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Sparks KS, Fialkowski MK, Dela Cruz R, Grandinetti A, Wilkens L, Banna JC, Bersamin A, Paulino Y, Aflague T, Coleman P, Deenik J, Fleming T, Novotny R. Acculturation and Health Status in the Children's Healthy Living Program in the Pacific Region. Int J Environ Res Public Health 2024; 21:448. [PMID: 38673359 PMCID: PMC11050529 DOI: 10.3390/ijerph21040448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024]
Abstract
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.
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Affiliation(s)
- Kalanikiekie S. Sparks
- Public Health Division, Acute and Communicable Disease Section, Oregon Health Authority, Salem, OR 97301, USA;
| | - Marie K. Fialkowski
- Nutrition Support Shared Resource, University of Hawaiʻi Cancer Center, University of Hawaiʻi at Mānoa, Honolulu, HI 96813, USA
| | - Rica Dela Cruz
- Human Nutrition, Food and Animal Sciences Department, College of Tropical Agriculture and Human Resources, University of Hawaiʻi at Mānoa, Honolulu, HI 96822, USA; (R.D.C.); (J.C.B.); (R.N.)
| | - Andrew Grandinetti
- Office of Public Health Studies, University of Hawaiʻi at Mānoa, Honolulu, HI 96822, USA;
| | - Lynne Wilkens
- Biostatistics Shared Resource, University of Hawaiʻi Cancer Center, University of Hawaiʻi at Mānoa, Honolulu, HI 96813, USA;
| | - Jinan C. Banna
- Human Nutrition, Food and Animal Sciences Department, College of Tropical Agriculture and Human Resources, University of Hawaiʻi at Mānoa, Honolulu, HI 96822, USA; (R.D.C.); (J.C.B.); (R.N.)
| | - Andrea Bersamin
- Department of Biology and Wildlife, College of Natural Sciences and Mathematics, University of Alaska Fairbanks, Fairbanks, AK 99775, USA;
| | - Yvette Paulino
- Margaret Perez Hattori-Uchima School of Health, University of Guam, Mangilao, GU 96913, USA;
| | - Tanisha Aflague
- Cooperative Extension and Outreach, College of Natural and Applied Sciences, University of Guam, Mangilao, GU 96913, USA;
| | - Patricia Coleman
- Cooperative Research, Extension, and Education Services, Northern Marianas College, Saipan, MP 96950, USA;
| | - Jonathan Deenik
- Tropical Plant and Social Sciences Department, College of Tropical Agriculture and Human Resources, University of Hawaiʻi at Mānoa, Honolulu, HI 96822, USA;
| | - Travis Fleming
- Agriculture, Community and Natural Resources Division, American Samoa Community College, Pago Pago, AS 96799, USA;
| | - Rachel Novotny
- Human Nutrition, Food and Animal Sciences Department, College of Tropical Agriculture and Human Resources, University of Hawaiʻi at Mānoa, Honolulu, HI 96822, USA; (R.D.C.); (J.C.B.); (R.N.)
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Hill CM, Nash SH, Hopkins SE, Boyer BB, OBrien DM, Bersamin A. Diet quality is positively associated with intake of traditional foods and does not differ by season in remote Yup'ik communities. Int J Circumpolar Health 2023; 82:2221370. [PMID: 37312577 PMCID: PMC10269404 DOI: 10.1080/22423982.2023.2221370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/15/2023] Open
Abstract
This study evaluated whether traditional food intake and diet quality differed by season in Yup'ik communities and examined the relationship between intake of traditional food groups and diet quality. Data were collected from 38 participants, ages 14-79 years, from two Yup'ik communities in Southwest Alaska from 2008 to 2010. Self-reported intake (24-h recalls) and dietary biomarker (nitrogen stable isotope ratio) data were collected twice in distinct seasons. Diet quality was assessed using the Healthy Eating Index. A paired sample t-test was used to test for seasonal differences in traditional food intake and diet quality, and linear regression was used to evaluate associations between traditional food intake and diet quality. Total traditional food intake and overall diet quality did not significantly differ by season, but there were differences in traditional food group intake and diet quality component scores. Diet quality was strongly associated with intake of traditional food groups including fish, tundra greens, and berries. Given the strong relationship between traditional food intake and diet quality, policies should aim to ensure continued access to traditional foods in Yup'ik communities amid environmental changes in the circumpolar North.
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Affiliation(s)
- Courtney M Hill
- Department of Biology and Wildlife, University of Fairbanks Alaska, Fairbanks, AK, USA
| | - Sarah H. Nash
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska, Fairbanks, AK, USA
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Scarlett E. Hopkins
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska, Fairbanks, AK, USA
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
| | - Bert B. Boyer
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska, Fairbanks, AK, USA
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
| | - Diane M. OBrien
- Department of Biology and Wildlife, University of Fairbanks Alaska, Fairbanks, AK, USA
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska, Fairbanks, AK, USA
| | - Andrea Bersamin
- Department of Biology and Wildlife, University of Fairbanks Alaska, Fairbanks, AK, USA
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska, Fairbanks, AK, USA
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Hill CM, Paschall MJ, Koller KR, Day GM, Lee FR, O’Brien DM, King DK, Palmer L, Thomas TK, Bersamin A. Obesity Prevalence and Dietary Factors Among Preschool-Aged Head Start Children in Remote Alaska Native Communities: Baseline Data from the " Got Neqpiaq?" Study. Child Obes 2023; 19:498-506. [PMID: 36473164 PMCID: PMC10541932 DOI: 10.1089/chi.2022.0143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: American Indian and Alaska Native preschool-aged children experience a high prevalence of obesity, yet are under-represented in obesity prevention research. This study examined obesity prevalence and dietary risk factors among Alaska Native preschool-aged children in southwest Alaska. Methods: The study used baseline data from "Got Neqpiaq?" a culturally centered multilevel intervention focused on Yup'ik Alaska Native children, aged 3-5 years, enrolled in Head Start in 12 communities in southwest Alaska (n = 155). The primary outcomes were BMI percentile, overweight, and obesity. Dietary factors of interest were measured using biomarkers: traditional food intake (nitrogen stable isotope ratio biomarker), ultraprocessed food intake (carbon stable isotope ratio biomarker), and vegetable and fruit intake (skin carotenoid status biomarker measured by the Veggie Meter). Cardiometabolic markers (glycated hemoglobin [HbA1c] and blood cholesterol) were also measured. Results: Among the Yup'ik preschool-aged children in the study, the median BMI percentile was 91, and the prevalence of overweight or obesity was 70%. The traditional food intake biomarker was negatively associated with BMI, whereas the ultraprocessed foods and vegetable and fruit biomarkers were not associated with BMI. HbA1c and blood cholesterol were within healthy levels. Conclusions: The burden of overweight and obesity is high among Yup'ik preschool-aged children. Traditional food intake is inversely associated with BMI, which underscores the need for culturally grounded interventions that emphasize traditional values and knowledge to support the traditional food systems in Alaska Native communities in southwest Alaska. Registered with ClinicalTrials.gov #NCT03601299.
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Affiliation(s)
- Courtney M. Hill
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, AK, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Mallie J. Paschall
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA, USA
| | - Kathryn R. Koller
- Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Gretchen M. Day
- Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Flora R. Lee
- Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Diane M. O’Brien
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Diane K. King
- Center for Behavioral Health Research and Services, University of Alaska Anchorage, Anchorage, AK, USA
| | - Lea Palmer
- Head Start Program, Rural Alaska Community Action Program, Inc., Anchorage, AK, USA
| | - Timothy K. Thomas
- Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Andrea Bersamin
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, AK, USA
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Walch AK, Ohle KA, Koller KR, Alexie L, Lee F, Palmer L, Nu J, Thomas TK, Bersamin A. Impact of Assistance Programs on Indigenous Ways of Life in 12 Rural Remote Western Alaska Native Communities: Elder Perspectives Shared in Formative Work for the "Got Neqpiaq?" Project. Int J Circumpolar Health 2022; 81:2024679. [PMID: 35037587 PMCID: PMC8765241 DOI: 10.1080/22423982.2021.2024679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 12/21/2021] [Accepted: 12/28/2021] [Indexed: 11/16/2022] Open
Abstract
For more than 50 years, government programmes in the USA have been in place to help those in need have consistent access to food and education. However, questions have surfaced regarding whether or not these support impact traditional ways, such as cultural activities, food preferences, and overall health, particularly for Indigenous populations. In this paper, we share insights voiced by Alaska Native Elders in the Yukon-Kuskokwim region of Alaska and their perceptions of regulations, assistance, and the impact government assistance programmes have had on their culture. Elders raised concerns so that those administering these programmes will consider how best to meet food security and education needs without interfering with Indigenous cultural practices and traditional lifestyle.
