Children's Healthy Living Program Research Articles

Acculturation and Health Status in the Children's Healthy Living Program in the Pacific Region.

Acculturation/enculturation has been found to impact childhood health and obesity status. The objective of this study is to use cross-sectional data to examine the association between proxies of adult/caregiver acculturation/enculturation and child health status (Body Mass Index [BMI], waist circumference [WC], and acanthosis nigricans [AN]) in the U.S.-Affiliated Pacific Islands (USAPI), Alaska, and Hawai'i. Study participants were from the Children's Healthy Living (CHL) Program, an environmental intervention trial and obesity prevalence survey. Anthropometric data from 2-8 year olds and parent/caregiver questionnaires were used in this analysis. The results of this study (n = 4121) saw that those parents/caregivers who identified as traditional had children who were protected against overweight/obesity (OWOB) status and WC > 75th percentile (compared to the integrated culture identity) when adjusted for significant variables from the descriptive analysis. AN did not have a significant association with cultural classification. Future interventions in the USAPI, Alaska, and Hawai'i may want to focus efforts on parents/caregivers who associated with an integrated cultural group as an opportunity to improve health and reduce child OWOB prevalence.

Proportion and Correlates of Children in the US-Affiliated Pacific Region Meeting Sleep, Screen Time, and Physical Activity Guidelines.

Limited data on 24-hour movement behaviors of children aged 5-8years exist globally. We describe the prevalence and sociodemographic associations of meeting physical activity (PA), sedentary recreational screen time (ST), and sleep guidelines among children from 11 jurisdictions in the US-Affiliated Pacific region. Cross-sectional representative data from 1192 children aged 5-8years living in the US-Affiliated Pacific region were drawn from the baseline 2012-2014 Children's Healthy Living Program. Sleep and moderate- to vigorous-intensity PA were calculated from accelerometry. ST and sociodemographic data were collected from caregiver surveys. The percentage of children meeting the Asia-Pacific 24-hour movement guidelines for PA (≥60min/d of moderate- to vigorous-intensity PA), sleep (≥9 and ≤ 11h/d) and ST (≤2h/d) were calculated. Generalized linear mixed models were used to examine associations with adiposity and sociodemographic variables. Twenty-seven percent (95% confidence interval, 24.6-30.0) of children met integrated guidelines; 98% (96.2-98.0) met PA, 78% (75.4-80.0) met sleep, and 35% (32.6-38.0) met ST guidelines. Females (adjusted odds ratio = 1.40 [95% confidence interval, 1.03-1.91]) and those living in lower-middle-income jurisdictions (2.29 [1.49-3.54]) were more likely to meet ST guidelines. Overweight children (0.62 [0.40-0.96]), those aged 8years (0.39 [0.22-0.69]), and children with caregivers of an education level of high school or beyond (0.44 [0.29-0.68]) were less likely to achieve ST guidelines. Children from midrange annual household incomes were less likely to meet combined guidelines (0.60 [0.39-0.92]). Three-quarters of children are not meeting integrated Asia-Pacific 24-hour movement guidelines. Future strategies for reducing ST and increasing integrated guidelines compliance are needed.

Diet Quality of Young Children in the US-Affiliated Pacific's Children's Healthy Living (CHL) Program.

