RESUMO
INTRODUCTION: Waist circumference is a common anthropometric measure for predicting abdominal obesity and insulin resistance. We developed optimal waist circumference cut points for children aged 2 to 8 years in the US-Affiliated Pacific (USAP) region based on the relationship of waist circumference and acanthosis nigricans in this population. METHODS: We conducted a cross-sectional analysis from the Children's Healthy Living Program's 2012-2013 data on 4,023 children. We used receiver-operating characteristic analysis to determine the sensitivity and specificity for acanthosis nigricans across waist circumference, by sex and age. We determined optimal waist circumference cutoff points corresponding to Youden index (J), (equal to [sensitivity + specificity] - 1), with acanthosis nigricans. We compared these cut points with the 90th percentile. RESULTS: The 90th-percentile cut points for boys aged 2 to 5 years (58.15 cm) and 6 to 8 years (71.63 cm) were slightly higher than for girls in both age groups (aged 2-5 y, 57.97 cm; 6-8 y: 70.37 cm). The optimal cut points (corresponding to the highest sensitivity and specificity) were as follows: for boys aged 2 to 5 years, 90th percentile (58.25 cm; sensitivity, 48.0%; specificity, 91.5%); for boys aged 6 to 8 years, 78th percentile (63.59 cm; sensitivity, 86.8%; specificity, 82.8%); for girls aged 2 to 5 years, 62nd percentile (53.27 cm; sensitivity, 71.4%; specificity, 63.1%), and for girls aged 6 to 8 years, 80th percentile (63.63 cm; sensitivity, 55.4%; specificity, 82.9%). CONCLUSION: Among USAP children, waist circumference was a reasonable predictor for acanthosis nigricans. Further analysis is warranted to examine causes of acanthosis nigricans at lower-than-expected waist circumference percentiles. The cut points can be used for early detection of metabolic risk.
Assuntos
Acantose Nigricans/epidemiologia , Estilo de Vida Saudável , Obesidade/epidemiologia , Circunferência da Cintura , Acantose Nigricans/diagnóstico , Índice de Massa Corporal , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Havaiano Nativo ou Outro Ilhéu do Pacífico , Circunferência da Cintura/etnologiaRESUMO
BACKGROUND: Few data are available on dual burden of under and over nutrition of children in the Pacific region. The objective was to examine prevalence of stunting at birth and current stunting and their relationship to obesity in US Affiliated Pacific (USAP) jurisdictions. METHODS: Cross sectional survey with cluster sampling by community. 5558, 2-8 years olds were measured in 51 communities in 11 USAP jurisdictions. The main outcome measures were stunting at birth, current stunting and obesity by body mass index. Prevalences of stunting at birth, current stunting and obesity were determined, adjusting for age distribution and community clustering. Differences by among age, sex, race and jurisdiction income levels were evaluated by chi-square analysis. Relationships of stunting at birth and current stunting with obesity were examined using a hierarchical model accounting for the study design. RESULTS: Prevalences were stunting at birth 6.8% (Standard Error, SE = 0.9%), current stunting 1.4% (SE = 0.2%) and obesity 14.03.8% (SE = 0.9%). Obesity was highest in upper middle income jurisdictions (UMIJ) at 17.5%. Stunting at birth differed by race (p = 0.0001) with highest prevalence among Native Hawaiian/Pacific Islanders (10.7%). Prevalence of stunting at birth was different by jurisdiction income level with 27.5% in lower middle income jurisdictions (LMIJ), and 22.2% in UMIJ, and 5.5% in higher than high income jurisdictions (HIJ) at 5.5% (p < 0.0001). Prevalence of current stunting was higher in LMIJ than HIJ (p = 0.001), although children with current stunting were less likely to have been stunted at birth. The association between stunting at birth and current stunting was negative (OR = 0.19, 95% CI: 0.05-0.69). CONCLUSIONS: Currently stunted children were marginally less likely to be obese than not stunted children in the USAP, where the prevalence of current stunting is low. Stunting (at birth and current) was highest in LMIJ, while UMIJ jurisdictions had the highest dual burden of malnutrition (that is the highest combination of both stunting at birth and obesity). TRIAL REGISTRATION: National Institutes for Health clinical trial # NCT01881373 (clinicaltrials.gov).