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Affiliation(s)
- Amanda K. Walch
- Dietetics & Nutrition, University of Alaska Anchorage, Anchorage, Alaska, USA
| | - Kathryn A. Ohle
- Early Childhood Education, Grand Valley State University, Grand Rapids, Michigan, USA
| | - Kathryn R. Koller
- Research Nurse Supervisor, Alaska Native Tribal Health Consortium, Research Services, Anchorage, Alaska, USA
| | - Lucinda Alexie
- Yukon-Kuskokwim Health Corporation Research Department, Associate Research Coordinator, Bethel, Alaska, USA
| | - Flora Lee
- Epidemiology Research Nurse, Alaska Native Tribal Health Consortium Research Services, Anchorage, Alaska, USA
| | - Lea Palmer
- Registered Dietitian Nutritionist, RurAL Cap Head Start, Anchorage, Alaska, USA
| | - Jennifer Nu
- Research Associate, Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, Alaska, USA
| | - Timothy K. Thomas
- Alaska Native Tribal Health Consortium Research Services, Anchorage, Alaska, USA
| | - Andrea Bersamin
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, Alaska, USA
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5
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Hill C, Nash SH, Bersamin A, Hopkins SE, Boyer BB, O’Brien DM, Chi DL. Seasonal variation in added sugar or sugar sweetened beverage intake in Alaska native communities: an exploratory study. Int J Circumpolar Health 2021; 80:1920779. [PMID: 33910491 PMCID: PMC8843354 DOI: 10.1080/22423982.2021.1920779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/01/2021] [Accepted: 03/15/2021] [Indexed: 10/24/2022] Open
Abstract
Excess added sugar intake contributes to tooth decay risk in Alaska Native communities. The goal of this exploratory study was to determine if there is seasonal variation in total added sugar intake or in the leading sources of added sugars in a Yup'ik population. Data were collected in spring and winter from 2008-2010 using self-reported intake data measured by 24-hour recall and by hair biomarker (carbon and nitrogen stable isotope). Seventy Yup'ik participants ages 14-70 years were recruited from two communities and data were collected twice from a subset of 38 participants. Self-reported added sugar intake (g/day), biomarker-predicted added sugar intake (g/day), and leading sources of added sugar were calculated. Seasonal variation was evaluated using a paired sample t-test. Total added sugar intake was 93.6 g/day and did not significantly differ by season. Sodas and other sugar-sweetened beverages (e.g. Tang, Kool-Aid) were the leading sources and added sugar from these sources did not significantly differ by season (p=.54 and p=.89, respectively). No seasonal variation in added sugar intake was detected by either self-report or biomarker. Dietary interventions that reduce intake of added sugars have the potential to reduce tooth decay in Yup'ik communities.
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Affiliation(s)
- Courtney Hill
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
| | - Sarah H. Nash
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska, Fairbanks, AK, USA
| | - Andrea Bersamin
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska, Fairbanks, AK, USA
| | - Scarlett E. Hopkins
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska, Fairbanks, AK, USA
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
| | - Bert B. Boyer
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska, Fairbanks, AK, USA
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
| | - Diane M. O’Brien
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska, Fairbanks, AK, USA
| | - Donald L. Chi
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
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Bersamin A, Hernández-Garbanzo Y, Atoloye AT, Gonzalez JU, Ríos-Castillo I, Oo TTM, Banna J, Shikieri AE, Bonsi E. Growing Our Commitment to Promoting Fruits and Vegetables: Looking Beyond the International Year of Fruits and Vegetables 2021. J Nutr Educ Behav 2021; 53:909-910. [PMID: 34763819 DOI: 10.1016/j.jneb.2021.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Andrea Bersamin
- Center for Alaska Native Health Research, University of Alaska Fairbanks
| | | | - Abiodun T Atoloye
- Uconn Rudd Center for Food Policy and Obesity, University of Connecticut
| | | | | | | | - Jinan Banna
- Department of Human Nutrition, Food and Animal Sciences, University of Hawaii Manoa
| | - Ahlam El Shikieri
- College of Applied Medical Sciences, Department of Clinical Nutrition, Taibah University
| | - Eunice Bonsi
- Department of Food and Nutritional Sciences, CAENS, Tuskegee University
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7
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Walch AK, Ohle KA, Koller KR, Alexie L, Sapp F, Thomas TK, Bersamin A. Alaska Native Elders' perspectives on dietary patterns in rural, remote communities. BMC Public Health 2021; 21:1645. [PMID: 34503462 PMCID: PMC8427848 DOI: 10.1186/s12889-021-11598-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 08/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Given the increasing rates of childhood obesity in Alaska Native children and the understanding that the most effective interventions are informed by and reflect the cultural knowledge of the community in which they are implemented, this project sought to gather the wisdom of local Yup'ik and Cup'ik Elders in the Yukon-Kuskokwim region of Alaska around how to maintain a healthy diet and active lifestyle. METHODS Perspectives were sought through the use of semi-structured focus groups, which were completed in person in twelve communities. All conversations were recorded, translated, transcribed, and analyzed using a qualitative approach, where key themes were identified. RESULTS Elders provided a clear and consistent recollection of what their life looked like when they were young and expressed their perspectives related to maintaining a healthy and traditional lifestyle. The key themes the Elders discussed included an emphasis on the nutritional and cultural benefits of traditional foods; concerns around changing dietary patterns such as the consumption of processed foods and sugar sweetened beverages; and concerns on the time and use of screens. Elders also expressed a desire to help younger generations learn traditional subsistence practices. CONCLUSIONS The risk of obesity in Alaska Native children is high and intervention efforts should be grounded in local knowledge and values. The perspectives from Yup'ik and Cup'ik Elders in the Yukon-Kuskokwim Delta area of Alaska provide a better understanding on local views of how to maintain a healthy diet, physical activities, and traditional values.
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Affiliation(s)
- Amanda K. Walch
- Dietetics & Nutrition Department, University of Alaska Anchorage, 146 Professional Studies Building, 3211 Providence Drive, Anchorage, AK 99508 USA
| | - Kathryn A. Ohle
- Early Childhood Education, Grand Valley State University, 441C Richard M. DeVos Center, 401 Fulton St. W, Grand Rapids, MI 49504-6431 USA
| | - Kathryn R. Koller
- Clinical & Research Services, Alaska Native Tribal Health Consortium, 3900 Ambassador Dr., Ste. 201, Anchorage, AK 99508 USA
| | - Lucinda Alexie
- Division of YKHC Medical Director, Yukon Kuskokwim Health Corporation, Post Office Box 528, Bethel, AK USA
| | - Flora Sapp
- Center for Alaska Native Health Research, Institute of Arctic Biology, University of Alaska Fairbanks, PO BOX 757000, Fairbanks, AK 99775 USA
| | - Timothy K. Thomas
- Clinical & Research Services, Alaska Native Tribal Health Consortium, 3900 Ambassador Dr., Ste. 201, Anchorage, AK 99508 USA
| | - Andrea Bersamin
- Center for Alaska Native Health Research, Institute of Arctic Biology, University of Alaska Fairbanks, PO BOX 757000, Fairbanks, AK 99775 USA
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Butel J, Braun KL, Nigg CR, Leon Guerrero R, Fleming T, Bersamin A, Coleman P, Novotny R. Estimating intervention dose of the multilevel multisite children's healthy living program intervention. Transl Behav Med 2021; 10:989-997. [PMID: 31116404 DOI: 10.1093/tbm/ibz073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Increased community collective efficacy (CE), defined as social cohesion among neighbors and their willingness to intervene for common good, is associated with improved community health outcomes. However, processes to increase CE and estimate its dose within an intervention are not well understood. The 2 year Children's Healthy Living (CHL) intervention aimed to improve child behaviors known to affect obesity. We used data from CHL to estimate CE dose and examine its association with a successful outcome from CHL-reduction in children's recreational screen time. Monthly reports from nine intervention communities were quantified, and CE dose was calculated for each community overall, at 4 time intervals (6, 12, 18, and 24 months), and for each CE building block-social bonding, social bridging, social leveraging, empowerment, and civic engagement. CE dose at each time interval and change in screen time was correlated using Spearman's rho. Next, communities were categorized as having a high CE dose or a low CE dose, and differences between four high-dose and five low-dose communities were compared using a two-tailed t-test. The correlation between change in screen time and CE dose was significant (rs = 0.83, p = .003). Significantly more activities facilitating empowerment and civic engagement were conducted in high-dose communities, which were more likely to show improvements in screen time, than in low-dose communities. This method of estimating an intervention's CE dose and examining change over time and effect of CE and its building blocks on intervention outcomes shows promise.
