An Exploratory Mixed Method Cross-Sectional Study to Identify Opportunities to Increase Enrollment and Retention of Native Hawaiian Students in an Undergraduate Dietetic Program

BACKGROUND

Native Hawaiians (NH) are underrepresented in dietetics, contributing to less than 1% of the profession nationally. Increasing the number of NH Registered Dietitian Nutritionists (RDN) is one mechanism to facilitate improved health outcomes in disparate populations.

OBJECTIVES

1) Identify and summarize NH student interests in the field of nutrition and dietetics; 2) Identify and contextualize factors that support and prohibit achievement of academic goals and aspirations; 3) Identify NH students' responsibility to the community; 4) Explore the context around NH alumni enrollment in nutrition and dietetics and their perceived impact of RDNs in the community; 5) Identify and describe supporting agencies that foster academic and professional success.

DESIGN

This exploratory mixed-methods cross-sectional study surveyed all levels of NH nutrition and dietetics students in the University of Hawai'i (UH) System. In addition, in-depth interviews were conducted with NH students, NH alumni, and supporting agencies to identify supports and barriers, explore the context of NH enrollment in nutrition and dietetics, and the contribution of dietetics to the NH community.

PARTICIPANTS/SETTING

Eighty-one NH students enrolled in a nutrition course across the UH system were surveyed. Nine of the 81 NH students surveyed, eight NH alumni, and persons from 15 identified supporting agencies were interviewed.

ANALYSIS

Survey responses were descriptively analyzed. Open-ended survey questions and interviews were analyzed through content analysis. To ensure findings were guided by NH perspective, data were triangulated by researchers and a NH dietetics advisory council.

RESULTS

Food and chronic disease prevention and management were topics that drew NH students to the field. Bridge/scholarship programs supported NH academic achievement. Education-related cost was a perceived barrier. Alumni and students shared varying degrees of responsibility to serve the NH community. Increasing the connection between NH values and the nutrition and dietetics curriculum are an identified need.

CONCLUSION

Findings illuminate opportunities to drive future programmatic efforts. The framework used in this study should be adaptable to other programs to support overall dietetics diversity initiatives.

Exploring Foods of the Pacific: Cultural Food Identity in the US Affiliated Pacific Region

Indigenous peoples of the Pacific have seen major shifts in dietary patterns due to foreign colonization, which introduced an array of new foods. Today, foods considered traditional and acculturated are consumed in various extents. However, the definitions and identity of traditional versus acculturated foods has become unclear as many introduced foods have been incorporated into Pacific cultures. The purpose of this study was to capture culturally relevant definitions of traditional, acculturated, and locally grown foods among 10 jurisdictions of the US-Affiliated Pacific (USAP) region with a focus on fruits and vegetables. Questionnaires were used to capture definitions of these terms, and to identify a list of foods (n=121) as traditional, acculturated, and/or locally grown in addition to classify them into food groups (ie, fruit, vegetable, starch, and/or grain). For the most part, definitions of traditional, acculturated, and locally grown were agreed upon by participating USAP jurisdictions, with some supplementary caveats presented by different jurisdictions. More foods were identified as acculturated (n=75) than traditional (n=37). Fruits (n=55) were the most frequent designation and about a third were vegetables (n=44). The majority of the jurisdictions reported growing at least half of the food items. This is the first study to identify and classify foods of the Pacific from the perspective of those indigenous to the USAP region. Understanding these similarities and differences in how food is classified and identified, through the lens of those from the Pacific, is crucial for nutrition education, and understanding what foods are locally grown is important for future sustainability.