Assuntos
Transtornos do Crescimento/epidemiologia , Estado Nutricional , Obesidade/epidemiologia , Fatores Etários , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Ilhas do Pacífico/epidemiologia , Prevalência , Fatores Sexuais , Fatores SocioeconômicosRESUMO
We estimated overweight and obesity (OWOB) prevalence of children in US-Affiliated Pacific jurisdictions (USAP) of the Children's Healthy Living Program compared with the contiguous United States. We searched peer-reviewed literature and government reports (January 2001-April 2014) for OWOB prevalence of children aged 2 to 8 years in the USAP and found 24 sources. We used 3 articles from National Health and Nutrition Examination Surveys for comparison. Mixed models regressed OWOB prevalence on an age polynomial to compare trends (n = 246 data points). In the USAP, OWOB prevalence estimates increased with age, from 21% at age 2 years to 39% at age 8 years, increasing markedly at age 5 years; the proportion obese increased from 10% at age 2 years to 23% at age 8 years. The highest prevalence was in American Samoa and Guam.
RESUMO
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.
Assuntos
Educação em Saúde/métodos , Promoção da Saúde/métodos , Obesidade Infantil/prevenção & controle , Desenvolvimento de Programas , Meio Social , Adolescente , Alaska , Criança , Pré-Escolar , Pesquisa Participativa Baseada na Comunidade , Família , Feminino , Havaí , Humanos , Masculino , Grupos Minoritários , Ilhas do Pacífico , Pais , Características de Residência , Populações VulneráveisRESUMO
INTRODUCTION: Fruit and vegetable consumption may reduce risk for chronic disease and obesity. Children's fruit and vegetable intake is mediated by a preference or willingness to try them. This study's primary objective was to adapt the previously validated WillTry tool and to evaluate the adapted version among children in Guam. METHODS: Adaptations to the WillTry tool included both novel fruits and vegetables unique to Guam and common ones. Children aged 3 to 11 years who attended 2 community-based summer day camps in 2013 were shown images matching 14 food questions in an initial interview and in a second interview conducted 3 to 72 hours later. Responses were "no," "maybe," or "yes" and were coded as 1, 2, or 3, respectively. A higher score indicated more willingness to try fruits and vegetables. Factor analyses determined components of willingness. Psychometric properties and reliability were analyzed. RESULTS: Sixty-five children completed the first interview, and 64 completed the second. Factor analyses revealed 3 components (scales):1) local novel (guava, breadfruit, eggplant, sweet sop, star apple, taro leaves), 2) local common (carrot, papaya, long beans, salad greens), and 3) imported (apple, canned peaches, canned corn). All but the imported scale had sufficient internal consistency (Cronbach's α > 0.69). Each scale had substantial reliability (ICC > 0.76). We found no significant differences by age, sex, or type of camp for any scale. Mean scores were 2.1 (local novel), 2.4 (local common), and 2.7 (imported), and all were significantly different. CONCLUSION: The adapted WillTry was culturally relevant and had psychometric properties similar to those of the original. An unexpected finding was the tool's potential for documenting the nutrition transition.
Assuntos
Doença Crônica/prevenção & controle , Preferências Alimentares/psicologia , Psicometria/métodos , Criança , Fenômenos Fisiológicos da Nutrição Infantil , Pré-Escolar , Dieta , Análise Fatorial , Feminino , Frutas , Guam , Promoção da Saúde , Humanos , Masculino , Obesidade Infantil/prevenção & controle , Psicometria/normas , Reprodutibilidade dos Testes , Inquéritos e Questionários , VerdurasRESUMO
Colorectal cancer (CRC) ranks among the three most common cancers in Guam (GU), Hawai'i (HI), and the mainland United States (US). CRC prevalence in these areas is high among Filipinos, and indigenous CHamorus and Native Hawaiians; however, data on these populations are frequently aggregated in epidemiological studies, which can mask true CRC disparities. We examined CRC cumulative incidence rates (CIRs) among CHamorus in GU, Filipinos in GU, HI, and the US, and Native Hawaiians in HI and the US. CRC CIRs were calculated for two age groups (20-49 years; early onset, and 50-79 years; senior) and four time periods (2000-2004, 2005-2009, 2010-2014, and 2015-2019), stratified by ethnicity, sex, and location. Data analyzed included all invasive CRC cases reported to the Surveillance, Epidemiology, and End Results 9-Registry (n = 166,666), the Hawai'i Tumor Registry (n = 10,760), and the Guam Cancer Registry (n = 698) between 2000 and 2019. Senior CIRs were highest in HI and lowest in GU throughout all time periods, with a downward trend observed for senior CIRs in the US and HI, but not GU. This downward trend held true for all ethnic groups, except for CHamorus in GU, females in GU, and females of CHamoru ethnicity in GU. In contrast, early onset CIRs increased across all locations, sexes, and ethnic groups, except for Filipinos in HI and males of Filipino ethnicity in HI. Our findings provide crucial insights for future research and policy development aimed at reducing the burden of CRC among indigenous populations.