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Affiliation(s)
- Jean Butel
- Colege of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Kathryn L Braun
- Office of Public Health Studies, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Claudio R Nigg
- Office of Public Health Studies, University of Hawaii at Manoa, Honolulu, HI, USA
| | | | | | | | | | - Rachel Novotny
- Colege of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Honolulu, HI, USA
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Koller KR, Flanagan CA, Nu J, Lee FR, Desnoyers C, Walch A, Alexie L, Bersamin A, Thomas TK. Storekeeper perspectives on improving dietary intake in 12 rural remote western Alaska communities: the "Got Neqpiaq?" project. Int J Circumpolar Health 2021; 80:1961393. [PMID: 34350814 PMCID: PMC8344255 DOI: 10.1080/22423982.2021.1961393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Low intake of fruits and vegetables and high intake of sugar-sweetened beverages persists as a public health concern in rural remote Alaska Native (AN) communities. Conducting key informant interviews with 22 storekeepers in 12 communities in the Yukon-Kuskokwim region of Alaska, we explored potential factors impeding or facilitating dietary change towards healthier food choices. We selected these sites as part of a multi-level intervention aimed at introducing more traditional AN subsistence foods, increasing fruit and vegetable intake, and decreasing SSB consumption among young children enrolled in Head Start (preschool) programmes (Clinicaltrials.gov #NCT03601299). Storekeepers in these communities agreed that seasonality and flight schedules were primary factors determining commercial foods’ availability. Several storekeepers noted that federal food assistance programmes that specify which food items may be purchased with funds received from the programme and community policies that set limits on less healthy items promote customer purchases of healthier products. The fact that storekeepers are comfortable enforcing government assistance programme guidelines, company policies, and tribal resolutions suggests an important role storekeepers play in improving nutritional intake in their communities.
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Affiliation(s)
- Kathryn R Koller
- Research Nurse Supervisor,Alaska Native Tribal Health Consortium Research Services, Anchorage, Alaska, USA
| | - Christie A Flanagan
- Research Program Manager, Alaska Native Tribal Health Consortium Research Services, Anchorage, Alaska, USA
| | - Jennifer Nu
- Research Associate, Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, Alaska, USA
| | - Flora R Lee
- Research Nurse, Alaska Native Tribal Health Consortium Research Services Anchorage, Alaska, USA
| | - Christine Desnoyers
- Research Coordinator, Yukon-Kuskokwim Health Corporation, Bethel Alaska, USA
| | - Amanda Walch
- Assistant Professor of Dietetics & Nutrition, University of Alaska Anchorage, Anchorage, Alaska, USA
| | - Lucinda Alexie
- Associate Research Coordinator, Yukon-Kuskokwim Health Corporation Research Department, Bethel, Alaska, USA
| | - Andrea Bersamin
- Associate Professor, Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, Alaska, USA
| | - Timothy K Thomas
- Director,Alaska Native Tribal Health Consortium, Research Services, Anchorage, Alaska, USA
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10
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Hill CM, Paschall MJ, O'Brien DM, Bersamin A. Characterizing Vegetable and Fruit Intake in a Remote Alaska Native Community Using Reflection Spectroscopy and 24-Hour Recalls. J Nutr Educ Behav 2021; 53:712-718. [PMID: 33715972 PMCID: PMC8783602 DOI: 10.1016/j.jneb.2021.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 02/01/2021] [Accepted: 02/05/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Characterize vegetable and fruit (VF) intake in a Yup'ik community using self-reported intake and skin carotenoid status (SCS) and evaluate the relationship between SCS and fish intake. METHODS Self-reported VF intake was measured using the 24-hour recall, SCS was measured by reflection spectroscopy via the Veggie Meter (Longevity Link Corporation), and fish intake was estimated by the nitrogen isotope ratio (NIR) for 80 participants in a remote community in Southwestern Alaska. Bivariate correlations were used to assess the relationship between self-reported VF intake, SCS, and NIR. RESULTS Intake of all VF subgroups was low. The SCS was higher for males (262.7 vs 185.3; P = 0.002) and participants consuming more than 1 VF serving (232.5 vs 183.0; P = 0.02). It was not associated with the NIR. CONCLUSIONS AND IMPLICATIONS Increasing VF intake is a way to improve diet in Yup'ik communities and the Veggie Meter is a simple and noninvasive tool to facilitate surveillance efforts.
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Affiliation(s)
- Courtney M Hill
- Department of Biology and Wildlife, University of Alaska Fairbanks, Fairbanks, AK
| | - Mallie J Paschall
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA
| | - Diane M O'Brien
- Department of Biology and Wildlife, University of Alaska Fairbanks, Fairbanks, AK; Center for Alaska Native Health Research, Institute of Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK
| | - Andrea Bersamin
- Department of Biology and Wildlife, University of Alaska Fairbanks, Fairbanks, AK; Center for Alaska Native Health Research, Institute of Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK.
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11
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Greenberg JA, Luick B, Alfred JM, Barber LR, Bersamin A, Coleman P, Esquivel M, Fleming T, Leon Guerrero RT, Hollyer J, Johnson EL, Novotny R, deBlair Remengesau S, Yamanaka A. The Affordability of a Thrifty Food Plan-based Market Basket in the United States-affiliated Pacific Region. Hawaii J Health Soc Welf 2020; 79:217-223. [PMID: 32666055 PMCID: PMC7350513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In an effort to characterize food costs in the United States (US)-affiliated Pacific Region, a first-time food cost survey was conducted in March 2014. A market basket survey was developed using an adaptation of the US Department of Agriculture Thrifty Food Plan. Surveys were conducted in the states of Alaska and Hawai'i; Portland, Oregon; the US-affiliated Pacific Islands of American Samoa (American Samoa); Commonwealth of the Northern Mariana Islands; the island of Pohnpei within the Federated States of Micronesia; Guam; Republic of the Marshall Islands; and Republic of Palau. Urban and rural communities were included. Multiple stores in multiple communities were surveyed in each jurisdiction. Food retailers (N = 74) ranged from convenience markets to supermarkets. Not all foods in the market basket survey were available in each of the communities. Inspection of available income data also showed that food costs represented a higher percentage of household income for American Samoa than those of Alaska, Hawai'i, and Portland. Thrifty Food Plan weighted weekly totals for the region ranged from $181.90 to $264.30. Weighting was based on the amount of the item converted to grams required for the Thrifty Food Plan menu. These food costs are significantly higher than those of Portland ($142.00) for the survey period. Protein foods, grains, vegetables, fruit, and dairy were the 5 most costly components, in descending order. Food affordability was assessed by comparing food costs across jurisdictions and examining estimated food costs to reported average jurisdiction incomes. The survey is intended to help inform public health policy and educational programs in the region. A locally adapted food survey would benefit future analyses, regional policy, and educational efforts.
