patricia coleman, nutrition and health programs team leader
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Patricia Coleman, Nutrition and Health Programs Team Leader. prevalence of young child Overweight and Obesity in the us affiliated Pacific Region: a meta Analysis from the children’s healthy living program ( chl ) *. - PowerPoint PPT PresentationTRANSCRIPT
Patricia Coleman, Nutrition and Health Programs Team Leader
PREVALENCE OF YOUNG CHILD OVERWEIGHT AND OBESITY IN THE US AFFILIATED PACIFIC REGION: A META ANALYSIS FROM THE CHILDREN’S HEALTHY LIVING PROGRAM (CHL)*
RACHEL NOVOTNY1, MARIE KAINOA FIALKOWSKI1, FENFANG LI1, DONALD VARGO2, YVETTE PAULINO3, PATRICIA COLEMAN4, ANDREA BERSAMIN5, CLAUDIO R NIGG1, JODI LESLIE1, RACHAEL LEON GUERRERO3, JONATHAN DEENIK1, JANG KIM4, LYNNE R WILKENS11UNIVERSITY OF HAWAII, 2AMERICAN SAMOA COMMUNITY COLLEGE, 3UNIVERSITY OF GUAM, 4NORTHERN MARIANAS COLLEGE, 5UNIVERSITY OF ALASKA, FAIRBANKS
Introduction: US NHANES is not conducted is US Affiliated Pacific (USAP) Region (USAP Islands, Hawai`i , Alaska).Method: A meta-analysis of published literature and publicly available agency reports was conducted to estimate overweight and obesity prevalence of 2-8 year (y) old USAP children. Contiguous US data (NHANES) served as reference. Literature search was limited to resources in English and 2-8y USAP children data from 2000 to 2013 and used CDC 2010 overweight and obesity reference data. USAP region sources (n=23) and NHANES articles (n=3; the contiguous U.S reference) included. Data were disaggregated into single years of age. The children measured for the age group were divided equally and the prevalence was assigned to each individual age. A mixed model regressed the prevalence on a polynomial in age, accounting for the prevalence variance and another model compared jurisdictions. Results: Overweight plus obesity increased from 21% at 2y, to 39% at 8y (p<0.0001) for the USAP. In comparison, combined overweight plus obesity increased from 24 % at 2y to 35% at 8y (p<.0001) for NHANES. USAP data showed with a sharp increase in prevalence at 5y. Obesity alone increased from 10% at 2y, doubling to 24% at 8y (p<0.0001)whereas overweight prevalence was stable from 2y (13%) to 8y (15%). Discussion: Further examination, monitoring and understanding of USAP young child obesity is needed.
*TO BE PRESENTED AT AMERICAN SOCIETY OF NUTRITION ANNUAL MEETING IN SAN DIEGO, APRIL 2014 & ABSTRACT PUBLISHED IN FASEB JOURNAL. PAPER SUBMITTED TO AJPH.
•
Methods
• Meta-analysis of published literature and publicly available agency reports for Hawaii, Alaska, and US-Affiliated Pacific Islands
• English only, 2-8 year olds • Year 2000 & newer, CDC overweight and
obesity reference data• Data disaggregated into single years of age
Methods cont.