A Qualitative Analysis of a Caregivers' Experience of Complementary Feeding in a Population of Native Hawaiian, Other Pacific Islander and Filipino Infants: The Timing of the Introduction of Complementary Foods, and the Role of Transgenerational Experience

The aim of this study was to investigate caregivers’ experiences of complementary feeding (CF) among the Native Hawaiian and Other Pacific Islander (NHPI), and Filipino populations. Research focused on the timing of CF commencement, and the influence of transgenerational experience on feeding practices. The experiences and practices of those who fed human milk exclusively (HME), were compared to those who included infant formula (F&HM). Caregivers of a subset of 32 infants who were participating in a larger longitudinal study relating to CF and diet diversity, took part in voluntary in-depth interviews relating to CF practices. Interviews were recorded and transcribed. Two researchers analyzed interview transcripts. Interrater reliability and saturation were established. Institutional Review Board exemption was confirmed prior to study commencement. Interviews with 29 caregivers of infants were included in this study. Only infants of the F&HM group had an early introduction to complementary foods (<4 months of age). Caregivers reported receiving conflicting advice from healthcare professionals (HCPs) in relation to timing of the introduction of complementary foods. Nonetheless, the majority of caregivers reported following the advice of HCPs. Extended family (including grandparents) played less of a role in infant feeding, compared to previous generations. While transgenerational practices were valued and included, ultimately, the perceived health and safety of the practice for infants influenced decisions.

Consumption of Traditional Fruits and Vegetables among Children in the US-Affiliated Pacific Region

Background

Traditional Pacific diets have many health benefits, including maintenance of a healthy weight and prevention of various diseases. Few studies have evaluated the frequency at which traditional diets are consumed in the Pacific, especially among children.

Objectives

This study examined the frequency of traditional and acculturated fruit and vegetable (F&V) intake among children in the US-affiliated Pacific (USAP) region.

Methods

Diet records of 3319 children ages 2 to 8 y old were analyzed for frequency of traditional or acculturated F&V intake within USAP jurisdictions of American Samoa, Commonwealth of the Northern Mariana Islands (CNMI), Federated States of Micronesia (FSM; FSM island states include Chuuk, Kosrae, Pohnpei, and Yap), Guam, Hawaii, Republic of the Marshall Islands (RMI), and Republic of Palau.

Results

Of the 95,304 food items recorded among participating children in the USAP jurisdictions, 15.2% were F&Vs. Of the 10 jurisdictions, children in the islands of Chuuk, Kosrae, Yap, and Pohnpei recorded the highest frequencies of traditional F&V intake relative to their total F&V intake (67.8%, 64.8%, 56.7%, and 52.5%, respectively). American Samoa and RMI recorded moderate frequency of traditional F&V intake (38.9% and 46.4%, respectively), whereas children in Hawaii, Guam, and CNMI recorded the lowest frequencies of traditional F&V intake relative to their total F&V intake (10.4%, 12.4%, and 15.3%, respectively). Children in Hawaii, Guam, Palau, and CNMI recorded high frequencies of acculturated F&V intake (37.8%, 31.2%, 34.5%, and 27.9%, respectively).

Conclusions

Overall, children in the USAP jurisdictions participating in this study recorded a low frequency of F&V intake. The differences in traditional F&V intake found between the USAP islands may be due to variation in economic income level and external influences on social and cultural norms among the island populations and variations of cost, accessibility, and convenience of each category of food to each island's population.

Hawai'i Registered Dietitian Nutritionist 2019-2020 Workforce Assessment

There is scant literature available on the Registered Dietitian Nutritionist (RDN) workforce in the United States, but a review of healthcare systems suggests that implementation of RDNs in primary care settings may improve access to care, patient satisfaction, and quality of care. The Area Health Education Center (AHEC), in partnership with the Hawai'i Academy of Nutrition and Dietetics (HAND), investigated 395 providers to evaluate the status of Hawai'i's RDN workforce. The research team utilized all available provider information and direct calling methodology to collect data from August 2019 to February 2020. Microsoft Excel software allowed for data analysis and ArcGIS mapping software was used to visualize provider totals and Full-Time Equivalencies (FTEs) across the state. This study identifies trends in workforce demographics and provider supply. Researchers found 100 RDNs providing direct patient care for a total of 82.4 FTEs. Women account for 94% of survey respondents, and the average age of providers was 48. RDNs who self-identify as being Asian American (41%) or White (47%) were the largest ethnic groups providing direct patient care. Seventy percent of the RDN workforce was located on O'ahu, while RDN FTEs are concentrated in mainly 5 zip codes, 1 on each of O'ahu, Kaua'i, and Maui and 2 on Hawai'i Island. Provider demand trends, increased training and retention efforts, and integration of nutritional services in healthcare teams should be further investigated.

