Children's Healthy Living (CHL) Program

12 Pages·2011·2.04 MB·English

CHIL Novotny
July 2011 Integrated USDA AFRI Competitive Coordinated
Agricultural Program (CAP) grant for
Child Obesity Prevention
• Community - based initiative
Alaska o Preliminary work
• Healthy Living in the Pacific Islands (HLPI, 2003 - 2006)
oEarmark funding
• HLPI- Healthy Pacific Child Project (HLPI - HPCP, 2004 - 2009)
GuamCMotmahremia Nonnaow rItsehlaealrntnRhd esopfublic of Hawaii •• PStaacoookifeihcNAE oKaFlRdirRdIems Irc aDomIrnmAketSe epfHtgueinrtn faigodtt iroeiv nfdHe gP ecgaaorclamitfhnipc t( ePLftuaaintcniDddvei Agn SgrgaHr na(,Ntn s2to 0( fv40uo/8nt3 nd-0 yi2/n 10Pg01I 1()-)N 5/o3v/o1t0n)y PI)
Rofe Ppuablaliuc theI sMlaanrdsshall • CprHeLve Gnot aclh:i Clda opbaceistiyty building, systems change & policy change to
Federated • CHL Structure:
MSictarotense osifa American o PI & 5 Lead (Land Grant) Site Co - Investigator scientists
Samoa o Pacific Land Grant Directors chair Local (State / Jurisdiction) Advisory
Committees (LAC)
• for alignment with local initiatives
External Advisory Committee
FFuunnddiinngg SSttrruuccttuurree JFernannikfe Cr hAanpdoeurlskoan Management Structure
Kathryn Kolasa
Suzanne Murphy
• University of Hawaii at Manoa is grant recipient & responsible to Boyd Swinburn
USDA
Program Steering
• Subcontracts for work occurring at geographic sites: Lead LeadC Soitme Cmoi-It t/e Ceo-PD Local
o American Samoa Community College Principal Deenik, Kim, Luick, Leon- Advisory
Investigator/ Guerrero, Novotny, Vargo Committees
o Northern Marianas College Project LG Dir. Chair
o University of Alaska at Fairbanks DNiorveocttnoyr Performance Sites MaAnggalo, nLae,w Yisu,en,
o University of Guam FGPAuaSal:am FuS;; MAClN,a RMskMIa;I;, Singeo, Yudin DDataaPt Maro aCgneraangmteermr /e -Ar W-n aTilBlyksDet n- sSu
• Funding allocated for work with other organizations managed at the Hawaii; Am. Samoa Data Entry - TBD
University of Hawaii at Manoa
Training / Education Center –
o College of Micronesia – FSM, RMI & Palau Coordinating Center – Novotny Dunn/Leon-Guerrero
o Kapiolani Community College (Hawaii) AFisasliksotawnstk Pirogram Director - Education Coordinator - TBD
o Windward Community College (Hawaii) PPCWrroeoonbggf rre/aar ImmeTn cAASeddp Cmmecoiiionnarli Sidsstuitrn pa-a ptTtoooBrrr Dt -- -WT Jraootenaggnnaebre CEenxOtteeurrtFr n-eaTaaccilal hiCkt aWaothmooarrmssk h-eu rTisn /B -i DH cTaBotDliloyner
OObbeessiittyy iinn tthhee UUSS –– AAffffiilliiaatteedd PPaacciiffiicc RReeggiioonn OObbjjeeccttiivveess
1. Conduct program / data inventories & needs assessment
• Understudied population
o Not included in National Health & Nutrition examination 2. Train 22 professionals & paraprofessionals
system (NHANES) since 1978
• Pacific populations at risk for obesity due to: 3. Develop Pacific food, nutrition & physical activity data
management & evaluation system
o Western influences / acculturation of Native populations
(nutrition transition)
4. Develop & conduct an environmental intervention in order to
o Shortage of trained nutrition & health professionals prevent, maintain or decrease young child overweight and
obesity in the Pacific Region
5. Evaluate the community based primary prevention
environmental intervention
6. Incur at least one environmental policy change per state /
jurisdiction
CHIL Novotny
NNeeeeddss AAsssseessssmmeenntt && TTrraaiinniinngg//EEdduuccaattiioonn PPllaann
DDaattaa aanndd PPrrooggrraamm IInnvveennttoorriieess
• Formal degree training in accredited programs - multidisciplinary
• 8 Geographic Sites aspects of obesity prevention (Associates to Doctorate)
o Hawaii, Alaska, Guam, CNMI, Am Samoa, Freely Associated
States (FSM, RMI, CNMI) • Two trainees per jurisdiction (8 from FSM)
• Freely Associated States will focus on Training & External o Enroll in an appropriate CHL degree program
Communication o Work with Lead Site Co-I at home site:
• Conduct data / program inventory & needs assessment
• Conduct intervention
• Translate CHL materials for local language & culture
• Disseminate / feedback to community (external
communication)
• Program evaluation
• Policy development & implementation
TTrraaiinneeee DDeeggrreeee PPrrooggrraamm Intervention Goal: Build the social / cultural, physical / built & political
/ economic environment to promote active play and intake of healthy food
Total number of trainees = 22 to prevent young child obesity in the Pacific Region.