Childhood diet can impact health outcomes over the life course. Few studies have assessed dietary quality among infants and children in the US-Affiliated Pacific (USAP) region. The aim of this study was to examine the differences in diet quality among Pacific children in the Children's Healthy Living (CHL) program by Pacific jurisdiction and by their World Bank Income Group (WBIG) level. This cross-sectional study used dietary records collected from 2012 to2015. Data were collected on 2- to 8-year-old children (n= 3,529) enrolled in the Children's Healthy Living Program for Remote Underserved Minority Populations in the Pacific region, conducted in the USAP jurisdictions of Alaska, Hawai'i, American Samoa, Commonwealth of the Northern Mariana Islands (CNMI), Guam, Federated States of Micronesia (FSM islands include Chuuk, Kosrae, Pohnpei, Yap), Republic of the Marshall Islands (RMI), and Republic of Palau. Diet quality was assessed using the Healthy Eating Index-2005 (HEI-2005). This HEI version was commensurate with the time of dietary data collection for the CHL project and previous studies, thus allowing cross-study comparisons. Means of total HEI-2005 scores between jurisdictions and their WBIG level were compared using linear models, with and without adjustment for age, sex, and dietary energy. Differences in mean HEI-2005 scores among children were found between jurisdictions and their WBIG level. Alaska had the highest adjusted mean score (63.3). RMI had the lowest adjusted mean score (50.1). By WBIG, lower-middle income jurisdictions had the lowest adjusted mean HEI-2005 score (56.0), whereas high income jurisdictions had the highest adjusted mean HEI-2005 score (60.5). Variation in children's diet quality was found between USAP jurisdictions, notably between jurisdictions of different WBIG levels. Future research is needed to deepen understanding of these differences in diet quality by WBIG level, such as whether differences may be attributable to the jurisdictions' varying food systems, and possibly explained by the nutrition transition. Understanding childhood diet quality in this region can inform approaches for nutrition programs in the Pacific region.

Diet and Acanthosis Nigricans over a Two-Year Period in Children of the Pacific Region.

The impact that dietary carbohydrates have on children developing type 2 diabetes remains controversial. Furthermore, there are limited pediatric longitudinal studies on changes in body mass index (BMI) and diet related to the development of acanthosis nigricans (AN), a risk factor associated with type 2 diabetes. Two 24 h dietary records were collected for 558 children, 2-8 years of age, at baseline and at a 2-year follow-up. Data on age, sex, BMI, and the presence of AN were also collected at each time point from the Children's Healthy Living Program. Logistic regression was used to determine factors associated with the presence of AN at follow-up. Multinominal regression was used to determine factors associated with changes in AN status. Linear regression was used to measure the associations between changes in dietary intake and in the Burke Score for AN. AN was present in 28 children at baseline and 34 children at follow-up. Adjusting for the presence of AN at baseline, age, sex, study group, baseline BMI, change in BMI z-score, time between assessments, and baseline intake, an increase from baseline for each teaspoon of sugar and serving of carbohydrate-rich food increased the risk for having AN at follow-up by 9% and 8%, respectively (p ≤ 0.05). An increased intake of added sugar (teaspoons) increased the risk of developing AN by 13% (p ≤ 0.01) and an increase in servings of foods rich in starch increased the risk of developing AN by 12% (p ≤ 0.01) compared to children who never had AN. Increasing the intake of fruit was also associated with decreased Burke Scores using multiple regression. However, the intake of energy and macronutrients were not associated with AN. Added sugar and foods rich in starch were independently associated with the occurrence of AN, suggesting the type of carbohydrates consumed is a factor in AN occurrence.

Children's Dietary Intake by Early Care and Education Setting in the US Affiliated Pacific

ObjectiveExamine differences in dietary intake of children aged 2–5 years in early care and education (ECE) setting in the US Affiliated Pacific (USAP). DesignSecondary analysis of cross-sectional data collected by the Children's Healthy Living program. ParticipantsChildren (n = 1,423) with complete dietary records and information on the ECE setting. Main Outcome MeasuresDietary intake by ECE setting; Head Start (HS), other ECE (OE), and no ECE. AnalysisComparison of mean dietary intake across ECE settings and multivariate logistic regression to evaluate ECE setting and likelihood for meeting dietary reference intake (DRI). ResultsChildren in HS and OE settings had a significantly higher intake of several food groups and nutrients, compared with no ECE; vegetables (0.4 cup-equivalents per thousand kcals [CETK] vs 0.3 CETK; P < 0.001), fruits (0.8 CETK vs 0.6 CETK; P = 0.001), milk (0.9 CETK for HS and 1.0 CETK for OE vs 0.8 CETK; P < 0.001). Sixty-five percent of the HS group met DRI and had greater odds of meeting calcium DRI (odds ratio, 1.8; 95% confidence interval, 1.2–2.7) compared with other groups. The OE group had the lowest proportion of children meeting recommended intakes for 19 out of 25 nutrients. Conclusions and ImplicationsMean intakes of foods and nutrients for children across the USAP meet some, but not all, recommendations and intakes vary across children attending various ECE setting types. Additional research on the clinical importance of these differences and the impact of the complex food systems in the USAP may identify systematic strategies for improving diet among children.