Assuntos
Neoplasias Colorretais , Havaiano Nativo ou Outro Ilhéu do Pacífico , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Neoplasias Colorretais/epidemiologia , Guam/epidemiologia , Havaí/epidemiologia , Incidência , Estados Unidos/epidemiologia , IdosoRESUMO
BACKGROUND: Although surveillance data are limited in the US Affiliated Pacific, Alaska, and Hawaii, existing data suggest that the prevalence of childhood obesity is similar to or in excess of other minority groups in the contiguous US. Strategies for addressing the childhood obesity epidemic in the region support the use of community-based, environmentally targeted interventions. The Children's Healthy Living Program is a partnership formed across institutions in the US Affiliated Pacific, Alaska, and Hawaii to design a community randomized environmental intervention trial and a prevalence survey to address childhood obesity in the region through affecting the food and physical activity environment. METHODS/DESIGN: The Children's Healthy Living Program community randomized trial is an environmental intervention trial in four matched-pair communities in American Samoa, the Commonwealth of the Northern Mariana Islands, Guam, and Hawaii and two matched-pair communities in Alaska. A cross-sectional sample of children (goal n = 180) in each of the intervention trial communities is being assessed for outcomes at baseline and at 24 months (18 months post-intervention). In addition to the collection of the participant-based measures of anthropometry, diet, physical activity, sleep and acanthosis nigricans, community assessments are also being conducted in intervention trial communities. The Freely Associated States of Micronesia (Federated States of Micronesia, and Republics of Marshall Islands and Palau) is only conducting elements of the Children's Healthy Living Program sampling framework and similar measurements to provide prevalence data. In addition, anthropometry information will be collected for two additional communities in each of the 5 intervention jurisdictions to be included in the prevalence survey. The effectiveness of the environmental intervention trial is being assessed based on the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework. DISCUSSION: The Children's Healthy Living Program environmental trial is designed to focus on capacity building and to maximize the likelihood of sustainable impact on childhood obesity-related behaviors and outcomes. The multiple measures at the individual, community, and environment levels are designed to maximize the likelihood of detecting change. This approach enhances the likelihood for identifying and promoting the best methods to promote health and well-being of the children in the underserved US Affiliated Pacific Region. TRIAL REGISTRATION: NIH clinical trial # NCT01881373.
Assuntos
Promoção da Saúde/organização & administração , Grupos Minoritários , Obesidade Infantil/prevenção & controle , Populações Vulneráveis , Alaska/epidemiologia , Fortalecimento Institucional , Criança , Pré-Escolar , Estudos Transversais , Humanos , Micronésia/epidemiologia , Obesidade Infantil/etnologia , Prevalência , Projetos de PesquisaRESUMO
Breast cancer disproportionately impacts Native Hawaiian, CHamoru, and Filipino women. Few culturally informed interventions addressing breast cancer survivors exist and none have been developed or tested specifically for Native Hawaiian, CHamoru, and Filipino women. This study aimed to conduct focus groups with Native Hawaiian, CHamoru, and Filipino women previously diagnosed with breast cancer to inform future research in Guam and Hawai'i. Convenience sampling and grounded theory approaches were used. Focus group sessions were conducted during summer 2023 and included questions to understand the barriers, motivators, and implementation recommendations for lifestyle interventions aimed at reducing the risk for breast cancer recurrence among the target population. Data saturation was reached after a total of seven focus groups (an average of four survivors/group per site) were conducted (three in Hawai'i and four in Guam), which represented 28 breast cancer survivors. Themes from the focus groups emerged around developing support systems with other survivors, providing physical activity and nutrition intervention activities and materials in multiple formats, and incorporating activities and foods that accommodate the side effects of breast cancer treatments and are culturally relevant. The average desired intervention length was eight weeks. These findings will inform the development and feasibility testing of a culturally informed lifestyle intervention for breast cancer survivors in Guam and Hawai'i.