• Children measured for the age group were divided equally and prevalence was assigned to each individual age
• Mixed model regressed the prevalence of a polynomial in age
Results
• OWOB increased from 21.0% at 2y to 39.2% at 8y (p<.0001) for the USAP
• NHANES increased from 24.2% at 2y to 34.8% at 8y (p<.0001)
• Sharp increase in prevalence at age 5y• USAP obesity alone increased from 10.2% at
2y to 23.6% at 8y (p<.0001)
CHL Population
U.S. Affiliated Pacific Region Need• Obesity - minimal data, no NHANES• Capacity - few trained professionals• Unique geography and culture - need
culturally tailored approach
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CHL Annual Meeting, Guam June 2013
CHL VisionWe envision sustainable community-based systems and environments to raise healthy
children in the Pacific Region
Children from the Republic of the Marshall Islands
CHL MissionIn partnership with our
community, our mission is to elevate the capacity of the
region to build and sustain a healthy food and physical
environment to help maintain healthy weight and prevent
obesity among young children in the Pacific region
Tafuna Elementary,
American Samoa,
April 2013
CHL GoalThe goal of CHL is to build social/cultural,
political/economic, and physical/built environments that will promote active play
and intake of healthy food to prevent young child obesity in the Pacific Region
Children from Yap State, Federated States of Micronesia
External Advisory CommitteeJennifer Anderson
Kathryn KolasaSuzanne MurphyWendy SnowdonBoyd Swinburn
Principal Investigator
Novotny
Program Steering Committee Lead Site Co-I :
Deenik, Kim, Bersamin, Leon-Guerrero/Barber, Novotny,
Vargo/Ropeti
External Communication Center Lead: Hollyer / Takahashi
Coordinating Center Program Director: NovotnyAssistant Program Director: FialkowskiProgram Administrator: YanConference Coordinator: ChunIT Manager: DeBusk
Data Center Lead: Wilkens
Data Coordinator: LiPerformance Sites FAS: FSM, RMI, Palau;
CNMI; Alaska; Guam; Hawaii; Am. Samoa
Local Advisory Committees LG Dir. Chair:
Currie, Samson, Taro;
Manglona; Sparrow, Yudin, Gallo, Aga
CHL Management Structure
Training / Education Center Lead: Dunn / Fialkowski
Education Coordinator: Leslie / Delormier
Intervention Center Lead: Nigg / Braun
Intervention Coordinator: ButelSituation Analysis Center
Lead: Fialkowski / DeBaryshe
CHL Target Population• Grant requirement: children ages 2 – 8 y
– Head Start – Preschool– Day Care– Kindergarten– Community Health Centers– Community Centers– Community Events– Supplemental Feeding Program for Women, Infants, &
Children
Images from CHL brochure, courtesy of Center on the Family
CHL Objectives1. Conduct program / data inventories & situation analysis – Situation Analysis
Work Group
2. (Degree) Train 22 professionals & paraprofessionals in obesity prevention – Training Work Group
3. Develop Pacific food, nutrition & physical activity data management & evaluation system – Data & External Communications Work Groups
4. Develop & conduct an environmental intervention (to prevent, maintain or decrease young child overweight & obesity in the Pacific Region) – Intervention and External Communication Work Groups
5. Evaluate the community - based primary - prevention environmental intervention – Data Center Work Group
6. Incur at least one obesity prevention policy change per state / jurisdiction – Program Steering Committee Work Group
CHL (6 behavioral outcomes, 3 health outcomes)Primary
1. Sleep by 15 min/day2. Moderate to vigorous physical activity by 10
min/day 3. Fruit & vegetable intake by 1 serving/day (1/2
c/day)4. Water intake by ½ cup/day
5. Sedentary behavior (screen time) by 10 min/day6. Sweetened beverage intake by ½ cup/day1. Prevalence of obesity by 8% (0.10 kg/m2 decrease in
BMI z- score)2. Waist circumference by 2%
Secondary3. Acanthosis nigricans by 5% Positive acanthosis nigricans
screen, CHL Study
Effective Evidence-Based Strategies from Randomized Controlled Trials
Decrease in SSB intake
Increase in F/V intake
Increase in water intake
Decrease in leisure screen