Food and Physical Activity Environment in the US-Affiliated Pacific Region: The Children's Healthy Living Program

ObjectiveTo describe the quality of food and physical activity (PA) environments by World Bank Income level in jurisdictions from the Children's Healthy Living Program. DesignBaseline cross-sectional community data were analyzed from 11 jurisdictions categorized by World Bank Income levels to describe exposure to different food and PA outlets. The Children's Healthy Living Program was a multilevel, multijurisdictional prevalence study and community intervention trial that reduced child obesity in the US-Affiliated Pacific region. SettingUS-Affiliated Pacific region. ParticipantsFood (n = 426) and PA (n = 552) Outlets. Main Outcome MeasuresPhysical activity and food scores that reflect the quality of the outlets that support being physically active and healthy eating options, respectively. AnalysisDescriptive statistics are presented as means ± SD or percentages. ResultsHigh-income-income level jurisdictions had higher food and PA scores than middle-income level jurisdictions. Conclusions and ImplicationsThe US-Affiliated Pacific region has limited quality food and PA outlets in underserved communities at risk for obesity. The findings in this paper can be used to develop tools and design interventions to improve the food and PA environment to increase a healthier, active lifestyle.

Influence of Teachers' Personal Health Behaviors on Operationalizing Obesity Prevention Policy in Head Start Preschools: A Project of the Children's Healthy Living Program (CHL)

ObjectiveTo quantify the Head Start (HS) teacher mediating and moderating influence on the effect of a wellness policy intervention. DesignIntervention trial within a larger randomized community trial. SettingHS preschools in Hawaii. ParticipantsTwenty-three HS classrooms located within 2 previously randomized communities. InterventionSeven-month multi-component intervention with policy changes to food served and service style, initiatives for employee wellness, classroom activities for preschoolers promoting physical activity (PA) and healthy eating, and training and technical assistance. Main Outcome MeasuresThe Environment and Policy Assessment and Observation (EPAO) classroom scores and teacher questionnaires assessing on knowledge, beliefs, priorities, and misconceptions around child nutrition and changes in personal health behaviors and status were the main outcome measures. AnalysisPaired t tests and linear regression analysis tested the intervention effects on the classroom and mediating and moderating effects of the teacher variables on the classroom environment. ResultsGeneral linear model test showed greater intervention effect on the EPAO score where teachers reported higher than average improvements in their own health status and behaviors (estimate [SE] = −2.47 (0.78), P < .05). Conclusions and ImplicationsStrategies to improve teacher health status and behaviors included in a multi-component policy intervention aimed at child obesity prevention may produce a greater effect on classroom environments.

Food Insecurity and Young Child BMI Status in the U.S. Affiliated Pacific (USAP) Region: Findings from the Children's Healthy Living Program