Assuntos
Neoplasias da Mama , Sobreviventes de Câncer , Havaiano Nativo ou Outro Ilhéu do Pacífico , Feminino , Humanos , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Grupos Focais , Havaí/epidemiologia , Estilo de Vida , Recidiva Local de Neoplasia , Sobreviventes , Promoção da Saúde , Assistência à Saúde Culturalmente Competente , Comportamentos Relacionados com a Saúde , Estilo de Vida SaudávelRESUMO
Pacific Islanders residing in the U.S. Affiliated Pacific Islands have had among the highest COVID-19-associated morbidity and mortality rates in the U.S. To reduce this disparity, we conducted a study to increase the reach and uptake of COVID-19 testing in Guam. Participants, who completed a pre-survey on demographics, health status, history of COVID-19 testing and vaccination, access to COVID-19 testing, sources of COVID-19 information, and knowledge and attitudes towards COVID-19 test results and transmission, were invited to attend an online educational session about COVID-19 testing and transmission and to complete a post-survey. There were significant positive changes between pre- and post-survey in knowledge and perceptions about COVID-19 testing and transmission, but changes were not necessarily due to exposure to the educational session. Compared to CHamoru participants (n = 380), Other Micronesians (n = 90) were significantly less knowledgeable about COVID-19 transmission and testing, were significantly more likely to not want to know if they had COVID-19, were more likely to believe if they did have COVID-19 there was not much that could be done for them, and that they would have difficulty in getting the needed healthcare. This study is another example of disparities in health knowledge and perceptions of certain Pacific Islander groups.
Assuntos
COVID-19 , População das Ilhas do Pacífico , Humanos , COVID-19/diagnóstico , COVID-19/epidemiologia , Teste para COVID-19 , GuamRESUMO
OBJECTIVES: To develop a breast cancer risk prediction model for Chamorro and Filipino women of the Mariana Islands and compare its performance to that of the Breast Cancer Risk Assessment Tool (BCRAT). DESIGN: Case-control study. SETTING: Clinics/facilities and other community-based settings on Guam and Saipan (Northern Mariana Islands). PARTICIPANTS: 245 women (87 breast cancer cases and 158 controls) of Chamorro or Filipino ethnicity, age 25-80 years, with no prior history of cancer (other than skin cancer), residing on Guam or Saipan for at least 5 years. PRIMARY AND SECONDARY OUTCOME MEASURES: Breast cancer risk models were constructed using combinations of exposures previously identified to affect breast cancer risk in this population, population breast cancer incidence rates and all-cause mortality rates for Guam. RESULTS: Models using ethnic-specific relative risks performed better than those with relative risks estimated from all women. The model with the best performance among both ethnicities (the Breast Cancer Risk Model (BRISK) model; area under the receiver operating characteristic curve (AUC): 0.64 and 0.67 among Chamorros and Filipinos, respectively) included age at menarche, age at first live birth, number of relatives with breast cancer and waist circumference. The 10-year breast cancer risk predicted by the BRISK model was 1.28% for Chamorros and 0.89% for Filipinos. Performance of the BCRAT was modest among both Chamorros (AUC: 0.60) and Filipinos (AUC: 0.55), possibly due to incomplete information on BCRAT risk factors. CONCLUSIONS: The ability to develop breast cancer risk models for Mariana Islands women is constrained by the small population size and limited availability of health services and data. Nonetheless, we have demonstrated that breast cancer risk prediction models with adequate discriminatory performance can be built for small populations such as in the Mariana Islands. Anthropometry, in particular waist circumference, was important for estimating breast cancer risk in this population.