Associations between Cultural Identity, Household Membership and Diet Quality among Native Hawaiian, Pacific Islander, and Filipino Infants in Hawai'i

Public health efforts to reduce diet-related health disparities experienced by indigenous peoples could be enhanced by efforts to improve complementary infant feeding practices. The latter is possible through interventions informed by cultural determinants. This cross-sectional secondary analysis explored possible determinants of the complementary feeding practices of Native Hawaiian, Pacific Islander, and/or Filipino infants (NHPIF) in Hawai'i, ages 3-12 months. The objective was to determine the association between caregiver cultural identity and infant household membership with indicators of infant diet healthfulness. The cultural identities, infant household memberships, early infant feeding practices and additional demographic information (infant age and sex, household income) were assessed via an online questionnaire. Surrogate reporting of the infants' diets over four days was evaluated using an image-based mobile food record (mFR). Data collected by the mFR were evaluated to derive the World Health Organization's minimum dietary diversity (MDD) indicator and food group consumption. Data were summarized by descriptive statistics and analyzed using multivariate linear and logistic regressions. Seventy infant participants, ages 3-12 months, and their primary caregivers completed the study. Of these, there were 56 infant participants between the age of 6-12 months. Approximately 10% of infants, ages 6-12 months, met MDD for all four days. Meeting MDD and the number of food groups consumed were significantly associated with age. Caregiver cultural identity, infant household membership and infant sex had non-significant associations with indicators of infant diet quality. Findings inform the influences shaping dietary patterns of Native Hawaiian, Pacific Islander and Filipino infants in Hawai'i.

Determination of Child Waist Circumference Cut Points for Metabolic Risk Based on Acanthosis Nigricans, the Children's Healthy Living Program

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.

Native Hawaiian Complementary Feeding Practices as Told by Grandparents: A Transgenerational Experience

BACKGROUND

Infancy is a significant disease prevention and health promotion stage in life. There is a need to examine factors influencing complementary feeding among Native Hawaiians through an indigenous framed lens.

OBJECTIVES

To identify Hawaiian complementary feeding practices through in-depth interviews with kūpuna (grandparents) from across the state of Hawai'i.

METHODS

The chain-referral-sampling method was used to identify Native Hawaiian kūpuna knowledgeable in Hawaiian complementary feeding practices from across 4 counties in Hawai'i. Interview question topics included sharing about their formative years, infant health, infant feeding, transgenerational knowledge, and opportunities and barriers related to traditional food consumption. Interviews were recorded and then transcribed. Three coders used NVivio12 to code transcripts using a priori and emergent themes. Institutional Review Board approval was received prior to data collection.

RESULTS

Fourteen kūpuna interviews were included in the analysis. A majority of the kūpuna were female. Most kūpuna shared that complementary feeding practices in their childhood and when their children and grandchildren were being raised reflected aspects of the traditional Hawaiian diet. Poi, or steamed mashed taro root, was the most common traditional Hawaiian dietary staple of infancy. However, kūpuna shared that traditional dietary practices evolved to reflect contemporary dietary practices such as the mixing of poi with infant cereal or milk. Female family members were prominent influences on kūpuna complementary feeding practices. Lifestyle and lack of knowledge were the most commonly shared reflections by kūpuna on the supports and barriers, respectively, to promoting and engaging in traditional Hawaiian complementary feeding practices.