2 2
2 2 2 2 2 2 2 2 2 SoScePinDaaalso/ttcoCotrrou,, r GlT,t oCueavhrecaihrelnfe ,Eorrn,v.
Extended Family,
Parents
Healthy
PolitiLcaawl/sE /c Poonliocmiesi c- Env. Food Intake HCehailltdhy
AK HI Guam CNMI AS Palau FSM RMI PIrnoStgetrraantmea t/;i JoFunoraoilsd,d N /ic aAttiicootninv;aitl,y Active Play / LOibveinsigt y/
Costs Physical Prevention
Physical/Built Env. Activity
Mountain,
FAS GardOecne/aFna,rm,
Health Center,
Church, School,
Store, Home
IInntteerrvveennttiioonn EEnnvviirroonnmmeennttaall CCoommppoonneennttss AAggee FFooccuuss
• Social / cultural • USDA grant requirement - focus on children 2 - 8 years old
o experiential gardening & other physical activity
o cooking & tasting • Environmental emphasis of CHL will benefit children of other
• Political / economic ages
o promote & incentivize low – cost, nutrient – dense, low energy –
dense food • Recruit children for intervention program through schools &
o promote and incentivize environment for physical activity school programs provides:
oconsistent sampling frame across sites
• Physical / built onatural grouping of children of target ages
o community garden / fishing
o enhance physical environments (eg. playgrounds, parks,
gardens) in community for active play
o improve usability of existing facilities for children (safety,
desirability, etc..)
CHIL Novotny
TThheeoorreettiiccaall EElleemmeennttss RReesseeaarrcchh IInntteerrvveennttiioonn DDeessiiggnn
• Social Ecological Model • Community-randomized controlled trial
o social / cultural, physical / built & political / economic environment
o 5 Geographic Sites (Hawaii, Alaska, Guam, CNMI, Am Samoa),
• Multilevel Model of Influences on Obesity totaling 20 communities and 40 schools/sampling units
o levels of influence – we focus on environment
o 4 communities in will be selected in two pairs from each
• Social Cognitive Theory geographic site (eg Hawaii)
o Dietary & physical activity behaviors influenced by • 1 community of each pair randomized to intervention & 1 to
• individual / personal factors (cognitive) comparison / control
• environmental factors • Communities identified based on census block / tract data
o CHL focus on environmental influences on diet & physical activity
• control individual / personal factors in design & analysis o Each selected community will have a preschool / Headstart and
an elementary school / program
• Angelo Framework
o community based participatory research (Boyd Swinburn - External Advisor) o 20 children/class in 8 schools in 4 communities (2 intervention
• identify community factors for intervention & 2 comparison) per geographic site (800 children total across
5 geographic sites)
• RE-AIM Framework
o evaluate the intervention
• provides indicators of reach, effectiveness, efficiency, impact & sustainability
GGrroouupp RRaannddoommiizzaattiioonn ((22--55 yy;; 55--88 yy)) MMaaiinn IInntteerrvveennttiioonn CCoommppoonneennttss –– FFoooodd EEnnvviirroonnmmeenntt
• Targets:
HI Guam AK CNMI AS o Dinetacrkeease sugar sweetened beverage
o Increase healthy local low cost nutrient
dense food intake
• Promotion in target school program
PS + ES PS + ES PS + ES PS + ES PS + ES environments
Cluster Cluster Cluster Cluster Cluster o families
n=40 n=40 n=40 n=40 n=40 o neighborhood stores
Control Control Control Control Control o neighborhood churches
PCCnSolu= n+s4t trE0eorSl PCCnSolu= n+s4t trE0eorSl PCCnSolu= n+s4t trE0eorSl PCCnSolu= n+s4t trE0eorSl CCnoPlu=EnSs4St t+r0eorl • ooo InforOCLmootahwoteki ocrin nonsg eati bngohuubttro iferohnootd odsde ncsoem fmooudnsity groups