Assuntos
Neoplasias da Mama , Feminino , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Risco , Neoplasias da Mama/epidemiologia , Estudos de Casos e Controles , Estudos Retrospectivos , Micronésia/epidemiologia , Fatores de Risco , Medição de RiscoRESUMO
Early childhood interventions have the potential to promote long-term healthy eating and physical activity habits to prevent obesity. However, research studies including indigenous young children are lacking. This study examined the effectiveness of the Food Friends®: Fun with New Foods™ and Get Movin' with Mighty Moves™ (FFMM) curricula on willingness to try fruits and vegetables (FV) and gross motor (GM) skills among preschoolers in Guam. A pre-post community-based study included preschoolers from Head Start (HS), gifted and talented education (Pre-GATE), and Pre-Kindergarten programs during school years (SY) 2017-2018 and 2018-2019. In SY2017-2018, the intervention group had a significant increase in imported FV when compared with the other three groups. No significant differences between groups were found on the other FV scales. Regarding gross motor skills, no significant differences between groups were found. In SY2018-2019, the intervention group had a significant increase in all FV scales except imported FV when compared with the enhanced intervention group. With gross motor skills, no significant differences were found between groups on its progress. These results warrant FFMM adaptations for the prevention of obesity among Guam preschoolers.
Assuntos
Dieta/normas , Frutas , Destreza Motora , Verduras , Desenvolvimento Infantil , Pré-Escolar , Feminino , Guam , Humanos , Masculino , Estado NutricionalRESUMO
The Pacific Tracker (PacTrac) is a web-based diet and physical activity assessment program created to analyze dietary recall or dietary record data from the Pacific region. Version 3.1 modifications make the tool available for public use (under check it out) to enter, analyze, view and print out data; and for research use, for saving and downloading of multiple entries in a research mode. PacTrac 3.1 (https://nappactrac31.ctahr.hawaii.edu/default.htm) is managed through the Children's Healthy Living Center of Excellence (CHL Center) at the College of Tropical Agriculture and Human Resources at the University of Hawai'i, in collaboration with the University of Hawai'i Cancer Center.
Assuntos
Dieta , Neoplasias , Criança , Exercício Físico , Humanos , UniversidadesRESUMO
Increased community collective efficacy (CE), defined as social cohesion among neighbors and their willingness to intervene for common good, is associated with improved community health outcomes. However, processes to increase CE and estimate its dose within an intervention are not well understood. The 2 year Children's Healthy Living (CHL) intervention aimed to improve child behaviors known to affect obesity. We used data from CHL to estimate CE dose and examine its association with a successful outcome from CHL-reduction in children's recreational screen time. Monthly reports from nine intervention communities were quantified, and CE dose was calculated for each community overall, at 4 time intervals (6, 12, 18, and 24 months), and for each CE building block-social bonding, social bridging, social leveraging, empowerment, and civic engagement. CE dose at each time interval and change in screen time was correlated using Spearman's rho. Next, communities were categorized as having a high CE dose or a low CE dose, and differences between four high-dose and five low-dose communities were compared using a two-tailed t-test. The correlation between change in screen time and CE dose was significant (rs = 0.83, p = .003). Significantly more activities facilitating empowerment and civic engagement were conducted in high-dose communities, which were more likely to show improvements in screen time, than in low-dose communities. This method of estimating an intervention's CE dose and examining change over time and effect of CE and its building blocks on intervention outcomes shows promise.
Assuntos
Obesidade , Projetos de Pesquisa , Criança , Estilo de Vida Saudável , HumanosRESUMO
Breast cancer is the second leading cause of cancer-related death among women on Guam and Hawai'i. Breast cancer incidence rates are described here for the multiethnic population in Guam, a United States (US) Pacific island territory, and compared to Hawai'i and other US populations, to understand the risk by age and race/ethnic group in this understudied group. The study included all breast cancer cases (n=576) reported to the Guam Cancer Registry, all breast cancer cases (n=8345) reported to the Hawai'i Tumor Registry and all breast cancer cases (n=678,637) reported to the Surveillance, Epidemiology, and End Results program from 2000 to 2009. Cumulative incidence rates by age were calculated for two time periods: 2000-2004 and 2005-2009. Differences were seen in cumulative incidence rates by age, ethnicity, and place of residence. Cumulative incidence rates by age 40 were the highest (0.7%) among Filipinos in Guam but, after age 40, the rates for Chamorros (indigenous Pacific Islanders of Guam) increased rapidly. The lifetime cumulative incidence rates were the highest for Chamorros in Guam (15.3%), close to the US rate (15.5%). Results were similar for 2005-2009. Women in Guam are at high risk for breast cancer, with the indigenous Chamorros having the highest risk, and the most prevalent Asian group of Filipinos, having a younger age at diagnosis. These patterns are similar to the comparable Pacific Islander and Filipino populations in Hawai'i and the US generally.
