Development and implementation of a food system intervention to prevent childhood obesity in rural Hawai'i.

This paper presents details the Healthy Foods Hawai'i (HFH) intervention trial, aimed to improve children's dietary behavior to prevent child obesity, by modifying the food environment with community-selected foods. Four communities were selected by ethnic composition, income level, two on O'ahu and one neighbor island. On each island one community was randomly assigned to intervention and one to control. The intervention was implemented through food stores in the intervention communities. HFH was designed to strengthen the network between local food producers, food distributors, storeowners and consumers, to increase the availability of healthier less energy dense foods for children in underserved rural communities of Hawai'i. The intervention includes phases: healthier beverages, snacks, condiments, and family meals. Moderate to high fidelity was achieved for educational materials (shelf labels, posters and educational displays). The number of educational displays varied by intervention phase and community. Posters were found in place 100% of the time. Shelf labels were found intact in the correct location. Low to moderate fidelity was achieved for distributors, with some products not stocked. In the intervention communities, 6-8 week phases focused on target foods with 40 food demonstrations. A total of 1582 food related samples were distributed. A high to moderate dose and reach of the overall intervention was achieved in delivery of the cooking demonstrations. A high to moderate dose and reach of the intervention was achieved overall; fidelity to the intervention protocol was moderate. To improve healthy local food availability in stores in rural communities in Hawai'i, agricultural producers reported needing additional support to sell and transport product to local stores, rather than to centralized distributors.

Nutritional characteristics and body mass index of children in the Commonwealth of the Northern Mariana Islands.

Children in the Commonwealth of the Northern Mariana Islands have been shown to have nutrient deficiencies, but data were estimated from a non-population-based sample. The current study is a cross-sectional assessment of 420 Commonwealth of the Northern Mariana Islands children, 6 months to 10 years old. Diet, height, and weight were measured. Dietary intake was collected with a 24-hour dietary recall and analyzed using the Pacific Tracker dietary assessment tool. Prevalence of dietary nutrient adequacy was estimated by the Estimated Average Requirement cut-point method. Fiber intake was one-third Adequate Intake (AI) and sodium intake was above the Tolerable Upper Intake Level for all ages. Calcium intake was half the AI for 4 to 8 years old, and less than half the AI for 9 to 10 years old. Meat/meat alternatives were double the recommendation, while all other food groups were below the recommendation for all ages. Prevalence of dietary nutrient adequacy for vitamin A, vitamin C, vitamin E, folate, magnesium, and phosphorus was lowest among 9- to 10-year-olds. Based on body mass index-for-age percentiles, 45% of 7- to 10-year-olds, 26% of 4- to 6-year-olds, and 25% of 2- to 3-year-olds were overweight or obese. Increasing whole grain, fruit, vegetable, and dairy intakes; reducing meat intakes and high-calorie foods and drinks; and increasing physical activity could improve nutrient intakes and body mass index status in this population.

Breastfeeding is associated with lower body mass index among children of the Commonwealth of the Northern Mariana Islands.

OBJECTIVE: To describe the prevalence of breastfeeding and overweight in the Commonwealth of the Northern Mariana Islands (CNMI), and the relationship between the two. DESIGN AND METHODS: A random cluster survey of 420 children (aged 6 months to 10 years), was conducted in the CNMI in June and July of 2005. Children were measured for weight and height and caregivers were asked about past feeding habits by trained investigators. RESULTS: Seventy-three percent of children were ever breastfed; 53% were still breastfed at 6 months, and 22% at 1 year of age. Five percent of children were found to be underweight (<5th percentile), while 15% were at risk for overweight (85th to <95th percentile) and 19% were overweight (>95th percentile), according to the Centers for Disease Control and Prevention body mass index for age reference data. Children who had been breastfed had a substantially lower body mass index than children who had not breastfed, after adjusting for age, sex, birthweight, and years of mother's education. DISCUSSION: These findings will be used to guide program development in the CNMI.