Food insecurity may negatively impact children's growth and weight status. The purpose of this study is to: (1) examine prevalence of food insecurity among young children in the Pacific region and by indigenous ethnic populations; (2) examine the relationship of food insecurity and child's weight status and whether there is a race modification of such relationship. Data used were from 11 USAP jurisdictions that participated in the Children's Healthy Living Program (CHL): Alaska, American Samoa, Commonwealth of Northern Mariana Islands, Guam, Hawai‘i, Republic of Marshall Islands, Republic of Palau, Pohnpei, Yap, Kosrae and Chuuk.Food insecurity was considered present if in the past 12 months, a child's household self‐reported that money for food ran out before the end of the month sometimes, most times or always. Child weight and height were measured by trained and standardized staff and child's weight status was determined according to the following CDC categories: underweight (BMI percentile&lt;5), healthy weight (5≤BMI percentile&lt;85), overweight (85≤BMI percentile&lt;95) and obese (BMI percentile ≥95). Child's race was categorized according to the US Office of Management and Budget (OMB) definitions: American Indian or Alaska Native (AIAN), Asian, Black, Native Hawaiian or Other Pacific Islander (NHPI), White, and More than one race. Child's race was also examined using Pacific ethnic definitions such as Native Hawaiian, Samoan, Chamorro, Chuukese, Marshallese, Kosraean, etc. Logistic regression models were used to examine the relationship of overweight and obesity (OWOB) and underweight with food insecurity, controlling for child's age, sex, and race.Of the 4,838 children included, 68% were healthy weight, 29% were OWOB, and 3% were underweight. Slightly over half experienced food insecurity (52%). Food insecurity differed significantly by race, with highest prevalence among Chuukese (81%), Marshallese (76%), Kosraean (74%), Pohnpeian (71%) and Yapese (60%). Logistic regression found significant race/ethnicity modification on the relationship of OWOB and underweight with food insecurity. Among Pohnpeians, children with food insecurity were 69% more likely to be OWOB than those without (OR=1.69, p=0.005). Among Chuukese, Samoan, and Mixed Race, however, children with food insecurity were 60–80% less likely to be OWOB than those without (ORs 0.2–0.4, p&lt;0.01). Among Hawaiian, Kosraean, Mixed Race, and White, food insecure children were more likely to become underweight than those with no insecurity. No significant association was observed among other race/ethnic groups.The Pacific region is experiencing the dual burden of obesity and underweight, as well as rapid dietary change. Food insecurity is an importing underlying driving force of such change. Interventions targeting food insecurity or childhood obesity should take consideration the stage of the nutrition transition and the complex ethnic composition in this region.Support or Funding InformationSupported by Agriculture and Food Research Initiative Grant no 2011‐68001‐30335 from the USDA National Institute of Food and Agriculture

Stunting and its relationship to Obesity in the US affiliated Pacific: a study of the Children's Healthy Living Program

The US Affiliated Pacific (US Pacific) has experienced nutrition transition over the last decades yet the region is not served by national surveys, and prevalence data on nutritional anthropometry are not widely available. The study will examine prevalence of stunting among young children in the US Pacific and its variability among the indigenous ethnic populations and, to examine whether stunting alters the risk for obesity and whether race/ethnicity modifies this relationship. Children were sampled from 51 communities in 11 US Pacific jurisdictions. Child's race was categorized according to the US Office of Management and Budget (OMB): American Indian or Alaska Native (AIAN), Asian, Black, Native Hawaiian or Other Pacific Islander (NHPI), White, and More than one race. Child's race was also examined by an expansion of OMB race/ethnicity groups and included 18 Pacific ethnic categories. Child's height and weight were measured by trained and standardized staff. Stunting was defined as height‐for‐age z score (HAZ) &lt;−2 SDs below the mean. Child's weight status was categorized based on CDC's 2000 reference data as: (1) underweight &lt;5th percentile BMI; (2) Healthy weight, &gt;=5th&lt;84th BMI percentile; (3) Overweight, &gt;=85th &lt;95th BMI percentile and (4) Obese, &gt;=95th BMI percentile. Cutoff values for biologically implausible values were &lt;−5 or &gt;3 for HAZ and &lt;−4 or &gt;5 for BMI z score. Prevalence estimates were weighted to 2010 census population size of children &lt;10 years of age for each community and adjusted for clustering of communities within jurisdictions. Logistic regression was used to examine the relationship between stunting and obesity, controlling for child's age, sex, and race/ethnicity. 5,376 children were studied. 65% were 2–5 years old and 51% were male. 61% were NHPI, 20% were More than one race group, 9% were Asian, 8% were White, 2% were AIAN and 0.3% were Black. Among NHPI, the 10 most prevalent ethnic groups were Samoan (25%), Chamorro (20%), Chuukese (11%), Marshallese (6%), Yapese (6%), Kosraean (5%), Native Hawaiian (5%), Pohnpeian (5%), Palauan (5%), and mixed within NHPI (10%). Filipino was the dominant Asian ethnic group (84%). The adjusted and weighted prevalence of stunting was 2.5% (SE=0.3%), obesity was 13.8% (SE=0.9%), and underweight was 2.5% (SE=0.3%). A significant difference in stunting prevalence was found by child's race/ethnicity (p&lt;0.001), but not by age group (2–5 vs 6–8y) or sex. The highest prevalence of stunting was among Pohnpeian (13%), Marshallese (11%), Kosraean (5%) and Chamorro (3%) children. No stunting was observed among Black or other NHPI (Carolinian, Tongan, Kiribati, Tokelaun, Tahitian, Etc.) children. Very low prevalence was observed among Native Hawaiian (0.3%), Samoan (0.3%), and Filipino (0.7%) children. Logistic regression showed that stunted children were less likely to become obese among all race/ethnic groups (ORs&lt;0.001, p&lt;0.0001) except for Native Hawaiian (OR=5.8; 95% CI: 3.7–9.0) where stunted children were 6 times more likely to become obese compared to non‐stunted children. No significant relationship was observed between stunting and obesity among Samoan and the “More than one race” groups. The Native Hawaiian relationship of stunting to obesity could be related to an earlier historical nutrition transition. Further examination of behaviors and environments that may explain ethnic differences in stunting and its relationship to obesity is warranted.Support or Funding InformationUSDA 2011‐68001‐30335