Assuntos
Asiático/estatística & dados numéricos , Neoplasias da Mama/etnologia , Adulto , Idoso , Neoplasias da Mama/epidemiologia , Feminino , Guam/epidemiologia , Guam/etnologia , Humanos , Incidência , Pessoa de Meia-Idade , Havaiano Nativo ou Outro Ilhéu do Pacífico/etnologia , Havaiano Nativo ou Outro Ilhéu do Pacífico/estatística & dados numéricosRESUMO
Sociocultural, geographic, and biologic factors contribute to cancer health disparities (CHDs) in indigenous Pacific peoples (IPPs) in Guam, Hawai'i, and the US Associated Pacific Islands (USAPI). IPPs experience a greater burden of CHDs that are associated with late-stage diagnosis and poor survival outcomes compared with majority populations in the United States. A 16-year partnership between the University of Guam (UOG) and University of Hawai'i Cancer Center (UHCC) aims to advance health equity in Guam, Hawai'i, and the USAPI through cancer research, training, and outreach. Investigators at collaborating institutions study issues of regional and cultural relevance in IPPs, including breast, cervical, liver, and oral cancers and use of tobacco and betel nuts (Areca nuts). Junior faculty with IPP ancestry or those who are focused on CHDs in IPPs receive mentorship and career development opportunities, academic fellowships are provided for graduate students, and Pacific Island communities are engaged through a participatory development process. The partnership has generated more than 90 peer-reviewed publications, more than 100 abstracts, and 11 grant awards. Thirty graduate scholars from under-represented minorities have been trained, including two who are now UOG faculty and are conducting independent research, contributing to the partnership, and mentoring scientists of tomorrow. Participatory community engagement has contributed to the passage of significant cancer prevention and control legislation in Hawai'i, Guam, and Saipan. Research capacity at UOG has increased significantly, and research at UHCC has expanded to address issues unique to IPPs. Graduate students from under-represented minorities are pursuing careers in cancer research. A regional research infrastructure has been established to support team science, and research findings are informing public health policy and planning.
Assuntos
Fortalecimento Institucional , Neoplasias Bucais , Guam , Havaí/epidemiologia , Humanos , Ilhas do Pacífico/epidemiologia , Estados Unidos/epidemiologiaRESUMO
This study is part of the Children's Healthy Living program in U.S. Affiliated Pacific region. The objectives were to estimate overweight and obesity (OWOB) prevalence and identify possible related risk factors among ethnic groups in Guam. In 2013, 865 children (2-8 years) were recruited via community-based sampling from select communities in Guam. Children's demographic and health behavior information; dietary intake; and anthropometric measurements were collected. Logistic regression, odds ratio, t-tests, and chi-square tests were used to determine differences and assess covariates of OWOB. The results indicate that 58% of children were living below the poverty level, 80% were receiving food assistance, and 51% experienced food insecurity. The majority of children surveyed did not meet recommendations for: sleep duration (59.6%), sedentary screen-time (83.11%), or fruit (58.7%) and vegetable (99.1%) intake, and consumed sugar sweetened beverages (SSB) (73.7%). OWOB affected 27.4% of children. Children affected by OWOB in this study were statistically more likely (p = 0.042) to suffer from sleep disturbances (p = 0.042) and consume marginally higher amounts (p value = 0.07) of SSB compared to children with healthy weight. Among Other Micronesians, children from families who considered themselves 'integrated' into the culture were 2.05 (CI 0.81-5.20) times more likely to be affected by OWOB. In conclusion, the OWOB prevalence among 2-8-year-olds in Guam was 27.4%; and compared with healthy weight children, children with OWOB were more likely to have educated caregivers and consume more SSBs. Results provide a basis for health promotion and obesity prevention guidance for children in Guam.
