Abstract
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.
Highlights
Childhood obesity prevalence and its associated health complications have become a major national and global public health issue
In this paper we focus on the community meetings (CM) and community feedback meetings (CFM), the goals of which were to (a) identify each Children’s Healthy Living (CHL) community’s assets and needs relating to healthy eating and active living, and (b) prioritize environmental intervention strategies relating to healthy eating and active living in order to inform intervention development
Since recommendations have been made in the literature [57] to encourage the publishing of formative research on program development, and because the US Affiliated Pacific Islands (USAPI)/HI/AK populations are underrepresented in the literature, a major objective of this paper was to provide to the wider scientific audience the CHL community engagement process (CEP) used in the underserved and minority populations of the USAPI/HI/AK
Summary
Childhood obesity prevalence and its associated health complications have become a major national and global public health issue. A state of emergency has been declared in the US Affiliated Pacific Islands (USAPI) due to the high prevalence of chronic health conditions in both adults and children in these island communities [24]. I.e., the cumulative living conditions surrounding a child, is associated with childhood obesity [27,28,29,30], interventions for young children that use sustainable, multi-strategy, and multi-setting approaches are needed [31]. An ecological approach, which targets the individual, social and built environments, and policies [32, 33], expands the potential of prevention efforts to address critical upstream determinants of obesity-related behaviors, to influence larger populations and to have a long-term, sustainable impact [34]. Evidence from ecological approaches is promising [35, 36], larger scale, adequately powered studies are needed
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