Underserved minority populations in the US Affiliated Pacific Islands (USAPI), Hawaii, and Alaska display disproportionate rates of childhood obesity. The region’s unique circumstance should be taken into account when designing obesity prevention interventions. The purpose of this paper is to (a), describe the community engagement process (CEP) used by the Children’s Healthy Living (CHL) Program for remote underserved minority populations in the USAPI, Hawaii, and Alaska (b) report community-identified priorities for an environmental intervention addressing early childhood (ages 2–8 years) obesity, and (c) share lessons learned in the CEP. Four communities in each of five CHL jurisdictions (Alaska, American Samoa, Commonwealth of the Northern Mariana Islands, Guam, Hawai‘i) were selected to participate in the community-randomized matched-pair trial. Over 900 community members including parents, teachers, and community leaders participated in the CEP over a 14 month period. The CEP was used to identify environmental intervention priorities to address six behavioral outcomes: increasing fruit/vegetable consumption, water intake, physical activity and sleep; and decreasing screen time and intake of sugar sweetened beverages. Community members were engaged through Local Advisory Committees, key informant interviews and participatory community meetings. Community-identified priorities centered on policy development; role modeling; enhancing access to healthy food, clean water, and physical activity venues; and healthy living education. Through the CEP, CHL identified culturally appropriate priorities for intervention that were also consistent with the literature on effective obesity prevention practices. Results of the CEP will guide the CHL intervention design and implementation. The CHL CEP may serve as a model for other underserved minority island populations.
Stunkard, A., & Burt, V. (1967). Obesity and the body image. II. Age at onset of disturbances in the body image. American Journal of Psychiatry, 123(11), 1443–1447. PubMed
Loder, R. T., Aronson, D. D., & Greenfield, M. L. (1993). The epidemiology of bilateral slipped capital femoral epiphysis. A study of children in Michigan. Journal of Bone and Joint Surgery American Volume, 75(8), 1141–1147.
Kaplan, T. A., & Montana, E. (1993). Exercise-induced bronchospasm in nonasthmatic obese children. Clin Pediatr (Phila), 32(4), 220–225. CrossRef
Friesen, C. A., & Roberts, C. C. (1989). Cholelithiasis. Clinical characteristics in children. Case analysis and literature review. Clin Pediatr (Phila), 28(7), 294–298. CrossRef
Strauss, R. S., Barlow, S. E., & Dietz, W. H. (2000). Prevalence of abnormal serum aminotransferase values in overweight and obese adolescents. Journal of Pediatrics, 136(6), 727–733. PubMed
Holst-Schumacher, I., Nunez-Rivas, H., Monge-Rojas, R., et al. (2008). Insulin resistance and impaired glucose tolerance in overweight and obese Costa Rican schoolchildren. Food and Nutrition Bulletin, 29(2), 123–131. PubMed
Pleis, J. R., & Lethbridge-Cejku, M. (2007). Summary health statistics for US adults: National Health Interview Survey, 2006. Vital Health Statistics, 10(235), 1–153.
Centers for Disease Control and Prevention. (2011). Obesity in K–8 students—New York City, 2006–2007 to 2010–2011 School years. MMWR Morbidity and Mortality Weekly Report, 60(49), 1673–1696.
Bartlett, S., Bobronnikov, E., Mendelson, M., et al. (2007). WIC Participant and Program Characteristics 2006, WIC-06-PC. Alexandria, VA: US Department of Agriculture, Food and Nutrition Service, Office of Analysis, Nutrition and Evaluation.
Ogden, C. L., Carroll, M. D., Kit, B. K., et al. (2012). Prevalence of obesity and trends in body mass index among US children and adolescents, 1999–2010. The journal of the American Medical Association, 307(5), 483–490. CrossRef
The Burden of Non-Communicable Disease, Stat. Board Resolution #48-01 Pacific Islands Health Officers Association, United States Affiliated Pacific Islands, 2010.
Summerbell, C. D., Waters, E., Edmunds, L. D., et al. (2005). Interventions for preventing obesity in children. The Cochrane Database of Systematic Reviews, 3, CD001871. PubMed
Arcan, C., Hannan, P. J., Fulkerson, J. A., et al. (2012). Associations of home food availability, dietary intake, screen time and physical activity with BMI in young American-Indian children. Public Health Nutrition, 1– 10.
Pabayo, R., Spence, J. C., Cutumisu, N., et al. (2012). Sociodemographic, behavioural and environmental correlates of sweetened beverage consumption among pre-school children. Public Health Nutrition, 1– 9.
de Jong, E., Visscher, T. L., Hirasing, R. A., et al. (2011). Association between TV viewing, computer use and overweight, determinants and competing activities of screen time in 4- to 13-year-old children. International Journal of Obesity (London).
