers et al. 2008) and subsequently East Porirua. Many Tokelauans were encouraged to come to New Zealand in the mid-1960s when a severe hurricane in Tokelau coincided with the need for industrial workers (Pene et al. 1999). Since economic deregulation, their unemployment levels have been about three times that of the total population (Statistics New Zealand 2007b). Tokelauans are now one of the most socio-economically deprived Pacific groups.
Like the Pacific population as whole, the Tokelauan population is relatively young: the median age is about half that of the total New Zealand population (19 years versus 36 years). Tokelauans have a level of extended-family living almost three times higher than that of any other ethnic group (37% compared to 10% for the total population). Because our previous work has shown that Tokelauan teenagers were the age group most ambivalent about living in extended families (Howden-Chapman et al. 2000), we were keen to understand more about their views of the impact of these living arrangements on their wellbeing and language acquisition.
Although over two-thirds of Tokelauans are New Zealand-born, there has been a marked increase in those who can hold everyday conversations in Tokelauan (Statistics New Zealand 2007b). This differs from the common language pattern in migrant families, where the first generation is fluent in their native tongue, the second generation understands the language but is less fluent, and the third generation understands some of the language but prefers not to speak it (Starks 2006, Hulsen et al. 2002).
CROWDING AND HEALTH
Previous qualitative research with Pacific families has highlighted the lack of "fit" between the state housing stock and its occupants (Jera 2005, Cheer et al. 2002). We are aware from our previous work that many extended families live in crowded three-bedroom houses, in part to lower the rent per person (Baker et al. 2003). There have been policy debates about whether we should be concerned about this (Gray 2001). A former chief executive of Housing New Zealand told a Parliamentary Select Committee that some people chose to live in overcrowded houses, even when offered alternatives. (2) An extended family replied that living in such close quarters meant that illnesses inevitably get shared and that they liked the company, "but not in a place this small" (Manukia, 28 August 1998).
Crowding is now regularly reported as a key progress indicator in the Social Report (see Ministry of Social Development 2008 for the latest). There is strong evidence that crowding increases the risk of close-contact infections such as meningococcal disease, rheumatic fever, tuberculosis and skin disease (Baker et al. 2000, Baker et al. in press, Jaine 2007, Das et al. 2007). Rates of these diseases for Maori and Pacific peoples are double those for Europeans (Baker and Zhang 2005). Crowding also increases the risk of being exposed to second-hand smoke (Howden-Chapman and Tobias 2000), which irritates the airways and increases the risks from infectious diseases. Tokelauans have the highest smoking prevalence of any Pacific group (Statistics New Zealand 2007a), although there are indications of emerging household rules about not smoking inside (Howden-Chapman et al. 2000).
After obtaining ethics agreement, we carried out both focus groups and individual interviews in as culturally sensitive manner as possible, accommodating both our participants' and their parents' wishes. Both the first and second authors are Tokelauan and the last author is Palangi (European ancestry). We were informed by current thinking about cross-cultural collaborations (Jones and Jenkins 2008).
After consulting with our community partners, the Wellington Tokelau Association, we interviewed 20 young people living in Wellington families that included grandparents. We sought a cross-section of young people from the three atolls who were living, or had previously lived, in extended families. Their ages ranged from 17 to late 20s and all except one were New Zealand-born. Two young people were still at school, eight were studying, three were young parents at home, and six were in work.
All the interviews except one were carried out in English. Interviews were tape-recorded and transcribed. We independently read the transcripts, thematically coded them and then discussed our themes.
"HOW DO YOU KNOW WHEN YOU'RE HEALTHY?"
We began by asking the young people what health meant to them. They shared a broad, holistic view. Many had absorbed, but not necessarily acted on, health education messages.
"Health means eating right, regular exercise and, yeah, just stick to walking because I hardly exercise." (Young man)
"Health means eating healthy food, regular exercise like walking to keep healthy. Making music makes me feel good and happy." (Young man)
Several young people included both Western and traditional ideas along with having an awareness of exposure to risks that could affect their long-term health.
"Good health means to me regular check-ups at the doctor to make sure you're alright and when you do feel that something is wrong with you that you do go to the doctor ... Good health also means to me eating right, and it also means, in...