Assuntos
Ingestão de Alimentos/fisiologia , Comportamento Alimentar/fisiologia , Inquéritos Epidemiológicos , Estilo de Vida , Obesidade Infantil/epidemiologia , Obesidade Infantil/etiologia , Constituição Corporal , Criança , Pré-Escolar , Dissonias/epidemiologia , Dissonias/etiologia , Escolaridade , Assistência Alimentar , Insegurança Alimentar , Guam/epidemiologia , Comportamentos Relacionados com a Saúde , Humanos , Obesidade Infantil/etnologia , Obesidade Infantil/psicologia , Pobreza , Prevalência , Fatores de Risco , Comportamento Sedentário , Bebidas Adoçadas com Açúcar/efeitos adversosRESUMO
In an effort to characterize food costs in the United States (US)-affiliated Pacific Region, a first-time food cost survey was conducted in March 2014. A market basket survey was developed using an adaptation of the US Department of Agriculture Thrifty Food Plan. Surveys were conducted in the states of Alaska and Hawai'i; Portland, Oregon; the US-affiliated Pacific Islands of American Samoa (American Samoa); Commonwealth of the Northern Mariana Islands; the island of Pohnpei within the Federated States of Micronesia; Guam; Republic of the Marshall Islands; and Republic of Palau. Urban and rural communities were included. Multiple stores in multiple communities were surveyed in each jurisdiction. Food retailers (N = 74) ranged from convenience markets to supermarkets. Not all foods in the market basket survey were available in each of the communities. Inspection of available income data also showed that food costs represented a higher percentage of household income for American Samoa than those of Alaska, Hawai'i, and Portland. Thrifty Food Plan weighted weekly totals for the region ranged from $181.90 to $264.30. Weighting was based on the amount of the item converted to grams required for the Thrifty Food Plan menu. These food costs are significantly higher than those of Portland ($142.00) for the survey period. Protein foods, grains, vegetables, fruit, and dairy were the 5 most costly components, in descending order. Food affordability was assessed by comparing food costs across jurisdictions and examining estimated food costs to reported average jurisdiction incomes. The survey is intended to help inform public health policy and educational programs in the region. A locally adapted food survey would benefit future analyses, regional policy, and educational efforts.
Assuntos
Assistência Alimentar/economia , Alimentos/economia , Promoção da Saúde/organização & administração , Custos e Análise de Custo/métodos , Alimentos/estatística & dados numéricos , Assistência Alimentar/estatística & dados numéricos , Promoção da Saúde/métodos , Promoção da Saúde/estatística & dados numéricos , Humanos , Obesidade/dietoterapia , Obesidade/epidemiologia , Obesidade/prevenção & controle , Ilhas do PacíficoRESUMO
This pilot study examined the influence of cultural immersion on willingness to try fruits and vegetables (FV) among children 3-12 years old in three summer camps in Guam with different cultural exposure levels: cultural immersion camp (CIC), high exposure; university day camp (UDC), moderate exposure; and recreational sports camp (RSC), zero exposure. Children, ages 3-12 years old for CIC and UDC and 5-12 years old for RSC, participated: CIC (n = 47), UDC (n = 23), and RSC (n = 33). Children's willingness to try FV was assessed with the Adapted WillTry tool before and after each program. Whole FV intakes were assessed concurrently using the mobile food record in CIC and UDC. Using multivariate regression, WillTry post-assessment outcomes were modeled adjusting for pre-assessment, child characteristics, exposure, and parent cultural affiliation. Unique to the Adapted WillTry tool are three FV scales, local novel, local common, and imported, which are classified by source (local or imported) and/or familiarity (novel or common). WillTry adjusted mean FV post-scores by highest exposure camp to lowest were 2.2, 2.3, and 2.2 for local novel and 2.6, 2.6, and 2.6 for local common. No differences among camps were significant; however, there was an increase in the willingness to try scores for all FV score types and camps. The Traditions pilot study demonstrated: (1) feasibility of a multi-arm parallel design using existing community programs in limited-resource environments and (2) further examination of nutrition education components and contexts are needed to understand diet behaviors of indigenous populations.