Swinburn, B., Pryor, J., McCabe, M., et al. (2007). The Pacific OPIC Project (Obesity Prevention in Communities)—objectives and designs. Pacific Health Dialog, 14(2), 139–146. PubMed
Foltz, J. L., May, A. L., Belay, B., et al. (2012). Population-level intervention strategies and examples for obesity prevention in children. Annual Review of Nutrition.
Hatch, J., Moss, N., Saran, A., et al. (1993). Community research: Partnership in black communities. American Journal of Preventive Medicine, 9(6 Suppl), 27–31. PubMed
Vega, W. A. (1992). Theoretical and pragmatic implications of cultural diversity for community research. American Journal of Community Psychology, 20(3), 375–391. CrossRef
Lapping, K., Marsh, D. R., Rosenbaum, J., et al. (2002). The positive deviance approach: Challenges and opportunities for the future. Food and Nutrition Bulletin, 23(4 Suppl), 130–137. PubMed
Nigg, C., Geller, K., Adams, P., et al. (2012). Successful dissemination of Fun 5—a physical activity and nutrition program for children. Behavioral Medicine Practice Policy Research, 2, 276–285. CrossRef
Martin, M. V. (2001). The land-grant university in the twenty first century. Journal of Agricultural and Applied Economics, 33(2), 377–380.
Morrill, J. S. (1858). Speech of Hon. Justin S. Morrill on the bill granting lands for agricultural colleges delivered in the house of representatives (p. 1858). Washington, D.C.: Congressional Globe Office.
Centers for Disease Control and Prevention. (2005). Perceptions of neighborhood characteristics and leisure-time physical inactivity–Austin/Travis County, Texas, 2004. MMWR Morbidity and Mortality Weekly Report, 54(37), 926–928.
Schultz, J., Utter, J., Mathews, L., et al. (2007). The Pacific OPIC Project (obesity prevention in communities): Action plans and interventions. Pacific Health Dialog, 14(2), 147–153. PubMed
US Census Bureau. Census 2000 Gateway. (2000). http://www.census.gov/main/www/cen2000.html. Accessed 17 Dec 2012.
Ching D. Facilitative skills for collaborative leaders. Pacific Center for Collaboration 2010.
Charmaz, K. (2002). Qualitative interviewing and grounded theory analysis. In J. Gubrium & J. A. Holstein (Eds.), Handbook of interview research (pp. 675–694). Thousand Oaks, CA: Sage Publications.
Sallis, J. F., McKenzie, T. L., Alcaraz, J. E., et al. (1997). The effects of a 2-years physical education program (SPARK) on physical activity and fitness in elementary school students. Sports, Play and Active Recreation for Kids. American Journal of Public Health, 87(8), 1328–1334. PubMedCentralPubMedCrossRef
Economos, C. D., Hyatt, R. R., Goldberg, J. P., et al. (2007). A community intervention reduces BMI z-score in children: Shape Up Somerville first year results. Obesity (Silver Spring), 15(5), 1325–1336. CrossRef
Ismail, S., Immik, M., Mazar, I., et al. (2003). Community-based food and nutrition programmes: What makes them successful. A review and analysis of experience. Rome: Food and Agriculture Organization of the United Nations.
Gittelsohn, J., Vijayadeva, V., Davison, N., et al. (2010). A food store intervention trial improves caregiver psychosocial factors and children’s dietary intake in Hawaii. Obesity (Silver Spring), 18(Suppl 1), S84–S90. CrossRef
Ramirez, V., Daniggelis, E., Gittelsohn, J., et al. (2004). Healthy foods Hawaii: Report of preliminary work and intervention ideas. Honolulu, HI: University of Hawai’i, Manoa and Johns Hopkins University.
Ramirez, V., Daniggelis, E., Gittelsohn, J., et al. (2005). Healthy foods Hawaii: Summary report from North Kohala community workshop. Honolulu, HI: University of Hawai’i, Manoa and Johns Hopkins University.
Davison, N., Workman, R., Daida, Y. G., et al. (2004). Healthy living in the Pacific Islands: Results of a focus group process to identify perceptions of health and collaboration in the U.S. affiliated Pacific Islands. Journal of Extension, 42(5). http://www.joe.org/joe/2004october/rb4.php.
- A Community Engagement Process Identifies Environmental Priorities to Prevent Early Childhood Obesity: The Children’s Healthy Living (CHL) Program for Remote Underserved Populations in the US Affiliated Pacific Islands, Hawaii and Alaska
Marie Kainoa Fialkowski
Rachael Leon Guerrero
Aufa’i Apulu Ropeti Areta
the CHL Team
- Springer US