CONCLUSIONS

Complementary feeding practices have evolved over generations but aspects of traditional Hawaiian feeding practices have remained. These findings are important when working with Hawaiian families because kūpuna play a prominent role in feeding infants.

Type, Timing, and Diversity of Complementary Foods Among Native Hawaiian, Pacific Islander, and Filipino Infants

Prevention is the recommended strategy for addressing childhood obesity and may be particularly important for minority groups such as Native Hawaiians, Pacific Islanders, and Filipinos (NHPIF) who display poorer health outcomes than other race/ethnic groups. Complementary feeding is a critical milestone in the first 1,000 days of life and plays a critical role in growth and eating habit formation. This cross-sectional study recruited NHPIF infants between 3 - 12 months of age residing on O'ahu, Hawai'i to examine timing and types of complementary foods introduced first as well as the dietary diversity of those infants 6 - 12 months of age. Basic demographic information and early feeding practices were assessed via online questionnaire. Diet was evaluated using the image-based mobile food record completed over 4-days. Images were evaluated to derive the World Health Organization's minimum dietary diversity (MDD) score. Data were analyzed using descriptive statistics and linear regressions. Seventy participants completed the study with a majority being between the ages of 6 - 12 months (n=56). About half of the participants were provided a complementary food prior to 6 months of age with the most common first complementary food being poi (steamed, mashed taro). Grains were the most commonly reported food group while the high protein food groups was the least commonly reported. Approximately 25% of infants 6 - 12 months of age met MDD all four days. Meeting MDD was significantly associated with age. Findings illuminate opportunities for improvement (eg, delayed introduction) and for promotion (eg, cultural foods) in NHPIF complementary feeding.

Open Educational Resource Textbook Impact on Students in an Introductory Nutrition Course

OBJECTIVE

To determine if student outcomes, usage, perceptions, and engagement differ between introductory nutrition courses that used an open educational resource (OER) textbook compared with a traditional textbook.

DESIGN

Cross-sectional.

SETTING

College introductory nutrition course.

PARTICIPANTS

Students enrolled in introductory nutrition courses that used a traditional textbook or an OER textbook.

INTERVENTION

Implementation of an OER textbook in all introductory nutrition courses during 1 semester.

MAIN OUTCOME MEASURE(S)

Usage, perceptions, and engagement with the textbook were evaluated by an online survey. Student outcome data (eg, grades) were collected from the learning management system at the end of the semester.

ANALYSIS

Differences in student outcomes, usage, perceptions, and engagement were determined by t tests. Open-ended responses on textbook likes and dislikes were evaluated by thematic analysis.

RESULTS

The number of students who completed the introductory nutrition course with a traditional textbook (n = 346) was higher than those who completed the course with an OER textbook (n = 311). There was no difference in student outcomes between textbooks. P values for student usage ranged from <.001 to .001, <.001 for engagement, and <.001 to .001 for perception with the OER textbook, with significantly better P values for outcomes than those with the traditional textbook. The $0 cost and place-based nature were noted as positive attributes of the OER textbook, whereas students appreciated the format and visual appeal of the traditional textbook.

CONCLUSIONS AND IMPLICATIONS

Academic performance in introductory nutrition was not affected by an OER textbook. An OER textbook for introductory nutrition may be an appropriate solution for institutions seeking to reduce student costs.

Plate Waste in School Lunch: Barriers, Motivators, and Perspectives of SNAP-Eligible Early Adolescents in the US

OBJECTIVE

To determine barriers, motivators, and perspectives regarding plate waste reduction of early adolescents.

DESIGN

Trained interviewers conducted audio-recorded individual interviews with adolescents.

SETTING

Elementary schools implementing the National School Lunch Program in Hawai'i, Montana, and Virginia.

PARTICIPANTS

Early adolescents (n = 47, aged 9-13 years) from families receiving or eligible to receive Supplemental Nutrition Assistance Program benefits were recruited to participate.