Assuntos
Dieta/etnologia , Preferências Alimentares/etnologia , Frutas , Promoção da Saúde/métodos , Verduras , Criança , Pré-Escolar , Feminino , Guam/etnologia , Humanos , Masculino , Projetos PilotoRESUMO
Importance: Pacific Islanders have among the highest rates of obesity and type 2 diabetes in the world. Targeting children is critical for primary prevention. Objectives: To prevent young child overweight and obesity and to improve health in the US-Affiliated Pacific region via the Children's Healthy Living Program. Design, Setting, and Participants: In this multijurisdictional, multilevel, multicomponent community randomized clinical trial, where all evaluable children were analyzed according to the random assignment of their community, hierarchical difference-in-difference models accounted for the community randomization, community clustering with jurisdictions, and these models were adjusted for the age and sex distribution of the community. The setting was 27 communities in 5 jurisdictions (Alaska, American Samoa, Commonwealth of the Northern Mariana Islands, Guam, and Hawaii). Participants were 4329 children (time 1) and 4042 children (time 2) aged 2 to 8 years in 27 selected communities from October 7, 2012, to October 25, 2015. Data analysis was completed in June 2018. Interventions: Nineteen activities addressed policy, environment, messaging, training, and 6 target behaviors (sleep time, screen time, physical activity, fruits and vegetables, water, and sugar-sweetened beverages). Main Outcomes and Measures: Primary outcomes were body size measurements. Secondary outcomes were acanthosis nigricans, sleep quality and duration, dietary intake, physical activity, and other questionnaire reponses. Results: The study included 27 communities and 8371 evaluable children (mean [SD] age, 5.4 [1.8] years; 50.9% male [n = 4264]). Data analysis included 952 children in the intervention group and 930 children in the control group aged 2 to 5 years at time 1; 825 children in the intervention group and 735 children in the control group aged 2 to 5 years at time 2; 565 children in the intervention group and 561 children in the control group aged 6 to 8 years at time 1; and 517 children in the intervention group and 560 children in the control group aged 6 to 8 years at time 2. The intervention communities showed significant improvement compared with control communities in overweight and obesity prevalence (effect size [d] = -3.95%; 95% CI, -7.47% to -0.43%), waist circumference (d = -0.71 cm; 95% CI, -1.37 to -0.05 cm), and acanthosis nigricans prevalence (d = -2.28%; 95% CI, -2.77% to -1.57%). Age and sex subgroup analysis revealed greater difference among the intervention communities in acanthosis nigricans prevalence in the group aged 2 to 5 years (-3.99%) vs the group aged 6 to 8 years (-3.40%), and the interaction was significant (d = 0.59%, P < .001), as well as the smaller difference in the group aged 2 to 5 years (-0.10%) vs the group aged 6 to 8 years (-1.07%) in screen time (d = -0.97 hour per day, P = .01). Conclusions and Relevance: The intervention reduced the prevalence of young child overweight and obesity and acanthosis nigricans. Comprehensive, effective, and sustainable interventions are needed to improve child health in the US-Affiliated Pacific region. Trial Registration: ClinicalTrials.gov Identifier: NCT01881373.
Assuntos
Acantose Nigricans/epidemiologia , Programas Gente Saudável , Sobrepeso/epidemiologia , Obesidade Infantil/epidemiologia , Alaska/epidemiologia , Samoa Americana/epidemiologia , Criança , Pré-Escolar , Feminino , Guam/epidemiologia , Havaí/epidemiologia , Humanos , Masculino , PrevalênciaRESUMO
This cross-sectional study examined the: (1) association between food store environment (FSE), fruit and vegetable (FV) availability and access, and prevalence of early childhood overweight/obesity (COWOB); and (2) influence of young child actual FV intake on the relationship between the FSE and early COWOB prevalence. Anthropometric and socio-demographic data of children (2 to 8 years; N=466) in baseline communities on Guam participating in the Children's Healthy Living (CHL) Program community trial were included. CDC year 2000 growth charts were used to calculate BMI z-scores and categories. FSE factors (fresh FV scores, store type) were assessed using the CX3 Food Availability and Marketing Survey amended for CHL. ArcGIS maps were constructed with geographic coordinates of participant residences and food stores to calculate food store scores within 1 mile of participant's residences. A sub-sample of participants (n = 355) had Food and Activity Log data to calculate FV and energy intakes. Bivariate correlations and logistic regression evaluated associations. Of 111 stores surveyed, 73% were small markets, 16% were convenience stores, and 11% were large grocery/supermarkets. Supermarkets/large grocery stores averaged the highest FV scores. Most participants did not meet FV intake recommendations while nearly half exceeded energy intake recommendations. Living near a small market was negatively correlated with BMI z-score (r = - 0.129, P < .05) while living near a convenience store was positively correlated with BMI z-score (r = 0.092, P < .05). Logistic regression analysis yielded non-significant associations. The high density of small markets may be an opportunity for FSE intervention but further investigation of Guam's FSE influence on health is needed.