A food store intervention trial improves caregiver psychosocial factors and children's dietary intake in Hawaii.

Diet-related chronic diseases are at epidemic levels in low-income ethnic minority populations. The purpose of this study is to decrease risk for obesity in children by modifying the food environment and conducting point-of-purchase promotions that will lead to changes in psychosocial factors and behaviors associated with healthier food choices among low-income communities with a preponderance of Native Hawaiians and Pacific Islanders. We implemented an intervention trial over a 9-11-month period in five food stores in two low-income multiethnic communities in Hawaii, targeting both children and their adult caregivers. The Healthy Foods Hawaii (HFH) intervention consisted of an environmental component to increase store stocking of nutritious foods, point-of-purchase promotions, interactive sessions, and involved local producers and distributors. We evaluated the impact of the program on 116 child-caregiver dyads, sampled from two intervention and two comparison areas before and after intervention implementation. Program impacts were evaluated using multivariable linear regression. The HFH program had a significant impact on caregiver knowledge and the perception that healthy foods are convenient. Intervention children significantly increased their Healthy Eating Index (HEI) score for servings of grains, their total consumption of water, and showed an average 8.5 point (out of 90 total, eliminating the 10 points for variety, giving a 9.4% increase) increase in overall HEI score. A food store intervention was effective in improving healthy food knowledge and perception that healthy foods are convenient among caregivers, and increased the consumption of several targeted healthy foods by their children. Greater intensity, sustained food system change, and further targeting for children are needed to show greater and sustained change in food-related behaviors in low-income Native Hawaiian and Pacific Islander communities.

A comparison of two systems for entering and assessing dietary data for a research study.

To reduce the cost of analyzing dietary data for research studies, we evaluated the accuracy of an entry and assessment system that could be used by trained food and nutrition professionals who did not routinely perform this type of task. We compared intakes from 24-hour recalls for 175 adult women and 185 schoolchildren using two methods for entry of dietary data. For the standard method, registered dietitians who routinely evaluate dietary data entered the recalls using a professional data entry program, RapidCalc. For the second method, other food and nutrition professionals were trained by the registered dietitians to use the Pacific Tracker program, a consumer-friendly dietary assessment system. Both programs use the same food composition table. Mean food group and nutrient intakes were similar for the two methods, differing by <10% on average for both adults and children. Correlations were also high, ranging from 0.77 to 0.96 for the women and from 0.76 to 0.94 for the children. For adults and children combined, mean energy intakes were remarkably close, at 2,067 kcal/d for RapidCalc and 2,072 kcal/d for Pacific Tracker, although absolute differences in energy intakes were >300 kcal/d for 23% of the women and 30% of the children. Costs are much lower with the Pacific Tracker method, unless the fees for the standard method are subsidized. We conclude that the Pacific Tracker method provides an accurate and cost-effective method of dietary data entry for research purposes.

The Pacific Tracker (PacTrac): Development of a dietary assessment instrument for the Pacific.

The Pacific Tracker (PacTrac) is a new dietary assessment program that can be used to evaluate dietary data for nutrition studies in the Pacific Islands. PacTrac is a modification of the Interactive Healthy Eating Index (IHEI) developed by the US Department of Agriculture's Center for Nutrition Policy and Promotion as an online interactive dietary assessment tool for use by the public. Creation of PacTrac required several modifications to the IHEI, including a function to save data to allow for later access and addition of Pacific Island foods. Sources for Pacific Island foods included the Cancer Research Center of Hawaii (CRCH) Food Composition Table (FCT) and recipes from Guam and the Commonwealth of the Northern Mariana Islands (CNMI). Initially, 344 foods in the CRCH FCT were added to the IHEI. Feedback from pilot sessions indicated it was too large and therefore difficult to navigate. Therefore, we removed the original IHEI database (over 7000 foods) and replaced it with the CRCH FCT (2778 foods) plus 85 recipes from Guam and 40 recipes from CNMI. We are currently using PacTrac to evaluate dietary data in Hawaii, Guam and CNMI.