PHENOMENON OF INTEREST

Factors influencing plate waste among adolescents and potential plate waste reduction strategies.

ANALYSIS

Coders analyzed content and thematic data to identify code categories and themes.

RESULTS

Main barriers to reducing school lunch plate waste were unsupportive school policy, undesirable food quality, satiation, and social influences. Key motivators to reducing school lunch plate waste were supportive school policy, including allowing students to share food with peers and save food to eat later; and social influences. Participants found it acceptable to throw away disliked food and unacceptable to throw away wanted food; they perceived that their peers did not care whether food was thrown away; and they thought their parents disliked wasting food.

CONCLUSION AND IMPLICATIONS

Results suggest that several factors might allow for minimization of school lunch plate waste in the National School Lunch Program, including improvements in food quality, food policy, and social influences. Under these important themes, strategies to employ may include improving food preparation and taste, allocating more time for students to finish lunch, allowing students to self-select food lunch items, and permitting them to share and save their leftover food.

Collecting wrappers, labels, and packages to enhance accuracy of food records among children 2-8 years in the Pacific region: Children's Healthy Living Program (CHL)

The aim was to describe differences in dietary outcomes based on the provision of food wrappers, labels or packages (WLP) to complement data from dietary records (DR) among children from the US Affiliated Pacific. The WLP were intended to aid food coding. Since WLP can be associated with ultra-processed foods, one might expect differences in sodium, sugar, and other added ingredients to emerge. Dietary intakes of children (2-8 y) in Alaska, Hawai'i, Commonwealth of the Northern Mariana Islands, and Guam were collected using parent/caregiver completed 2-day DR. Parents were encouraged to collect WLP associated with the child's intake. Trained staff entered data from the DRs including the WLP when available using PacTrac3, a web application. Of the 1,868 DRs collected and entered at the time of this report, 498 (27%) included WLP. After adjusting for confounders (sex, age, location, education, food assistance), the DRs with WLP had significantly higher amounts of energy (kcal), total fat, saturated fat, added sugar, and sodium. These results suggest the inclusion of WLP enhanced the dietary intake data. The intake of energy, fat, added sugar and sodium derived from processed foods and foods consumed outside the home was better captured in children who had WLP.

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)

OBJECTIVE

To quantify the Head Start (HS) teacher mediating and moderating influence on the effect of a wellness policy intervention.

DESIGN

Intervention trial within a larger randomized community trial.

SETTING

HS preschools in Hawaii.

PARTICIPANTS

Twenty-three HS classrooms located within 2 previously randomized communities.

INTERVENTION

Seven-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 MEASURES

The 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.

ANALYSIS

Paired 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.

RESULTS

General 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 IMPLICATIONS

Strategies 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.

Recruitment Strategies and Lessons Learned from the Children's Healthy Living Program Prevalence Survey

The US Affiliated Pacific region's childhood obesity prevalence has reached epidemic proportions. To guide program and policy development, a multi-site study was initiated, in collaboration with partners from across the region, to gather comprehensive information on the regional childhood obesity prevalence. The environmental and cultural diversity of the region presented challenges to recruiting for and implementing a shared community-based, public health research program. This paper presents the strategies used to recruit families with young children (n = 5775 for children 2 - 8 years old) for obesity-related measurement across eleven jurisdictions in the US Affiliated Pacific Region. Data were generated by site teams that provided summaries of their recruitment strategies and lessons learned. Conducting this large multi-site prevalence study required considerable coordination, time and flexibility. In every location, local staff knowledgeable of the community was hired to lead recruitment, and participant compensation reflected jurisdictional appropriateness (e.g., gift cards, vouchers, or cash). Although recruitment approaches were site-specific, they were predominantly school-based or a combination of school- and community-based. Lessons learned included the importance of organization buy-in; communication, and advance planning; local travel and site peculiarities; and flexibility. Future monitoring of childhood obesity prevalence in the region should consider ways to integrate measurement activities into existing organizational infrastructures for sustainability and cost-effectiveness, while meeting programmatic (e.g. study) goals.