Head Start Wellness Policy Intervention in Hawaii: A Project of the Children's Healthy Living Program

The increased prevalence of childhood overweight and obesity across the United States and the Pacific has become a serious public health concern, with especially high prevalence among Native Hawaiian and Pacific Islander (NHPI) children. This study aimed to measure the effect of a Head Start (HS) policy intervention for childhood obesity prevention. Twenty-three HS classrooms located in Hawaii participated in the trial of a 7-month policy intervention with HS teachers. Classroom- and child-level outcome assessments were conducted, including: the Environment and Policy Assessment and Observations (EPAO) of the classroom environment; plate waste observations to assess child intake of fruit and vegetables; and child growth. The intervention showed a positive and significant effect on classroom EPAO physical activity (PA) and EPAO total scores. Although mean BMI z-score (zBMI) increased at postintervention for both intervention (mean = 0.60; standard deviation [SD], 1.16; n = 114) and delayed-intervention groups (mean = 0.35; SD, 1.17; n = 132), change in zBMI was not significantly different between the groups (p = 0.50; p = 0.48). These findings contribute evidence on the potential for HS wellness policy to improve the PA environment of HS classrooms. More research is needed to link these policy changes to other child outcomes.

Anthropometric measurement standardization in the US-affiliated pacific: Report from the Children's Healthy Living Program.

Anthropometric standardization is essential to obtain reliable and comparable data from different geographical regions. The purpose of this study is to describe anthropometric standardization procedures and findings from the Children's Healthy Living (CHL) Program, a study on childhood obesity in 11 jurisdictions in the US-Affiliated Pacific Region, including Alaska and Hawai'i. Zerfas criteria were used to compare the measurement components (height, waist, and weight) between each trainee and a single expert anthropometrist. In addition, intra- and inter-rater technical error of measurement (TEM), coefficient of reliability, and average bias relative to the expert were computed. From September 2012 to December 2014, 79 trainees participated in at least 1 of 29 standardization sessions. A total of 49 trainees passed either standard or alternate Zerfas criteria and were qualified to assess all three measurements in the field. Standard Zerfas criteria were difficult to achieve: only 2 of 79 trainees passed at their first training session. Intra-rater TEM estimates for the 49 trainees compared well with the expert anthropometrist. Average biases were within acceptable limits of deviation from the expert. Coefficient of reliability was above 99% for all three anthropometric components. Standardization based on comparison with a single expert ensured the comparability of measurements from the 49 trainees who passed the criteria. The anthropometric standardization process and protocols followed by CHL resulted in 49 standardized field anthropometrists and have helped build capacity in the health workforce in the Pacific Region. Am. J. Hum. Biol. 28:364-371, 2016. © 2015 Wiley Periodicals, Inc.