PS + ES PS + ES PS + ES PS + ES PS + ES
Cluster Cluster Cluster Cluster Cluster • Experience with foods
Intenr=ve4n0tion Intenr=ve4n0tion Intenr=ve4n0tion Intenr=ve4n0tion Intenr=ve4n0tion oo CTaosotkiningg
IntPCenSrlu= v+se4 tnE0etrSion IntPCenSrlu= v+se4 tnE0etrSion IntPCenSrlu= v+se4 tnE0etrSion InPCtneSlru= +nvs4e tE0nerStio InPCtneSlru= +nvs4e tE0enrStio • oo DevelGEfoonrpooh d&was n/iinmrcegepc iilnpetmeaskeen to pf o plircoimesoted
PS = Pre-school; ES = Elementary School; Total n = 800 @ baseline
IInntteerrvveennttiioonn CCoommppoonneennttss HHyyppootthheesseess
PPhhyyssiiccaall AAccttiivviittyy EEnnvviirroonnmmeenntt
Compared to comparison group, children in the intervention group will
• Targets: have:
o Decrease screen time
o Increase active play with healthy local physical activities 1. 7% lower gain in BMI for age & sex
• Promote in target school program environments
oo FParomgirlaiems staff 2. 15 min / d more sleep
o Enhance opportunity for activity in neighborhood
o Provide information & experience - equipment to 3. 5 % less acanthosis nigricans
health
o Provide experience
• Policy 4. 0.5 c / d less sugar-sweetened beverage intake & 0.5 c / d more
o Enhance opportunity & infrastructure water intake
5. 1 serving / d more fruit & vegetable intake
6. 10 min / d less TV / video viewing & 10 min / d more physical
Cultural Dance, Guam activity
CHIL Novotny
RReesseeaarrcchh MMeeaassuurreemmeenntt MMeeaassuurreess ooff CChhiillddrreenn
Minimum Detectable Differences (MDD) • Child Anthropometry
critical level = 0.05 (two-sided), power = 80%, and attrition rate = 10% o Weight & height to determine BMI (2 - 8y)
MDD for: • Functional Outcomes of Obesity
o Sleep quality & duration - min / d (questionnaire & accelerometry)
Daily Minutes in o Acanthosis nigricans - parent report & interviewer verification
Daily servings Moderate to
#r ecchriulditreedn Total # (OMveearnw=e0ig.3h4t, (oMf feraunit=/1v.e1g8s, Vi(gMoreoauns= A2c6t.i3v,ity • Food
Comparison # groups per group post Effect size* SD=0.2467) SD=0.79) SD=13.5) o Dietary intake by 2 d diary
Pacific region, ages 2-8§ 40 20 720 0.28 7.0% 0.22 3.8 • Dietary quality: healthy eating index
Pgraocuifpic§ region, each age 20 20 300 0.40 9.9% 0.32 5.4 • Fobodev gerroaugpess,: wadadteerd, fsruugiat r/s v, esugegtaarb slwe,e leotceanl efdoods
Site-specific, ages 2-8† 8 20 144 0.54 13.3% 0.43 7.3 • Nutrients: protein, fat, carbohydrate
Site-specific, each age 4 20 72 0.76 18.9% 0.60 10.3 o Food costs from store survey
group† o Food security from parent survey
*§E afdfejucst tseidze f oisr aG sRtaTn (dcalurdstiezreidn gm) ibnyim geuomg rdaeptheicct asbitlee difference (MDD) • Physical Activity
o Physical activity by 2 d diary
o Child accelerometry for a 7- d period
o Child screen time questionnaire
RReeaacchh,, EEffffiiccaaccyy,, AAddooppttiioonn,, RReesseeaarrcchh IInntteerrvveennttiioonn AAnnaallyyssiiss
IImmpplleemmeennttaattiioonn && MMaaiinntteennaannccee ((RREE--AAIIMM))
• Research Objectives:
oDetermine prevalence of obesity at baseline
• Framework to document intervention effectiveness and
sustainability
oDetermine prevalence & incidence of obesity over
• Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion time through the comparison groups
interventions: the RE-AIM framework. American Journal of Public Health. 1999;89(9):1322-
1327.