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Affiliation(s)
- Joshua A. Greenberg
- Department of Natural Resources and Environment, University of Alaska Fairbanks, Fairbanks, AK (JAG, BL)
| | - Bret Luick
- Department of Natural Resources and Environment, University of Alaska Fairbanks, Fairbanks, AK (JAG, BL)
| | | | - L. Robert Barber
- College of Natural & Applied Sciences, University of Guam, Mangilao, Guam (LRB, RTLG, JH)
| | - Andrea Bersamin
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, AK (AB)
| | - Patricia Coleman
- Cooperative Research, Extension, and Education Services, Northern Marianas College, Saipan, Northern Mariana Islands (PC)
| | - Monique Esquivel
- College of Tropical Agriculture and Human Resources, University of Hawai‘i at Mānoa, Honolulu, HI (ME, RN, AY)
| | - Travis Fleming
- Agriculture, Community and Natural Resources Division, American Samoa Community College, Pago Pago, American Samoa (TF)
| | | | - James Hollyer
- College of Natural & Applied Sciences, University of Guam, Mangilao, Guam (LRB, RTLG, JH)
| | | | - Rachel Novotny
- College of Tropical Agriculture and Human Resources, University of Hawai‘i at Mānoa, Honolulu, HI (ME, RN, AY)
| | | | - Ashley Yamanaka
- College of Tropical Agriculture and Human Resources, University of Hawai‘i at Mānoa, Honolulu, HI (ME, RN, AY)
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12
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Walch A, Bersamin A. Traditional Food Intake Is Positively Associated with Diet Quality among Low-Income, Urban Alaska Native Women. Journal of Hunger & Environmental Nutrition 2020; 15:264-272. [DOI: 10.1080/19320248.2019.1619648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Amanda Walch
- Dietetics and Nutrition Department, University of Alaska Anchorage, Anchorage, AK, USA
| | - Andrea Bersamin
- Center for Alaska Native Health Research, Institute of Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK, USA
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13
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Choy K, Nash SH, Hill C, Bersamin A, Hopkins SE, Boyer BB, O'Brien DM. The Nitrogen Isotope Ratio Is a Biomarker of Yup'ik Traditional Food Intake and Reflects Dietary Seasonality in Segmental Hair Analyses. J Nutr 2019; 149:1960-1966. [PMID: 31268149 PMCID: PMC6825821 DOI: 10.1093/jn/nxz144] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 05/29/2019] [Accepted: 06/04/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The nitrogen isotope ratio (NIR) is a promising index of traditional food intake for an Alaska Native (Yup'ik) population, which can be measured in blood and hair. However, the NIR has not been calibrated to high-quality measures of Yup'ik traditional food intake. OBJECTIVES Our primary objective was to examine associations between intakes of Yup'ik traditional food groups, including fish, marine mammals, birds, land mammals, berries, greens, and total traditional foods, and the NIR. In an exploratory analysis, we also examined whether NIR analyzed sequentially along hair could reflect dietary seasonality. METHODS We recruited 68 participants from 2 Yup'ik communities in the Yukon Kuskokwim region of Southwest Alaska (49% female, aged 14-79 y). Participants completed 4 unscheduled 24-h food recalls over the period peak of RBC and hair synthesis preceding a specimen collection visit. The NIR was measured in RBCs ( n = 68), a proximal hair section (n = 58), and sequential segments of hair from individuals in the upper 2 quartiles of traditional food intake having hair >6 cm in length, plus 2 low subsistence participants for reference (n = 18). Diet-biomarker associations were assessed using Pearson's correlation and linear regression. RESULTS Intakes of fish, marine mammals, berries, and greens were significantly associated with the NIR. The strongest dietary association was with total traditional food intake (R2 = 0.62), which indicated that each 1‰ increase in the RBC NIR corresponded to 8% of energy from traditional foods. Hair NIR appeared to fluctuate seasonally in some individuals, peaking in the summertime. CONCLUSIONS Findings support the use of the RBC and hair NIR to assess total traditional food intake in a Yup'ik population. Analyses of sequential hair NIR provided evidence of seasonality in traditional food intake, although seasonal variations were modest relative to interindividual variation.
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Affiliation(s)
- Kyungcheol Choy
- Department of Cultural Anthropology, Hanyang University ERICA, Ansan, South Korea,Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Sarah H Nash
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK, USA,Department of Biology and Wildlife, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Courtney Hill
- Department of Biology and Wildlife, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Andrea Bersamin
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK, USA,Department of Biology and Wildlife, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Scarlett E Hopkins
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK, USA,Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
| | - Bert B Boyer
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK, USA,Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
| | - Diane M O'Brien
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK, USA,Department of Biology and Wildlife, University of Alaska Fairbanks, Fairbanks, AK, USA,Address correspondence to DMO (e-mail: )
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14
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Bersamin A, Izumi BT, Nu J, O’brien DM, Paschall M. Strengthening adolescents' connection to their traditional food system improves diet quality in remote Alaska Native communities: results from the Neqa Elicarvigmun Pilot Study. Transl Behav Med 2019; 9:952-961. [PMID: 31570921 PMCID: PMC6937549 DOI: 10.1093/tbm/ibz087] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
In remote Alaska Native communities, traditional foods are inextricably linked to health and food security. Degradation of the traditional food system over the past several decades has resulted in a shift in dietary patterns that have contributed to increased rates of chronic diseases and food insecurity among Alaska Native People. Interventions are needed to address this. Our objectives were to evaluate the preliminary efficacy of a school-based intervention-Neqa Elicarvigmun or the Fish-to-School Program-on diet quality, fish intake, and attitudes and beliefs around traditional foods (specifically fish) using a pre-post comparison group design with data collection occurring at three time points. Study participants were 76 middle and high school students in two remote Alaska Native communities (population <900) in southwestern Alaska. We used a participatory approach to design the school-based, multilevel intervention that included activities in the cafeteria, classroom, and community. Multilevel analyses showed that students in the experimental community showed significant improvements in diet quality compared to the comparison community (Beta = 4.57; p < .05). Fish intake, measured using the stable nitrogen isotope ratio of hair, a validated biomarker, also increased significantly in the experimental community (Beta = 0.16; p < .05). Leveraging the cultural and physical resources of the traditional food system for the Neqa Elicarvigmun program represents a strength-based approach that improves diet quality, increases adolescents' connection to their traditional culture, and by promoting the local food system supports food security. Embedding the program into the local culture may result in faster adoption and greater sustainability of the program.
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Affiliation(s)
- Andrea Bersamin
- Center for Alaska Native Health Research and Institute of Arctic Biology, University of Alaska Fairbanks, Fairbanks, USA
| | - Betty T Izumi
- Oregon Health & Science University - Portland State University School of Public Health, Portland, USA
| | - Jennifer Nu
- Center for Alaska Native Health Research and Institute of Arctic Biology, University of Alaska Fairbanks, Fairbanks, USA
| | - Diane M O’brien
- Center for Alaska Native Health Research and Institute of Arctic Biology, University of Alaska Fairbanks, Fairbanks, USA
| | - Mallie Paschall
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA, USA
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15
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Hill C, O'Brien D, Paschall M, Bersamin A. Validity of Reflection Spectroscopy as a Biomarker of Vegetable and Fruit Intake in a Yu'pik Alaska Native Population (P18-124-19). Curr Dev Nutr 2019. [DOI: 10.1093/cdn/nzz039.p18-124-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
Reflection spectroscopy serves as a biomarker of vegetable and fruit intake by measuring skin carotenoids, however it's validity in populations who consume high levels of salmon (another source of carotenoids) is unknown. Our objective was to validate reflection spectroscopy as a biomarker for vegetable and fruit intake among Yup'ik Alaska Native people in a remote community who consume a subsistence diet rich in salmon.
Methods
We assessed the convergent validity of a portable reflection spectroscopy device (The Veggie Meter), two 24-hour recalls using NDSR 2018, and the nitrogen stable isotope ratio of hair (a validated biomarker of fish intake) collected from adults (>18 years) in a remote Alaska community.
Results
The study population (n = 84) was primarily Yup'ik Alaska Native (84%), evenly distributed by sex (45.2% male), and had a mean age of 47.5 years. The mean skin carotenoid score was 222.23 ± 105.81. The median number of fruit servings reported was 0.33 (range = 0 to 4.0), while median servings of vegetables was 1.55 (range = 0 to 11.44). Men had significantly higher skin carotenoid scores than women (202 vs 248; P = .001). Participants who consumed 3 or more servings of vegetables and fruit had a significantly greater Veggie Meter score than participants who consumed less than 3 servings (255 vs 202 respectively; P = .059). The relationship did not change when controlling for fish intake in a general linear model.
Conclusions
Consistent with previous findings, vegetable and fruit intake is very low among Yup'ik people. Findings suggest that the Veggie Meter distinguishes between participants who consume high and low levels of vegetables and fruit. Participants consumed lower levels of fish than estimated in previous studies in southwestern Alaska. At this level of fish intake, fish does not appear to confound the relationship between the Veggie Meter and vegetable and fruit intake.
Funding Sources
Research reported here was supported by UAF BLaST, funded by the National Institute Of General Medical Sciences of the National Institutes of Health.
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Affiliation(s)
| | | | | | - Andrea Bersamin
- Center for Alaska Native Health Research, University of Alaska Fairbanks
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16
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Maurice AC, Philip J, Bersamin A. Yup'ik identity and socioeconomic status are associated with child consumption of traditional food and weight in rural Yup'ik communities. Ethn Health 2019; 24:312-322. [PMID: 28540735 PMCID: PMC6120808 DOI: 10.1080/13557858.2017.1331338] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 05/07/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE In remote, Alaska Native communities, traditional foods remain a significant source of essential nutrients and appear to protect against the development of chronic diseases. Relatively low intake of traditional foods among Alaska Native children is therefore of concern. The aim of this study was to identify household and parental predictors of child traditional food (TF) consumption and weight in remote Yup'ik communities of Alaska. DESIGN Children (10-18 years old) and parents in two communities (populations <500) were invited to participate in this cross-sectional study. Intake of traditional foods among children and parents was estimated from two-24 h recalls using NDS-R. Weight and height were measured and BMI calculated. Sociodemographic factors, including income and education, were collected from parents. A partial least square path modeling analysis and bootstrapping were performed to identify predictors of child TF consumption and weight. RESULTS Parental intake of traditional foods, Yup'ik identity and income were positively associated with child intake of traditional foods. Further, parental intake of traditional foods predicted lower child BMI. Parental education was negatively associated with child traditional food intake and positively associated with child BMI. CONCLUSIONS Findings suggest that interventions targeting parents may be an effective strategy to increase intake of traditional foods and improve diet quality among Alaska Native youth.