The Pacific Retail Food Store Environment: Findings from the Children's Healthy Living Program

A community's retail food environment (RFE) is an important determinant of health. Healthy food, including fruits/vegetables [F/V], availability, quality, and promotions may influence food choices. This study's purpose was to describe the RFE of 154 stores in 4 jurisdictions from 2012-2014 participating in the Children's Healthy Living (CHL) Program. The CX3 Food Availability and Marketing Survey, a standardized RFE assessment survey, was adapted for the Pacific. About half of the stores (47%) were small markets (SM), 27% convenience stores (CS), 17% supermarket chains (SC), 6% large grocery stores (LG), and 3% of other type. SM was dominant in CNMI (69%) and Guam (75%) compared to SC in Alaska (46%). In Hawaii, the majority were CS (35%) and SM (28%). Among all stores, the majority had unhealthy foods (61%) and promotions for unhealthy foods (93%) present near check-out. The majority (60%) had unhealthy food ads with less than 20% with healthy food ads. Few stores (29%) had health promotion items around the F/V display, or items promoting locally grown produce. Using the CX3 standardized RFE scoring criteria; 32% of stores surveyed met CX3 standards for F variety and quality, 42% met for V variety and quality, and 43% met for other healthy food availability. Significant jurisdiction differences (p<.001) were observed in the percentage of stores meeting CX3 standards on F only, with Alaska (49%) and Hawaii (50%) higher than CNMI (22%) and Guam (11%). Many of the stores surveyed did not meet CX3 RFE standards and present an F/V intervention opportunity. USDA AFRI # 2011-68001-30335

Child Obesity and Acanthosis Nigricans in the Children's Healthy Living Program (CHL)

Due to high levels of adult obesity and diabetes in the United States (US) Affiliated Pacific region, and paucity of data among young children, the Children's Healthy Living (CHL) program conducted prevalence surveys for young child obesity and acanthosis nigricans in eight jurisdictions. Children (4,017; 2-8yo) were weighed, measured, and assessed for acanthosis nigricans (AN). AN prevalence (%) differed by jurisdiction (X2 = 107.7, p < 0.001): Alaska, 0; American Samoa, 5; Commonwealth of the Northern Marianas (CNMI), 9; Guam, 3; Hawaii, 1; Palau, 5; Pohnpei, 12; Republic of the Marshall Islands (RMI), 11, and Overall, 5. Overweight prevalence (%) differed by jurisdiction (X2 = 72.3, p < 0.001): Alaska, 21; American Samoa, 20; CNMI, 11; Guam, 13; Hawaii, 17; Palau, 9; Pohnpei, 18; RMI, 2; and Overall, 15. Obesity prevalence (%) differed by jurisdiction (X2 = 96.6, p < 0.001): Alaska, 16; American Samoa 23; CNMI, 16; Guam, 14; Hawaii, 16; Palau, 16; Pohnpei, 4; RMI, 0; and Overall, 16. AN prevalence (%) was higher among 6-8yo (7) than 2-5yo (4, X2 = 23.6, p<0.001), and among Asian (8), Hawaiian and Pacific Islander (6), and among those of more than one race (3), than among Native American/Alaskan (0), Black (0), and White (0) (X2 = 44.5, p < 0.001). AN prevalence (%) was higher among those who were obese (17) compared to other weight categories (3) (X2 = 253, p < 0.001). Presence of AN, and its relationship to obesity, suggests an urgent need for attention to young children in US Affiliated Pacific populations. USDA 2011-68001-30335

Comparing Growth Assessments Using CDC and WHO Reference Data in Native Hawaiian Pacific Islander Children: Baseline Data from the Children's Healthy Living (CHL) Program in Hawaiʻi