oTest the intervention for impact
IInntteerrvveennttiioonn DDaattaa AAnnaallyyssiiss IInntteerrvveennttiioonn MMeeaassuurreemmeenntt TTiimmeelliinnee
• Unit of randomization is community - group randomized
trial (GRT)
oStratified by a few important covariates (eg. size of the
school group)
oComparison of the intervention & control groups at
group level, rather than at the child level 2 d diet/PA 2 d diet/PA 2 d diet/PA 2 d diet/PA
Screen time Screen time Screen time Screen time
…. …. …. ….
• Children will be clustered within groups (randomization
units)
CHIL Novotny
IInntteerrvveennttiioonn MMeeaassuurreemmeenntt TTiimmeelliinnee IInntteerrvveennttiioonn RReesseeaarrcchh IInnnnoovvaattiioonn
• Unique, understudied people in fragile & remote environment
• Measurements
o Limited food options & physical space for activity
oBaseline (Sept / Oct 2012) o Opportunity for large impact
o9 mo. (June / July 2013)
• Community “environmental” change
o18 mo. (Mar / Apr 2013) o Local low cost nutrient dense food policy & availability
(stores, lunch wagons…)
o27 mo. (Dec / Jan 2014)
o Active play policy & opportunity (safe, space, rules allow)
• Pre-post analysis: baseline to 18 mo • Positive deviance / Appreciative inquiry approach
• Follow up / maintenance: 27 mo
Food Store, Rural Oahu, Hawaii
PPoolliiccyy cchhaannggee ttoo pprreevveenntt cchhiilldd oobbeessiittyy PPrroommoottiioonn//PPoolliiccyy EExxaammppllee
iinn tthhee PPaacciiffiicc RReeggiioonn Safe Physical Activity Environment:
Controlling Wild Dogs
• Local Advisory Committee & Lead Site Investigator will
lead local policy change using CHL findings
• Year 5 CHL Annual meeting will include policy planning
Micronesia
IInntteeggrraattiioonn ooff IInnssttrruuccttiioonn,, RReesseeaarrcchh,, && EExxtteennssiioonn RReesseeaarrcchh DDiisssseemmiinnaattiioonn // EExxtteennssiioonn
• CHL is integrated – research, education (degree • Prevalence & incidence data
seeking) & outreach
o CHL (research) intervention - community based -
platform for education (instruction) • Effective elements of the intervention, providing effective
• Trainees will have a CHL project appropriate to intervention components to control communities
level
o Developed with Academic Advisor & Lead Site
Co-I of their home
o Work with local advisory committee (extension)
o Results of CHL & the student work presented to
community agencies (Dept. Health, Education &
Agriculture) (extension)
o Policy recommendations (extension)
CHIL Novotny
LLoonngg TTeerrmm SSuussttaaiinnaabbiilliittyy
• Resources / framework for continuation
o Land Grant Infrastructure - existing professionals & CHL trained child obesity
prevention professionals
o Coordination & action through Local Advisory Committees
o Pacific food, nutrition & physical activity data system CChhiillddrreenn’’ss HHeeaalltthhyy LLiivviinngg TTeeaamm &&
o Community ownership of intervention changes
• Collaborations / Partnership / Alignment TThhee FFoooodd && PPhhyyssiiccaall AAccttiivviittyy
o RMATRIX - UH Research Center of Minority Institutions Multidisciplinary &