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Affiliation(s)
| | - Jacques Philip
- Center for Alaska Native Health Research, Institute of Arctic Biology, University of Alaska Fairbanks,
| | - Andrea Bersamin
- Center for Alaska Native Health Research, Institute of Arctic Biology, University of Alaska Fairbanks,
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17
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Walch A, Loring P, Johnson R, Tholl M, Bersamin A. Traditional Food Practices, Attitudes, and Beliefs in Urban Alaska Native Women Receiving WIC Assistance. J Nutr Educ Behav 2019; 51:318-325. [PMID: 30409694 PMCID: PMC8731265 DOI: 10.1016/j.jneb.2018.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 09/07/2018] [Accepted: 09/09/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To identify practices, attitudes, and beliefs associated with intake of traditional foods among Alaska Native women. DESIGN Cross-sectional study that measured traditional food intake; participation in food-sharing networks; presence of a hunter or fisherman in the home; the preference, healthfulness, and economic value of traditional foods; and financial barriers to obtaining these foods. PARTICIPANTS Purposive sample of 71 low-income Alaska Native women receiving Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) assistance in Anchorage, AK. ANALYSIS Bivariate and multivariate regression analyses. RESULTS Traditional foods contributed 4% of total daily calories. Given a choice, 63% of participants indicated that they would prefer half or more of the foods they ate to be traditional (ie, not store-bought). The majority of participants (64%) believed that traditional foods were healthier than store-bought foods. Of all participants, 72% relied on food-sharing networks for traditional foods; only 21% acquired traditional foods themselves. Participants who ate more traditional foods preferred traditional foods (B = .011 P = .02). IMPLICATIONS FOR RESEARCH AND PRACTICE Traditional food intake was low and findings suggested that Alaska Native women living in an urban setting prefer to consume more but are unable to do so. Future research might examine the effect of enhancing social networks and implementing policies that support traditional food intake.
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Affiliation(s)
- Amanda Walch
- Dietetics and Nutrition Department, University of Alaska Anchorage, Anchorage, AK
| | - Philip Loring
- Department of Geography, Environment, and Geomatics, University of Guelph, Ontario, Canada
| | - Rhonda Johnson
- Department of Health Sciences, University of Alaska Anchorage, Anchorage, AK
| | - Melissa Tholl
- Dietetics and Nutrition Department, University of Alaska Anchorage, Anchorage, AK
| | - Andrea Bersamin
- Center for Alaska Native Health Research and Institute of Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK.
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18
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Abstract
BACKGROUND Food insecurity is a public health concern. The pillars of food security include food access, availability and utilisation. For some indigenous peoples, the pillars may focus on traditional foods. OBJECTIVE To conduct a scoping review on traditional foods and food security in Alaska. DESIGN Google Scholar and the High North Research Documents were used to search for relevant primary research using the following terms: “traditional foods”, “food security”, “access”, “availability”, “utilisation”, “Alaska”, “Alaska Native” and “indigenous”. RESULTS Twenty four articles from Google Scholar and four articles from the High North Research Documents met the inclusion criteria. The articles revealed three types of research approaches, those that quantified traditional food intake (n=18), those that quantified food security (n=2), and qualitative articles that addressed at least one pillar of food security (n=8). CONCLUSIONS Studies that estimate the prevalence of traditional food insecurity in Alaska are virtually absent from the literature. Instead most studies provide a review of factors related to food security. Research investigating dietary intake of traditional foods is more prevalent. Future research should include direct measurements of traditional food intake and food security to provide a more complete picture of traditional food security in Alaska.
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Affiliation(s)
- Amanda Walch
- Department of Biology & Wildlife, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Andrea Bersamin
- Department of Biology & Wildlife, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Philip Loring
- School of Environment and Sustainability, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Rhonda Johnson
- Department of Health Sciences, University of Alaska Anchorage, Anchorage, AK, USA
| | - Melissa Tholl
- Department of Dietetics & Nutrition, University of Alaska Anchorage, Anchorage, AK, USA
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19
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Novotny R, Davis J, Butel J, Boushey CJ, Fialkowski MK, Nigg CR, Braun KL, Leon Guerrero RT, Coleman P, Bersamin A, Areta AAR, Barber LR, Belyeu-Camacho T, Greenberg J, Fleming T, Dela Cruz-Talbert E, Yamanaka A, Wilkens LR. Effect of the Children's Healthy Living Program on Young Child Overweight, Obesity, and Acanthosis Nigricans in the US-Affiliated Pacific Region: A Randomized Clinical Trial. JAMA Netw Open 2018; 1:e183896. [PMID: 30646266 PMCID: PMC6324447 DOI: 10.1001/jamanetworkopen.2018.3896] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
IMPORTANCE Pacific Islanders have among the highest rates of obesity and type 2 diabetes in the world. Targeting children is critical for primary prevention. OBJECTIVES To prevent young child overweight and obesity and to improve health in the US-Affiliated Pacific region via the Children's Healthy Living Program. DESIGN, SETTING, AND PARTICIPANTS In this multijurisdictional, multilevel, multicomponent community randomized clinical trial, where all evaluable children were analyzed according to the random assignment of their community, hierarchical difference-in-difference models accounted for the community randomization, community clustering with jurisdictions, and these models were adjusted for the age and sex distribution of the community. The setting was 27 communities in 5 jurisdictions (Alaska, American Samoa, Commonwealth of the Northern Mariana Islands, Guam, and Hawaii). Participants were 4329 children (time 1) and 4042 children (time 2) aged 2 to 8 years in 27 selected communities from October 7, 2012, to October 25, 2015. Data analysis was completed in June 2018. INTERVENTIONS Nineteen activities addressed policy, environment, messaging, training, and 6 target behaviors (sleep time, screen time, physical activity, fruits and vegetables, water, and sugar-sweetened beverages). MAIN OUTCOMES AND MEASURES Primary outcomes were body size measurements. Secondary outcomes were acanthosis nigricans, sleep quality and duration, dietary intake, physical activity, and other questionnaire reponses. RESULTS The study included 27 communities and 8371 evaluable children (mean [SD] age, 5.4 [1.8] years; 50.9% male [n = 4264]). Data analysis included 952 children in the intervention group and 930 children in the control group aged 2 to 5 years at time 1; 825 children in the intervention group and 735 children in the control group aged 2 to 5 years at time 2; 565 children in the intervention group and 561 children in the control group aged 6 to 8 years at time 1; and 517 children in the intervention group and 560 children in the control group aged 6 to 8 years at time 2. The intervention communities showed significant improvement compared with control communities in overweight and obesity prevalence (effect size [d] = -3.95%; 95% CI, -7.47% to -0.43%), waist circumference (d = -0.71 cm; 95% CI, -1.37 to -0.05 cm), and acanthosis nigricans prevalence (d = -2.28%; 95% CI, -2.77% to -1.57%). Age and sex subgroup analysis revealed greater difference among the intervention communities in acanthosis nigricans prevalence in the group aged 2 to 5 years (-3.99%) vs the group aged 6 to 8 years (-3.40%), and the interaction was significant (d = 0.59%, P < .001), as well as the smaller difference in the group aged 2 to 5 years (-0.10%) vs the group aged 6 to 8 years (-1.07%) in screen time (d = -0.97 hour per day, P = .01). CONCLUSIONS AND RELEVANCE The intervention reduced the prevalence of young child overweight and obesity and acanthosis nigricans. Comprehensive, effective, and sustainable interventions are needed to improve child health in the US-Affiliated Pacific region. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01881373.