time
Increase in PA
Increase in sleep
Policies to ban SSB
Product & shelf labeling
Healthy lifestyle
Education
Policies: promote F/V consumption
Product & shelf
labeling
Gardening
Healthy lifestyle
education
Policies to promote water
intake
Increase access to
clean Water
Healthy lifestyle
education
Policies to reduce screen
time
Healthy lifestyle
education
Policies to promote PA
Change Built Environment
to promote PA
Healthy lifestyle
education
Healthy lifestyle
education
ANGELO –Analysis Grid for Elements Linked to Obesity (Swinburn and colleagues)
CHL SITUATIONAL ANALYSIS & SCAN MERGE
PRIORI-TIZE
FORMU-LATE
GOALS
Demographic, health, risk, and other data
Community suggestions to address obesogenicenvironments Physical Social Policy
Scientific literature
Strategies from:
Community
Literature
Importance
Do-ability
Action Plans
Healthy Eating1. Decrease in SSB
intake2. Increase in water
intake3. Increase in fruit
& vegetable intake
Physical Activity4. Decrease in
leisure screen time5. Increase in sleep6. Increase in
physical activity
Top Strategies from Communities (Nov 2011-Feb 2012)Overall Priorities Alaska Am Sam CNMI Guam Hawaii
1. Educate parents, siblings, grandparents, children, communities on healthy living X X X X X
2. Importance of family, teachers, leaders, other respected figures as role models setting a healthy living example X X X X
3. Better and more free community activities and resources to promote healthy living X X X X X
4. Community resources maintained and accessible during all times making physical activity easier X X X X
5. Improve drinking water access/facilities X X X X
6. School policies need to be changed to make school lunches healthier, encourage water intake, increase physical activity, and reduce sugar sweetened beverage
X X X X
7. Change government policies to promote healthy lifestyle, prohibit use of food stamps to buy junk food, control stray dogs and moose
X X X X
8. Limit screen time X X9. Healthy local-grown, garden-fresh produce should be easily accessible and affordable
X X X X X
MERGE -- Much of what the community wants is supported by the literature
Supported by literature
Supported by community
Policies X XAccess to water X XEnvironmental changes for PA X XHealthy living education X XProduct and shelf labeling XAccess to affordable produce (including gardening)
X X
PRIORITIZE - Communities prioritized the merged list of strategies (May-June 2012)
Merged list of strategies posted on flip chart paper
Presented to 10 selected communities, 2 each in:• Alaska• American Samoa• CNMI• Guam• Hawaii
Participants prioritized based on• Importance• Feasibility (Do-ability)
FORMULATE– Intervention Community Action Planning (LAC)
1. Bring together key stakeholders, including parents, teachers, and leaders to implement the strategy
2. Adapt the strategy to the locale
3. Promote and implement the strategy
4. Establish a mechanism to monitor fidelity and outcomes
5. Use data to improve implementation
Other communities are testing interventions to reduce childhood obesity,
ANDthey are willing to share their materials and ideas!
In implementing these strategies, CHL:
• Partners with, supports, and “adds value” to existing programs that are conducting activities related to our 6 behavioral outcomes.
• Builds local capacity to sustain programs and policy changes.
• Promotes a common CHL message.• Collects data on the timeline of implementing strategies
and on the extent to which strategies are implemented at given time points.
Cross-cutting Functions1. Review assessment data for policy &
physical environment related to the 6 CHL behaviors
2. Partner & advocate for environmental change
3. Promote the CHL message
4. Train the trainers
CHL Intervention: Cross-Cutting Functions, Activities & Behavioral Targets ↓SSB
↑F/V
↑PA
↑Water
↓Screen
↑Sleep
Review Assessment Data for Policy & Physical Environment related to the 6 CHL behaviorsa. Review preschool wellness policy assessment data to identify training needsb. Review community assessment data to identify areas for advocacy for PA env.