Translational Research Infrastructure Expansion EEnnvviirroonnmmeenntt iinn tthhee PPaacciiffiicc RReeggiioonn
o U54 University of Hawaii / University of Guam Partnership Grant to Reduce Cancer
Health Disparities
o PIHOA - Pacific Island Health Officers Association (Health Ministers / Directors of
Health for the Pacific Region)
o Pacific-wide collaborative chronic disease prevention planning team (World Health
Organization, the Food & Agriculture Organization & the Secretariat of the Pacific
Community, Centers for Disease Control & UNICEF)
• Spin off / Follow on proposals
• Policy change to redirect program resources to support healthy living for children,
& prevention of child obesity
TTeeaamm HHaawwaaiiii
UUnniivveerrssiittyy ooff HHaawwaaiiii ((UUHH)) SSyysstteemm
• Dr. Rachel Novotny, PI & Hawaii Lead Investigator, UH Manoa,
College of Tropical Agriculture & Human Resources (CTAHR)
o Nutritional Epidemiologist & Anthropologist – food patterns,
physical activity & health effects among diverse ethnic
populations
• 13 Hawaii-based Co-Investigators in agriculture, child development,
culinary arts, economics, nutrition, nursing, physical activity,
psychology, veterinary medicine across the UH System
• Fiscal, administrative & program staff
• Interim Land Grant Director, CTAHR, Univ. Hawaii at Manoa – Dr.
Sylvia Yuen
HHaawwaaiiii MMooddeerrnn LLooccaall FFooooddss HHaawwaaiiii NNaattiivvee && LLooccaall FFooooddss
Tropical Fruits Seafood Salads
From a Taste of Heeia 2010
CHIL Novotny
HHaawwaaiiii TTrraaddiittiioonnaall PPhhyyssiiccaall AAccttiivviittyy HHaawwaaiiii MMooddeerrnn PPhhyyssiiccaall AAccttiivviittyy
Keiki Hula Auana
Keiki Hula Kahiko
Photo by Roy Yamasaki & Laua’e President Obama body surfing
Kurokawa
Surfing
Pounding Poi
Lua, Ancient Fighting Art
Photo by Dana Edmunds
Paddling Hawaiian
outrigger canoe
DDrr.. BBrreett LLuuiicckk
TTeeaamm AAllaasskkaa A16la Yskeaa rLse UadS DSAite nCuotr-iItniovne setdiguactaotrion &
UUnniivveerrssiittyy ooff AAllaasskkaa FFaaiirrbbaannkkss food safety funding
NIH funded for obesity prevention, diet
& physical activity assessment among
• Dr. Bret Luick - Lead Site Co-I
Alaska Natives
oNutritionist, economist & extension specialist 15 years experience with food cost
• Dr. Andrea Bersamin – Co-I assessment
oNutritionist ASgcrhicouoltlu oraf lN Sactuiernacl eRse s&o Curocoepse &rative
• Dr. Joshua Greenburg – Co-I Extension Service
oResource economist
• Land Grant Director: Dr. Carol Lewis
AAllaasskkaa NNaattiivvee && MMooddeerrnn FFooooddss AAllaasskkaa NNaattiivvee && MMooddeerrnn AAccttiivviittyy
CHIL Novotny
TTeeaamm AAmmeerriiccaann SSaammooaa
DDrr.. DDoonn VVaarrggoo,, LLeeaadd SSiittee CCoo--II
RReesseeaarrcchh CCoooorrddiinnaattoorr
SSiiaauunnooffoo LLooggoollooggoo,, SSiittee CCoo--II
FFaammiilliieess,, 44--HH,, NNuuttrriittiioonn
RReebbeeccccaa FFiiaammee,, EExxtteennssiioonn
SSiittee PPrroojjeecctt MMaannaaggeerr
SShhaarroonn FFaannoolluuaa,, RReesseeaarrcchh
SSiittee PPrroojjeecctt MMaannaaggeerr
AAggnneess VVaarrggoo,, RReesseeaarrcchh
IInntteerrvveennttiioonn SSppeecciiaalliisstt
LLaanndd DDGGaarrnnaa n nMMtt DDaaggiirreeeeoocc AAttooggrraa ((&& DDeeaann)):: DDrr..