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

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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

OBJECTIVES

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Interaction matters: Strategies to promote engaged learning in an online introductory nutrition course

Fostering interaction in the online classroom is an important consideration in ensuring that students actively create their own knowledge and reach a high level of achievement in science courses. This study focuses on fostering interaction in an online introductory nutrition course offered in a public institution of higher education in Hawai'i, USA. Interactive features included synchronous discussions and polls in scheduled sessions, and social media tools for sharing of information and resources. Qualitative student feedback was solicited regarding the new course features. Findings indicated that students who attended monthly synchronous sessions valued live interaction with peers and the instructor. Issues identified included technical difficulties during synchronous sessions, lack of participation on the part of fellow students in discussion and inability to attend synchronous sessions due to scheduling conflicts. In addition, few students made use of the opportunity to interact via social media. While students indicated that the interactive components of the course were valuable, several areas in which improvement may be made remain. Future studies may explore potential solutions to issues identified with new features to further promote interaction and foster learning in the course. Recommendations for instructors who are interested in offering online science courses in higher education are provided.

Ethnicity and acculturation: do they predict weight status in a longitudinal study among Asian, Hispanic, and non-Hispanic White early adolescent females?

Background

The prevalence of overweight and obesity among adolescents has increased over the past decade. Prevalence rates are disparate among certain racial and ethnic groups. This study sought to longitudinally examine the relationship between overweight status (≥85th percentile according to the Centers for Disease Control and Prevention growth charts) and ethnic group, as well as acculturation (generation and language spoken in the home) in a sample of adolescent females.

Methods

Asian (n=160), Hispanic (n=217), and non-Hispanic White (n=304) early adolescent girls participating in the multistate calcium intervention study with complete information on weight, ethnicity, and acculturation were included. Multiple methods of assessing longitudinal relationships (binary logistic regression model, linear regression model, Cox proportional-hazards regression analysis, and Kaplan–Meier survival analysis) were used to examine the relationship.

Results

The total proportion of girls overweight at baseline was 36%. When examining by ethnic group, the proportion varied with Hispanic girls having the highest percentage (46%) in comparison to their Asian (23%) and Non-Hispanic White (35%) counterparts. Although the total proportion of overweight was 36% at 18 months, the variation across the ethnic groups remained with the proportion of Hispanic girls becoming overweight (55%) being greater than their Asian (18%) and non-Hispanic White (34%) counterparts. However, regardless of the statistical approach used, there were no significant associations between overweight status and acculturation over time.

Conclusion

These unexpected results warrant further exploration into factors associated with overweight, especially among Hispanic girls, and further investigation of acculturation’s role is warranted. Identifying these risk factors will be important for developing targeted obesity prevention initiatives.

Using the ANGELO model to develop the children's healthy living program multilevel intervention to promote obesity preventing behaviors for young children in the U.S.-affiliated Pacific Region

BACKGROUND

Almost 40% of children are overweight or obese by age 8 years in the US-Affiliated Pacific, inclusive of the five jurisdictions of Alaska, Hawaii, American Samoa, Guam, and the Commonwealth of the Northern Mariana Islands. This article describes how the Children's Healthy Living (CHL) Program used the ANGELO (Analysis Grid for Environments/Elements Linked to Obesity) model to design a regional intervention to increase fruit and vegetable intake, water consumption, physical activity, and sleep duration and decrease recreational screen time and sugar-sweetened beverage consumption in young children ages 2-8 years.

METHODS

Using the ANGELO model, CHL (1) engaged community to identify preferred intervention strategies, (2) reviewed scientific literature, (3) merged findings from community and literature, and (4) formulated the regional intervention.