In the diverse US Affiliated Pacific Centers for Disease Control (CDC) 2000 and 2006 World Health Organization (WHO) reference data are available to assess child growth. WHO reference data includes children who met recommended breastfeeding guidelines from six countries, while CDC data describes growth of US children where few were breastfed. Baseline data from the CHL program in Hawai'i (n=941) was used to calculate BMI z‐scores and percentiles to compare growth relative to the two reference data sets and identify the role of breastfeeding history, age, sex, and ethnicity on growth assessment. Mean BMI z‐scores calculated with CDC reference data were lower than WHO (z‐score difference=‐0.31, p&lt;0.001). A general linear model on BMI z differences against child age, sex, ethnicity and breastfeeding history showed the difference by CDC reference was greater in boys than girls (z score difference = 0.20, p&lt;0.001). No difference was found by breastfeeding history, age or ethnicity. Kappa statistics showed strong agreement between the two references on CDC defined BMI categories (weighted Kappa=0.50, p&lt;0.001), with percentage of agreement highest for healthy weight (92%), followed by obese (85%), then overweight (76%). CDC and WHO growth reference data samples differ by breastfeeding history and ethnicity; differences between BMI z‐scores calculated from the two reference data sets were not related to either factor. Researchers and practitioners can choose either reference data to analyze BMI and child growth in NHPI children but should be cautious that CDC growth references may underestimate childhood overweight and obesity, and delay early intervention.

Young Children's Screen Time and Obesity in the U.S. Affiliated Pacific: The Children's Healthy Living Program

Screen time is associated with adverse health outcomes among young children, including obesity. The purpose of this study is to describe screen time in young children and relate it to obesity from five U.S. Affiliated Pacific jurisdictions in the Children's Healthy Living Program.In a sample of 3,331 children (2‐8 yo), mean overall screen time was 4.2 hours (h) per day (d) (sd=2.9), 4.1 h/d (sd=3.0) for weekdays, and 4.5 h/d (sd=3.3) for weekends. Mean time spent watching TV was 2.3 h/d (sd=1.4); playing inactive video games, 1.0 h/d (sd=1.2), and playing active video games, 0.9 h/d (sd=1.2). A linear regression model with screen time as the dependent variable found significant differences by child's sex, age, race, BMI status (based on CDC's definition of obesity), and jurisdiction. Mean screen time was higher by 0.43 h in girls than boys (p&lt;.001), by 0.26 h in 6‐8 than 2‐5 year olds (p=0.01), and by 0.24 h in overweight/obese than healthy weight children (p=0.02). Mean screen time was higher among Asians and multiracial children than Whites (p&lt;.001). Alaska had the lowest mean (3.3 h) while Guam the highest (4.9 h).Similar results were found for TV watching and playing active or inactive video games by sex, age, race and jurisdiction. Mean time on active video games was 0.11 h higher in overweight/obese than healthy weight children (p=0.02). Mean TV time was 0.1 h higher in overweight/obese than healthy weight children (p=0.06).Compared to healthy weight children, overweight/obese children had more screen time, and in particular, for playing active video games and TV viewing. Such findings have important intervention implications.

Fast Food Environment among Low‐Income Communities in the Pacific Region: Findings from the Children's Healthy Living Program

Understanding community fast food environments is important to address obesity, particularly in low‐income populations. This study examines menus of fast food restaurants (FFR) across 4 US Affiliated Pacific Regions in the Children's Healthy Living Program. &#x0D; A total of 91 FFR were surveyed using a modified Fast Food Observation Form from the Bridging the Gap Community Obesity Measures Project, including 40 in Alaska, 9 in the Commonwealth of the Northern Mariana Islands (CNMI), 5 in Guam, and 37 in Hawaii. Burger and Fries, Sandwich/Sub Shop, Plate Lunch/Lunch Truck, and Chinese/Pan‐Asian were the top 4 FFR types.&#x0D; Food and beverages offered on the menu were assessed in 80 FFR. The most common foods were salad (48%), sandwich (44%), fries (44%), and cheeseburger (36%). The most common beverages were fountain drink (73%), bottled water (71%), can/bottled soda (56%), and 100% juice (48%). Among 87 FFR assessed for fruit and vegetable (FV) dishes on the menu, 75% had at least one. Among 16 FFR with a dollar menu, 56% had FV, salad, or yogurt (FVSY) items. Among 34 restaurants with a children's menu, 76% had FVSY items and 76% had skim/1% milk, 100% juice, or bottled water. Significant regional differences were found on the availability of FV as sides (p&lt;0.01, with Alaska highest, CNMI lowest) or of FVSY items on a children's menu (p=0.04, with Hawaii highest, CNMI lowest). &#x0D; Intervention messages aimed at changing eating behaviors among families in low‐income communities can focus on availability and identification of healthy food and beverage options among FFR.