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Affiliation(s)
- Rachel Novotny
- Department of Human Nutrition, Food and Animal Science, College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Honolulu
| | - James Davis
- Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu
| | - Jean Butel
- Department of Human Nutrition, Food and Animal Science, College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Honolulu
| | - Carol J. Boushey
- Department of Human Nutrition, Food and Animal Science, College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Honolulu
- Nutrition Support Shared Resource, University of Hawaii Cancer Center, Honolulu
| | - Marie Kainoa Fialkowski
- Department of Human Nutrition, Food and Animal Science, College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Honolulu
| | - Claudio R. Nigg
- Office of Public Health Studies, Myron B. Thompson School of Social Work, University of Hawaii at Manoa, Honolulu
| | - Kathryn L. Braun
- Office of Public Health Studies, Myron B. Thompson School of Social Work, University of Hawaii at Manoa, Honolulu
| | | | - Patricia Coleman
- Cooperative Research and Extension Education Services, Northern Marianas College, Saipan, Northern Mariana Islands
| | - Andrea Bersamin
- Department of Biology and Wildlife, University of Alaska, Fairbanks
| | - Aufai Apulu Ropeti Areta
- Agriculture, Community and Natural Resources Division, American Samoa Community College, Pago Pago
| | - Leroy R. Barber
- Division of Agriculture and Life Sciences, College of Natural and Applied Sciences, University of Guam, Mangilao
| | - Tayna Belyeu-Camacho
- Cooperative Research and Extension Education Services, Northern Marianas College, Saipan, Northern Mariana Islands
| | - Joshua Greenberg
- School of Natural Resources and Extension, University of Alaska, Fairbanks
| | - Travis Fleming
- Agriculture, Community and Natural Resources Division, American Samoa Community College, Pago Pago
| | | | - Ashley Yamanaka
- Office of Public Health Studies, Myron B. Thompson School of Social Work, University of Hawaii at Manoa, Honolulu
| | - Lynne R. Wilkens
- Department of Human Nutrition, Food and Animal Science, College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Honolulu
- Biostatistics and Informatics Shared Resource, University of Hawaii Cancer Center, Honolulu
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20
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Novotny R, Wilkens LR, Nigg CR, Braun K, Butel J, Areta A, Coleman P, Belyeu‐Camacho T, Greenberg J, Bersamin A, Guerrero RL, Barber LR, Fialkowski MK, De la Cruz‐Talbert E. Effectiveness of the Children's Healthy Living (CHL) Multilevel Multicomponent Community Intervention Program in 5 US affiliated Pacific Jurisdictions. FASEB J 2018. [DOI: 10.1096/fasebj.31.1_supplement.640.37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | | | - Aufai Areta
- American Samoa Community CollegePago PagoAmerican Samoa
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21
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Banna J, Bersamin A. Community involvement in design, implementation and evaluation of nutrition interventions to reduce chronic diseases in indigenous populations in the U.S.: a systematic review. Int J Equity Health 2018; 17:116. [PMID: 30103753 PMCID: PMC6090789 DOI: 10.1186/s12939-018-0829-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 07/24/2018] [Indexed: 11/19/2022] Open
Abstract
Background Indigenous peoples of the United States disproportionately experience chronic diseases associated with poor nutrition, including obesity and diabetes. While chronic disease related health disparities among Indigenous people are well documented, it is unknown whether interventions adequately address these health disparities. In addition, it is unknown whether and to what extent interventions are culturally adapted or tailored to the unique culture, worldview and nutrition environments of Indigenous people. The aim of this review was to identify and characterize nutrition interventions conducted with Indigenous populations in the US, and to determine whether and to what degree communities are involved in intervention design, implementation and evaluation. Methods Peer-reviewed articles were identified using MEDLINE. Articles included were published in English in a refereed journal between 2000 and 2015, reported on a diet-related intervention in Indigenous populations in the US, and reported outcome data. Data extracted were program objectives and activities, target population, geographic region, formative research to inform design and evaluation, partnership, capacity building, involvement of the local food system, and outcomes. Narrative synthesis of intervention characteristics and the degree and type of community involvement was performed. Results Of 1060 records identified, 49 studies were included. Overall, interventions were successful in producing changes in knowledge, behavior or health (79%). Interventions mostly targeted adults in the Western region and used a pre-test, post-test design. Involvement of communities in intervention design, implementation, and evaluation varied from not at all to involvement at all stages. Of programs reporting significant changes in outcomes, more than half used at least three strategies to engage communities. However, formative research to inform the evaluation was not performed to a great degree, and fewer than half of the programs identified described involvement of the local food system. Conclusions The extent of use of strategies to promote community engagement in programs reporting significant outcomes is notable. In planning interventions in Indigenous groups, researchers should consider ways to involve the community in intervention design, execution and evaluation. There is a particular need for studies focused on Indigenous youth in diverse regions of the US to further address diet-related chronic conditions.
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Affiliation(s)
- Jinan Banna
- Department of Human Nutrition, Food and Animal Sciences at the University of Hawai'i at Mānoa, Honolulu, USA.
| | - Andrea Bersamin
- Center for Alaska Native Health Research, Institute of Arctic Biology at the University of Alaska Fairbanks, Fairbanks, USA
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22
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Power JM, Bersamin A. A Text Messaging Intervention (Txt4HappyKids) to Promote Fruit and Vegetable Intake Among Families With Young Children: Pilot Study. JMIR Form Res 2018; 2:e13. [PMID: 30684412 PMCID: PMC6334673 DOI: 10.2196/formative.8544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 03/25/2018] [Accepted: 04/24/2018] [Indexed: 12/02/2022] Open
Abstract
Background Increasing fruit and vegetable intake among low-income populations, especially children, is a priority for United States federal food assistance programs. With over 49 million federal food assistance program recipients, cost-effective and efficient methods are needed to effectively deliver nutrition education to such a large population. Objective The objective of our study was to examine the preliminary efficacy and acceptability of a text messaging intervention, Txt4HappyKids, to promote fruit and vegetable intake among families with young children. Methods The intervention was evaluated using a pre-post study design. Parents (N=72) in Alaska were recruited from venues that serve a predominantly low-income population to participate in an 11-week intervention based on social cognitive theory. Parents received two texts per week promoting child fruit and vegetable intake. Behaviors, self-efficacy, and attitudes related to fruit and vegetable intake were measured at baseline and postintervention. Perceived changes in behaviors and open-ended feedback were also collected postintervention. Results Of all participants, 67.3% (72/107) completed the intervention. We found no changes in behavior (P=.26), self-efficacy (P=.43), or attitudes (P=.35) related to fruit and vegetable intake from pre- to postintervention. Completers reported that since their participation in Txt4HappyKids, 92% (66/72) served more fruits and vegetables to their child because they thought fruits and vegetables were beneficial, 86% (62/72) tried to follow a healthier diet, 85% (61/72) tried different ways of preparing fruits and vegetables, and 81% (58/72) were more aware of the foods their child consumes. Additionally, 79% (57/72) of completers thought that Txt4HappyKids was credible, 71% (51/72) found texts useful, and 82% (59/72) would recommend it to a friend. Conclusions A text messaging intervention was not sufficient to increase fruit and vegetable intake among families with young children. However, parents felt positively impacted by Txt4HappyKids and were receptive to nutrition information, despite the absence of face-to-face contact. High satisfaction among completers indicates that text messaging may be an acceptable complement to budget-constrained nutrition programs. These findings are an important first step in developing larger multi-level interventions utilizing mobile technology; however, a more rigorous evaluation of the Txt4HappyKids intervention is warranted.
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Affiliation(s)
- Julianne Mary Power
- Center for Alaska Native Health Research, Institute of Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK, United States
| | - Andrea Bersamin
- Center for Alaska Native Health Research, Institute of Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK, United States
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Affiliation(s)
- Betty T. Izumi
- School of Public Health, Oregon Health & Science University – Portland State University
| | - Andrea Bersamin
- Center for Alaska Native Health Research, Institute of Arctic Biology, University of Alaska Fairbanks
| | | | | | - Mary Murimi
- Department of Nutritional Sciences, Texas Tech University
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Yonemori KM, Ennis T, Novotny R, Fialkowski MK, Ettienne R, Wilkens LR, Leon Guerrero RT, Bersamin A, Coleman P, Li F, Boushey CJ. 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). J Food Compost Anal 2018; 64:112-118. [PMID: 29398780 DOI: 10.1016/j.jfca.2017.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
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.