RESULTS

More than 900 community members across the Pacific helped identify intervention strategies on importance and feasibility. Nine common intervention strategies emerged. Participants supported the idea of a regional intervention while noting that cultural and resource differences would require flexibility in its implementation in the five jurisdictions. Community findings were merged with the effective obesity-reducing strategies identified in the literature, resulting in a regional intervention with four cross-cutting functions: (1) initiate or strengthen school wellness policies; (2) partner and advocate for environmental change; (3) promote CHL messages; and (4) train trainers to promote CHL behavioral objectives for children ages 2-8 years. These broad functions guided intervention activities and allowed communities to tailor activities to maximize intervention fit.

CONCLUSIONS

Using the ANGELO model assured that the regional intervention was evidence based while recognizing jurisdiction context, which should increase effectiveness and sustainability.

Misreporting of dietary intake affects estimated nutrient intakes in low-income Spanish-speaking women

Misreporting of dietary intake affects the validity of data collected and conclusions drawn in studies exploring diet and health outcomes. One consequence of misreporting is biological implausibility. Little is known regarding how accounting for biological implausibility of reported intake affects nutrient intake estimates in Hispanics, a rapidly growing demographic in the United States. Our study explores the effect of accounting for plausibility on nutrient intake estimates in a sample of Mexican-American women in northern California in 2008. Nutrient intakes are compared with Dietary Reference Intake recommendations, and intakes of Mexican-American women in a national survey are presented as a reference. Eighty-two women provided three 24-hour recalls. Reported energy intakes were classified as biologically plausible or implausible using the reported energy intakes to total energy expenditure cutoff of <0.76 or >1.24, with low-active physical activity levels used to estimate total energy expenditure. Differences in the means of nutrient intakes between implausible (n=36) and plausible (n=46) reporters of energy intake were examined by bivariate linear regression. Estimated energy, protein, cholesterol, dietary fiber, and vitamin E intakes were significantly higher in plausible reporters than implausible. There was a significant difference between the proportions of plausible vs implausible reporters meeting recommendations for several nutrients, with a larger proportion of plausible reporters meeting recommendations. Further research related to misreporting in Hispanic populations is warranted to explore the causes and effects of misreporting in studies measuring dietary intake, as well as actions to be taken to prevent or account for this issue.

Children's Healthy Living (CHL) Program for remote underserved minority populations in the Pacific region: rationale and design of a community randomized trial to prevent early childhood obesity

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.

Dietary patterns are associated with dietary recommendations but have limited relationship to BMI in the Communities Advancing the Studies of Tribal Nations Across the Lifespan (CoASTAL) cohort

OBJECTIVE

Traditional food systems in indigenous groups have historically had health-promoting benefits. The objectives of the present study were to determine if a traditional dietary pattern of Pacific Northwest Tribal Nations (PNwT) could be derived using reduced rank regression and if the pattern would be associated with lower BMI and current Dietary Reference Intakes.

DESIGN

The baseline data from the Communities Advancing the Studies of Tribal Nations Across the Lifespan (CoASTAL) cohort were used to derive dietary patterns for the total sample and those with plausibly reported energy intakes.

SETTING

Pacific Northwest Coast of Washington State, USA.

SUBJECTS

Adult PNwT members of the CoASTAL cohort with laboratory-measured weight and height and up to 4 d of dietary records (n 418).

RESULTS

A traditional dietary pattern did not evolve from the analysis. Moderate consumption of a sweet drinks dietary pattern was associated with lower BMI while higher consumption of a vegetarian-based dietary pattern was associated with higher BMI. The highest consumers of the vegetarian-based dietary pattern were almost six times more likely to meet the recommendations for dietary fibre.

CONCLUSIONS

Distinct dietary patterns were found. Further exploration is needed to confirm whether the lack of finding a traditional pattern is due to methodology or the loss of a traditional dietary pattern among this population. Longitudinal assessment of the CoASTAL cohort's dietary patterns needs to continue.