Determinants of Young Children's Sleep Duration in the U.S. Affiliated Pacific: The Children's Healthy Living Program

Sleep plays an important role in the health of young children and is associated with childhood obesity. This study reports sleep duration and its determinants in young children from five jurisdictions in the U.S. Affiliated Pacific (USAP) from the Children's Healthy Program (CHL).Questions on children's demographic profile, sleep duration, and screen time were all adapted from previous studies and answered by parents/caregivers. The results reported include 3,894 children (2‐8 yo). Mean sleep duration was 9.6 hours (h) (sd=1.7). Twenty‐four percent of the children slept between 11‐13 hours daily, 66% slept between 8 to 10 hours and 10% slept less than 8 hours daily.A linear regression model of sleep duration found the following significant predictors: child's sex, age, race, family income and geographical location. Mean sleep duration was higher by 0.13 h in girls than boys (p=0.03), by 0.58 h for 2‐5 year olds than 6‐8 year olds (p&lt;.001), and by 0.38 h for children from families with an income of more than $35,000 than those with a lower income (p&lt;.001). Compared to Whites, American Indians/Alaska Natives, Native Hawaiians/Pacific Islanders, and multiracial children had significantly lower mean sleep duration (p&lt;.05). Children from American Samoa had the highest mean (10.2 h), while children from Guam had the lowest mean (9.2 h). There was a significant negative association between screen time and sleep (p&lt;.001) and a non‐significant negative association between physical activity and sleep. Interventions targeting sleep duration among young children need to consider socio‐demographic and geographic differences.

Wellness Policy and the Head Start Environment: The Moderating Role of Head Start Teachers in the Children's Healthy Living Program in Hawai'i

School wellness policy intervention for childhood obesity prevention has shown mixed results in preschool environments, with teachers considered a contributing factor to the variation. This study's objective was to examine whether a wellness policy intervention influenced the physical activity (PA) and nutrition environment in preschool classrooms and whether the effect depends on teachers' skills, knowledge and behaviors related to nutrition and PA. The wellness policy intervention was conducted in 23 Head Start classes, of which 11 were assigned to the intervention and 12 served as control. Classroom environments were assessed by the Environment and Policy Assessment and Observations (EPAO). Monthly surveys were mailed to teachers, asking if they had experienced any improvements in their nutrition and PA skills or knowledge, and other health behaviors and indicators. Health behaviors and indicators assessed included: increased water consumption; decreased sugar‐sweetened beverage consumption; increased level of PA; and improved weight control, blood pressure control, or stress management. Among classes where teachers' improvements in monthly surveys were greater than or equal to the mean, average EPAO‐total scores in the intervention group were 2.2 points higher than the control group (p=0.01) and mean EPAO‐PA scores were 3.5 points higher than the control group (p=0.003). In contrast, in classes where teachers had lower than the mean improvements, no significant difference was observed in either the total or PA EPAO mean scores between the two intervention groups. Wellness activities targeted at teachers in the HS environment may increase the effectiveness of wellness policy initiatives.

Indigenous Workforce Training by the Children's Healthy Living Program (CHL) to Prevent Childhood Obesity in the Pacific

Indigenous Workforce Training by the Children's Healthy Living Program (CHL) to Prevent Childhood Obesity in the Pacific

Children's Healthy Living Program (CHL) for Remote Underserved Minority Populations of the Pacific Region

Children's Healthy Living Program (CHL) for Remote Underserved Minority Populations of the Pacific Region