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Affiliation(s)
- Kim M Yonemori
- University of Hawai'i Cancer Center, 701 Ilalo Street, Honolulu, HI 96813, USA
| | | | | | | | | | - Lynne R Wilkens
- University of Hawai'i Cancer Center, 701 Ilalo Street, Honolulu, HI 96813, USA
| | | | | | | | | | - Carol J Boushey
- University of Hawai'i Cancer Center, 701 Ilalo Street, Honolulu, HI 96813, USA
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Philip J, Ryman TK, Hopkins SE, O'Brien DM, Bersamin A, Pomeroy J, Thummel KE, Austin MA, Boyer BB, Dombrowski K. Bi-cultural dynamics for risk and protective factors for cardiometabolic health in an Alaska Native (Yup'ik) population. PLoS One 2017; 12:e0183451. [PMID: 29091709 PMCID: PMC5665420 DOI: 10.1371/journal.pone.0183451] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 08/06/2017] [Indexed: 11/17/2022] Open
Abstract
Alaska Native people experience disparities in mortality from heart disease and stroke. This work attempts to better understand the relationships between socioeconomic, behavioral, and cardiometabolic risk factors among Yup'ik people of southwestern Alaska, with a focus on the role of the socioeconomic, and cultural components. Using a cross-sectional sample of 486 Yup'ik adults, we fitted a Partial Least Squares Path Model (PLS-PM) to assess the associations between components, including demographic factors [age and gender], socioeconomic factors [education, economic status, Yup'ik culture, and Western culture], behavioral factors [diet, cigarette smoking and smokeless tobacco use, and physical activity], and cardiometabolic risk factors [adiposity, triglyceride-HDL and LDL lipids, glycemia, and blood pressure]. We found relatively mild associations of education and economic status with cardiometabolic risk factors, in contrast with studies in other populations. The socioeconomic factor and participation in Yup'ik culture had potentially protective associations with adiposity, triglyceride-HDL lipids, and blood pressure, whereas participation in Western culture had a protective association with blood pressure. We also found a moderating effect of participation in Western culture on the relationships between Yup'ik culture participation and both blood pressure and LDL lipids, indicating a potentially beneficial additional effect of bi-culturalism. Our results suggest that reinforcing protective effects of both Yup'ik and Western cultures could be useful for interventions aimed at reducing cardiometabolic health disparities.
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Affiliation(s)
- Jacques Philip
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, Alaska, United States of America
| | - Tove K. Ryman
- Bill and Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Scarlett E. Hopkins
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, Alaska, United States of America
| | - Diane M. O'Brien
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, Alaska, United States of America
| | - Andrea Bersamin
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, Alaska, United States of America
| | - Jeremy Pomeroy
- Marshfield Clinic Research Institute, Marshfield, Wisconsin, United States of America
| | - Kenneth E. Thummel
- Department of Pharmaceutics, University of Washington, Seattle, Washington, United States of America
| | - Melissa A. Austin
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Bert B. Boyer
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, Alaska, United States of America
| | - Kirk Dombrowski
- Department of Sociology, University of Nebraska, Lincoln, Nebraska, United States of America
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Nu J, Bersamin A. Collaborating With Alaska Native Communities to Design a Cultural Food Intervention to Address Nutrition Transition. Prog Community Health Partnersh 2017; 11:71-80. [PMID: 28603153 DOI: 10.1353/cpr.2017.0009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND To address changing dietary patterns and declining dietary quality in indigenous communities, there is growing interest in implementing interventions that promote nutrient-dense, culturally important foods. OBJECTIVES To describe formative research and an ongoing collaborative process to design a multilevel nutrition inter vention-Neqa Elicarvigmun or the Fish-to-School (F2S) Program-that reconnects students to their local food system in a remote Yup'ik community in Western Alaska. METHODS Qualitative data that explored the connection between salmon and well-being were collected and collaboratively reviewed with a community work group and analyzed using thematic analysis. Findings were used to co-design the nutrition intervention. LESSONS LEARNED Formative research Thndings and ongoing collaboration between academic and community partners informed the Thnal intervention design. CONCLUSIONS Because people's behaviors and interactions with culturally signiThcant foods are embedded in cultural perceptions and local contexts, it is important for nutrition interventions to address local perceptions of these foods.
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Power JM, Braun KL, Bersamin A. Exploring the Potential for Technology-Based Nutrition Education Among WIC Recipients in Remote Alaska Native Communities. J Nutr Educ Behav 2017; 49:S186-S191.e1. [PMID: 28689556 PMCID: PMC5505314 DOI: 10.1016/j.jneb.2016.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 11/12/2016] [Accepted: 11/15/2016] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Estimate media technology use in Alaska Native communities to inform the feasibility of technology-based nutrition education. METHODS A self-administered questionnaire was mailed to a random selection of about 50% of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) authorized representatives in remote Alaska Native communities (n = 975). Media technology use, interest in media technology-based nutrition education, and potential barriers were assessed. Chi-square tests were used to investigate associations among technology use, age, and education. RESULTS Technology use was common among respondents (n = 368); use was significantly more common among younger age groups and participants with a higher level of education. Smartphone (78.8%) and Facebook (95.8%) use was comparable to national averages, but having a computer at home (38.4%) was much less likely. Less than 50% of participants have Internet access at home. CONCLUSIONS AND IMPLICATIONS Findings shed light on new opportunities for WIC and other programs to deliver nutrition education to Alaska Native people in remote communities.
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Affiliation(s)
- Julianne M Power
- Center for Alaska Native Health Research and the Institute of Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK
| | - Kathryn L Braun
- Office of Public Health Studies, University of Hawai'i, Honolulu, Hawaii
| | - Andrea Bersamin
- Center for Alaska Native Health Research and the Institute of Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK.
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Novotny R, Li F, Leon Guerrero R, Coleman P, Tufa AJ, Bersamin A, Deenik J, Wilkens LR. Dual burden of malnutrition in US Affiliated Pacific jurisdictions in the Children's Healthy Living Program. BMC Public Health 2017; 17:483. [PMID: 28532446 PMCID: PMC5440961 DOI: 10.1186/s12889-017-4377-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 05/07/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Few data are available on dual burden of under and over nutrition of children in the Pacific region. The objective was to examine prevalence of stunting at birth and current stunting and their relationship to obesity in US Affiliated Pacific (USAP) jurisdictions. METHODS Cross sectional survey with cluster sampling by community. 5558, 2-8 years olds were measured in 51 communities in 11 USAP jurisdictions. The main outcome measures were stunting at birth, current stunting and obesity by body mass index. Prevalences of stunting at birth, current stunting and obesity were determined, adjusting for age distribution and community clustering. Differences by among age, sex, race and jurisdiction income levels were evaluated by chi-square analysis. Relationships of stunting at birth and current stunting with obesity were examined using a hierarchical model accounting for the study design. RESULTS Prevalences were stunting at birth 6.8% (Standard Error, SE = 0.9%), current stunting 1.4% (SE = 0.2%) and obesity 14.03.8% (SE = 0.9%). Obesity was highest in upper middle income jurisdictions (UMIJ) at 17.5%. Stunting at birth differed by race (p = 0.0001) with highest prevalence among Native Hawaiian/Pacific Islanders (10.7%). Prevalence of stunting at birth was different by jurisdiction income level with 27.5% in lower middle income jurisdictions (LMIJ), and 22.2% in UMIJ, and 5.5% in higher than high income jurisdictions (HIJ) at 5.5% (p < 0.0001). Prevalence of current stunting was higher in LMIJ than HIJ (p = 0.001), although children with current stunting were less likely to have been stunted at birth. The association between stunting at birth and current stunting was negative (OR = 0.19, 95% CI: 0.05-0.69). CONCLUSIONS Currently stunted children were marginally less likely to be obese than not stunted children in the USAP, where the prevalence of current stunting is low. Stunting (at birth and current) was highest in LMIJ, while UMIJ jurisdictions had the highest dual burden of malnutrition (that is the highest combination of both stunting at birth and obesity). TRIAL REGISTRATION National Institutes for Health clinical trial # NCT01881373 (clinicaltrials.gov).
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Affiliation(s)
- Rachel Novotny
- University of Hawaii, 1955 East West Road, Honolulu, HI 96822 USA
| | - Fenfang Li
- University of Hawaii, 1955 East West Road, Honolulu, HI 96822 USA
| | | | - Patricia Coleman
- Nutrition & Health Programs, Building F, PO Box 501250, Saipan, MP 96950 Northern Mariana Islands
- Northern Marianas College, Saipan, Northern Mariana Islands
| | - Aifili J. Tufa
- University of Hawaii, 1955 East West Road, Honolulu, HI 96822 USA
| | | | - Jonathan Deenik
- University of Hawaii, 1955 East West Road, Honolulu, HI 96822 USA
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Nigg CR, Ul Anwar MM, Braun K, Mercado J, Kainoa Fialkowski M, Ropeti Areta AA, Belyeu-Camacho T, Bersamin A, Guerrero RL, Castro R, DeBaryshe B, Vargo AM, Braden KW. A Review of Promising Multicomponent Environmental Child Obesity Prevention Intervention Strategies by the Children's Healthy Living Program. J Environ Health 2016; 79:18-26. [PMID: 29120137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Childhood obesity has increased rapidly over the last three decades in the U.S. Individual-level interventions targeting healthy eating and physical activity have not significantly impacted clinical measures of obesity in children. Focusing “upstream” on physical, social, cultural, political, and economic environments may be more effective. The purpose of this qualitative review is to analyze published environmental interventions that effectively prevented or reduced obesity in children ages 2–10 years by working within their family, school, and/or community environment to increase physical activity, reduce sedentary behaviors, or improve healthy diet. Through an electronic database search, 590 original articles were identified and 33 were read in full. Using Brennan and co-authors’ (2011) rating system, 18 were rated as effective intervention studies. This analysis showed that interventions targeting multiple environments (e.g., family, school, and community) show promise in reducing childhood obesity. Further research is needed to test interventions targeting multiple environments in different communities and populations.