The relevancy of community-based methods: using diet within Native American and Alaska Native adult populations as an example

The rates of obesity, diabetes, and heart disease in Native Americans and Alaska Natives far exceed that of the general US population. There are many postulating reasons for these excessive rates including the transition from a traditional to a contemporary diet. Although information on the dietary intakes of Native American and Alaska Native communities are limited, there seems to be a consensus that the Native American and Alaska Native diet is high in total fat, saturated fat, cholesterol, and sodium. Further information on the diet needs to be attained so that dietary interventions can effectively be implemented in these communities. An approach that is community based is proposed as the best solution to understanding the Native diet and developing culturally tailored interventions to sustainably improve diet.

Estimated nutrient intakes from food generally do not meet dietary reference intakes among adult members of Pacific Northwest tribal nations

Diet is influential in the etiology of chronic diseases in many populations including Native Americans. The objective of this report is to present the first comprehensive dietary survey, to our knowledge, of a representative sample of nonpregnant adults from Pacific Northwest tribal nations participating in the Communities Advancing the Studies of Tribal Nations Across the Lifespan (CoASTAL) cohort. Only participants who completed 1-4 d of dietary records and had weights and heights measured in the laboratory were eligible for this analysis (n = 418). Mean nutrient intakes were stratified by gender for the total sample, those with plausibly reported energy intakes (rEI), and those with implausibly rEI. Estimates of nutrient intakes were compared with Dietary Reference Intakes (DRI). Nutrient estimates from NHANES 2001-2002 were used as a reference. Among both men and women, total fat contributed 34-37% of energy intake and saturated fat contributed 11-12% of energy intake. Daily cholesterol intakes ranged from 262 to 442 mg. A majority of men and women were not meeting recommendations for vitamins A, C, and E, magnesium, and sodium. For a majority of the nutrients examined, plausibility resulted in higher mean estimates. The CoASTAL cohort nutrient profile is similar to NHANES 2001-2002, with a majority of DRI recommendations not being met. Adequate dietary intake information may be more important for this population, because Native Americans experience a disproportionate burden for diseases.

Evaluation of dietary assessment tools used to assess the diet of adults participating in the Communities Advancing the Studies of Tribal Nations Across the Lifespan cohort

BACKGROUND

Accurate assessment of dietary intake is essential for researchers and public health practitioners to make advancements in public health. This is especially important in Native Americans who display disease prevalence rates that are dramatically higher than the general US population.

OBJECTIVE

To evaluate three dietary assessment tools: dietary records, a food frequency questionnaire (FFQ), and a shellfish assessment survey among Native American adults from the Communities Advancing the Studies of Tribal Nations Across the Lifespan (CoASTAL) cohort.

DESIGN

The CoASTAL cohort was composed of randomly selected individuals from three tribal registries of Pacific Northwest Tribal Nations. This cross-sectional study used data from the baseline of CoASTAL and was restricted to the non-pregnant adults (aged 18 years or older) who completed the shellfish assessment survey (n=500), an FFQ (n=518), dietary records (n=444), weight measures (n=493), and height measures (n=496). Paired t tests, Pearson correlation coefficients, and percent agreement were used to evaluate the dietary records and the FFQ with and without accounting for plausibility of reported energy intake (rEI). Sensitivity and specificity as well as Spearman correlation coefficients were used to evaluate the shellfish assessment survey and the FFQ compared to dietary records.

RESULTS

Statistically significant correlations between the FFQ and dietary records for selected nutrients were not the same by sex. Accounting for plausibility of rEI for the dietary records and the FFQ improved the strength of the correlations for percent energy from protein, energy from carbohydrate, and calcium for both men and women. In addition, the association between rEI (dietary records and FFQ) and weight became significant when the sample was limited to plausible rEI. The shellfish assessment survey was found to similarly assess shellfish consumption in comparison to the FFQ.

CONCLUSIONS

These results support the benefit of multiple measures of diet, including regional and culturally specific surveys, especially among Native Americans. Accounting for plausibility of rEI may ensure more accurate estimations of dietary intakes.