Quarter Pounder 510 cal 26 g fat 1190 mg Na 9 g sugar
Small Fries 230 cal 11 g fat 160 mg Na 0 g sugar No nutritional information available
Small Coke 150 cal 0 g fat 10 mg Na 40 g sugar
4pc Nuggets 190 cal 12 g fat 400 mg Na 0 g sugar
TTeeaamm CCNNMMII
TTeeaamm CCNNMMII
Northern Marianas College
Cooperative, Research, Extension and Extension Service
From left: Jonathan Kiyoshi (Nutrition Educator Assistant), Tayna Belyeu-Camacho (Site Co-I), Patricia Coleman (Interim
Site Manager), Rose Castro (Site Co-I), Bonnie T. Royal (Administrative Contact), Jang H. Kim (Lead Site Co-I)
Land Grant Director: Mr. Ross M. Manglona
CHIL Novotny
NNoorrtthheerrnn MMaarriiaannaass CCoolllleeggee NNoorrtthheerrnn MMaarriiaannaass CCoolllleeggee
• Site Co-I: Tayna Belyeu-Camacho
• Lead Site Co-I: Jang Ho Kim, PhD
oNon-Communicable Disease
oFood Scientist at NMC-CREES Prevention and Control Program
oDevelop value-added products using Coordinator
local produce oExtensive experiences to plan and
oprovide food safety training and implement program addressing
consultation on HACCP and GMP childhood obesity and diabetes
oProgram Steering Committee, oOutreach, needs assessment work
training program work group group
NNoorrtthheerrnn MMaarriiaannaass CCoolllleeggee NNoorrtthheerrnn MMaarriiaannaass CCoolllleeggee
• Interim Site Manager: Patricia Coleman
• Site Co-I: Rose Castro –Expanded Food and Nutrition
oNutrition Educator Education Program (EFNEP), Diet,
oProvide nutrition research-based Physical Activity, and Health Program
information to the community (DPAH), & CNMI-Healthy Living in
oIntervention work group the Pacific Islands (HLPI) Nutrition
Program Leader
–Extensive experiences to manage
programs addressing childhood
obesity and diabetes
CHIL Novotny
PPhhyyssiiccaall AAccttiivviittyy TTeeaamm GGuuaamm
Lead Site Co-Investigator
• Rachael T. Leon Guerrero, PhD, RD
Site Co-Investigators:
• Gena A. Rojas, MS
• L. Robert Barber, PhD
• Yvette C. Paulino, PhD
• Margaret Hattori-Uchima, MSN, RN
• Roseann M. Jones, PhD
Land Grant (Cooperative Ext) Director:
Lee S. Yudin, PhD
RRaacchhaaeell TT.. LLeeoonn GGuueerrrreerroo,, PPhhDD,, RRDD LL.. RRoobbeerrtt BBaarrbbeerr,, PPhhDD
• Guam Lead Site Co-Investigator
• Guam Co-investigator
• Nutrition faculty with 11 years experience in
Extension/Outreach doing obesity & chronic • Professor/Specialist in Ag Economics;
disease prevention programs, Guam EFNEP ANR Program Leader; Guam Sustainable
Coordinator, and Co-Leader of 2 NCI-funded Ag Coordinator
research projects
• Guam Cooperative Extension Service,
• Guam Cooperative Extension Service, College College of Natural & Applied Sciences,
of Natural & Applied Sciences, University of University of Guam
Guam
MMaarrggaarreett HHaattttoorrii--UUcchhiimmaa,, RRNN,, MMSSNN RRoosseeaannnn MM.. JJoonneess,, PPhhDD
• Guam Co-investigator • Guam Co-Investigator
• Professor of Economics, Studies of
• Assistant Professor of Nursing, research in Guam’s health system; PI for US SBA
health disparities, experience in funded research of regional impact of
community health outreach, work with trade, health, and migration
Chuukese migrants in Guam
• School of Business and Public
• School of Nursing & Health Sciences, Administration, University of Guam
University of Guam