XX
XX
XX
XX
X X
Partner and Advocate for Environmental Change a. Work with coalitions to advocate for
i. Better access to parks that are safe & invitingii. Better access to clean wateriii. Safer environments for walking & bikingiv. Better food placement in storesv. Gardens & hydroponics
b. Partner with existing entities to purchase or obtain sponsorship fori. Water in the preschoolsii. Gardening supplies for preschool kidsiii. Sports equipment for preschool kidsiv. Campaigns & messages
X
X
X
X
XX
X
X
X
X
X
XXX
X
X
X
X X X
Promote the CHL Message a. Support role models to deliver CHL messages in variousb. Enhance existing social marketing campaigns related to 6 CHL behaviorsc. Advertise CHL or other activities that promote 6 CHL target behaviors
XXX
XXX
XXX
XXX
XXX
XXX
Train the Trainers a. Train individuals to promote gardening in preschools & communitiesb. Train individuals to lead interactive, hands-on, & family-based sessionsc. Train preschool providers on wellness policiesd. Train preschool providers in curricula related to 6 CHL target behaviors e. Train role models (community champions, role celebrities, role models)
XXXXX
XXXXX
XXXXX
XXXXX
XXXXX
XXXXX
CHL TEAM CNMI
Jang Ho Kim, Tayna Belyeu-Camacho, Rose Castro, Jesse Deleon Guerrero, Marilynn Duenas, Randall Nelson, & me
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CNMI work w/role models (RM)
• Village focused instead of CNMI-wide focus• RM identified by key informants, knowledge of
community • Empowerment of stakeholders/role models• Training and technical support • Building on assets, strengths, influences of role
model group—integral role in driving the intervention
• Diverse backgrounds
Village Logos
TASA Role Models
Enhancing the Built Environment in Kagman
Policy: Child Care Licensing RegulationsPolicy & Advocacy
• Require each child care center to have policies that focus on the implementation of the CHL behaviors
• Require procedures/plans for implementation
• Align inspection checklist with policy requirements
• Mobilize partners for support
• Get approval from governor
Training • First training slated for May-
demonstrate burden of COWOB, critical role they play-get buy-in
• Include child care administrators, owners, managers, and child care providers
• Write the policy in • Subsequent trainings to focus on
implementation of one or two CHL behaviors
• CCDF benefits
Prevalence SurveyFreely Associated States: Palau, Marshalls, Chuuk, Kosrae, Pohnpei, Yap
• Determine the prevalence rates of underweight, overweight, and obesity in a representative sample of young children, ages 2 – 8y, from each jurisdiction
• Provide descriptive information on similar measures as CHL Intervention Study
• Approximate sample size 200 per jurisdiction Marshalls, Kosrae, Pohnpei, Chuuk, Yap, Palau)
• Data: Anthropometry, Acanthosis Nigricans, Accelerometry, Questionnaire (Sleep etc...),Food and Activity logs, Community obesity prevention environmental assessment, Food & Utility cost survey
• Most Survey elements completed in Pohnpei (Oct 28-Nov 8, 2013) and RMI ( Jan 1-Feb 4, 2014)
• Palau survey: April 7-18, 2014; Chuuk Survey July 14 to Aug 14, 2014; Yap October 2014; Kosrae Jan 2015
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I. CHL Scholarship ProgramProvide academic degree training for indigenous students in CHL region- 2 from each jurisdiction, including 2 from each state of Freely Associated States of Micronesia
II. CHL Capacity Building Program for the Pacific Region Help develop sustainable, culturally appropriate, nutrition courses & programs & within existing academic institutions in the region
Capacity Building Through Training
CHL Students – Cohort 1
CHL Students – Cohort 2
CHL PhasesPhase 1: Situation
Analysis
• Inventories• Community
Meetings• Community
Readiness
Phase 2: Measurement
•Participant•Community•Data entry
Phase 3: Intervention
• Implementation •Monitoring•Data entry
Phase 4: Measurement
•Participant•Community•Data Entry
Phase 5: Evaluation, Dissemination, Policy & Data
Systems Development
Trai
ning
3,919
PhysicalActivity
•Decrease in recreational screen time•Increase in sleep•Increase in physical activity
HealthyFood Intake
•Decrease in sugar-sweetened beverage intake•Increase in water intake•Increase in fruit and vegetable intake
Children’s Healthy Living Program
Obesity Preventio
n
Overall Outcome
: Healthy Young Child
Environmental Changes
Promote Outcomes
Political/Economic Env.Examples:•Influence leash laws
Physical/Built Env.Examples:•Ensure water fountains are available & maintained
Social/Cultural Env.Examples:•Family, teachers, church leaders, other respected role models setting example of healthy living
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Community-Based
Environmental Intervention
& Policy Change
Data Systems
Training/Education
Si yu’us maase yan olomwaay!