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Novotny R, Li F, Fialkowski MK, Bersamin A, Tufa A, Deenik J, Coleman P, Guerrero RL, Wilkens LR. Prevalence of obesity and acanthosis nigricans among young children in the children's healthy living program in the United States Affiliated Pacific. Medicine (Baltimore) 2016; 95:e4711. [PMID: 27631218 PMCID: PMC5402561 DOI: 10.1097/md.0000000000004711] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Estimate prevalence of obesity and acanthosis nigricans (AN) among children in United States Affiliated Pacific (USAP) jurisdictions.Cross-sectional measurement of weight, height, and AN in 5775, 2 to 8 years old in 51 communities-Hawai'i, Alaska, Commonwealth of the Northern Mariana Islands, Guam, American Samoa, Palau, Republic of the Marshall Islands (RMI), 4 Federated States of Micronesia (Pohnpei, Yap, Kosrae, Chuuk). Analyses weighted to jurisdiction-specific sex and age distributions accounting for clustering of communities within jurisdictions.Prevalence of obesity was 14.0%, overweight 14.4%, healthy weight 68.9%, and underweight 2.6%, higher in males (16.3%) than females (11.6%), higher among 6 to 8 years old (16.3%) than 2 to 5 years old (12.9%), highest in American Samoa (21.7%), and absent in RMI. In total, 4.7% of children had AN, with no sex difference, higher in 6 to 8 years old (6.8%) than 2 to 5 years old (3.5%) and highest in Pohnpei (11.9%), and absent in Alaska. Obesity was highly associated with AN (odds ratio = 9.25, 95% confidence interval = 6.69-12.80), with the strongest relationships among Asians, followed by Native Hawaiians and Pacific Islanders (NHPI).Obesity, age, and Asian and NHPI race were positively associated with AN.
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Affiliation(s)
- Rachel Novotny
- University of Hawaii at Manoa, Honolulu
- Correspondence: Rachel Novotny, University of Hawaii at Manoa, Honolulu, Honolulu, Hawaii (e-mail: )
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Novotny R, Li F, Guerrero RL, Coleman P, Fleming T, Bersamin A, Deenik J, Wilkens LR. Stunting and its relationship to Obesity in the US affiliated Pacific: a study of the Children's Healthy Living Program. FASEB J 2016. [DOI: 10.1096/fasebj.30.1_supplement.33.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Li F, Novotny R, Wilkens LR, Fialkowski MK, Guerrero RRT, Coleman P, Bersamin A, Fleming T, Deenik J. Food Insecurity and Young Child BMI Status in the U.S. Affiliated Pacific (USAP) Region: Findings from the Children's Healthy Living Program. FASEB J 2016. [DOI: 10.1096/fasebj.30.1_supplement.273.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Li F, Wilkens LR, Novotny R, Fialkowski MK, Paulino YC, Nelson R, Bersamin A, Martin U, Deenik J, Boushey CJ. Anthropometric measurement standardization in the US-affiliated pacific: Report from the Children's Healthy Living Program. Am J Hum Biol 2015; 28:364-71. [PMID: 26457888 DOI: 10.1002/ajhb.22796] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 09/04/2015] [Accepted: 09/19/2015] [Indexed: 11/05/2022] Open
Abstract
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.
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Affiliation(s)
- Fenfang Li
- Department of Human Nutrition, Food and Animal Sciences, University of Hawai'i at Mānoa, Honolulu, Hawai'i
| | - Lynne R Wilkens
- Cancer Center, University of Hawai'i at Mānoa, Honolulu, Hawai'i
| | - Rachel Novotny
- Department of Human Nutrition, Food and Animal Sciences, University of Hawai'i at Mānoa, Honolulu, Hawai'i
| | - Marie K Fialkowski
- Department of Human Nutrition, Food and Animal Sciences, University of Hawai'i at Mānoa, Honolulu, Hawai'i
| | - Yvette C Paulino
- School of Nursing and Health Sciences, University of Guam, Mangilao, Guam
| | - Randall Nelson
- Land Grant Program, Northern Marianas College, Saipan, Northern Mariana Islands
| | - Andrea Bersamin
- Department of Alaska Native Health, University of Alaska, Fairbanks, Alaska
| | - Ursula Martin
- Land Grant Program, American Samoa Community College, Pago Pago, American Samoa
| | - Jonathan Deenik
- Department of Tropical Plants and Soil Science, University of Hawai'i at Mānoa, Honolulu, Hawai'i
| | - Carol J Boushey
- Cancer Center, University of Hawai'i at Mānoa, Honolulu, Hawai'i
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Fialkowski MK, DeBaryshe B, Bersamin A, Nigg C, Leon Guerrero R, Rojas G, Areta AAR, Vargo A, Belyeu-Camacho T, Castro R, Luick B, Novotny R. A community engagement process identifies environmental priorities to prevent early childhood obesity: the Children's Healthy Living (CHL) program for remote underserved populations in the US Affiliated Pacific Islands, Hawaii and Alaska. Matern Child Health J 2015; 18:2261-74. [PMID: 24043557 PMCID: PMC4220109 DOI: 10.1007/s10995-013-1353-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Underserved minority populations in the US Affiliated Pacific Islands (USAPI), Hawaii, and Alaska display disproportionate rates of childhood obesity. The region’s unique circumstance should be taken into account when designing obesity prevention interventions. The purpose of this paper is to (a), describe the community engagement process (CEP) used by the Children’s Healthy Living (CHL) Program for remote underserved minority populations in the USAPI, Hawaii, and Alaska (b) report community-identified priorities for an environmental intervention addressing early childhood (ages 2–8 years) obesity, and (c) share lessons learned in the CEP. Four communities in each of five CHL jurisdictions (Alaska, American Samoa, Commonwealth of the Northern Mariana Islands, Guam, Hawai‘i) were selected to participate in the community-randomized matched-pair trial. Over 900 community members including parents, teachers, and community leaders participated in the CEP over a 14 month period. The CEP was used to identify environmental intervention priorities to address six behavioral outcomes: increasing fruit/vegetable consumption, water intake, physical activity and sleep; and decreasing screen time and intake of sugar sweetened beverages. Community members were engaged through Local Advisory Committees, key informant interviews and participatory community meetings. Community-identified priorities centered on policy development; role modeling; enhancing access to healthy food, clean water, and physical activity venues; and healthy living education. Through the CEP, CHL identified culturally appropriate priorities for intervention that were also consistent with the literature on effective obesity prevention practices. Results of the CEP will guide the CHL intervention design and implementation. The CHL CEP may serve as a model for other underserved minority island populations.
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Li F, Novotny R, Fialkowski M, Wilkens L, McGlone K, Uchima M, Nelson R, Bersamin A, Vargo A. Determinants of Young Children's Sleep Duration in the U.S. Affiliated Pacific: The Children's Healthy Living Program. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.902.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Fenfang Li
- Human Nutrition, Food, and Animal SciencesUniversity of HawaiiUnited States
| | - Rachel Novotny
- Human Nutrition, Food, and Animal SciencesUniversity of HawaiiUnited States
| | - Marie Fialkowski
- Human Nutrition, Food, and Animal SciencesUniversity of HawaiiUnited States
| | - Lynne Wilkens
- Human Nutrition, Food, and Animal SciencesUniversity of HawaiiUnited States
| | - Katalina McGlone
- Human Nutrition, Food, and Animal SciencesUniversity of HawaiiUnited States
| | | | | | | | - Agnes Vargo
- American Samoa Community CollegeUnited States
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Fialkowski M, Li F, Bersamin A, Leon Guerrero R, Kim J, Novotny R. The Pacific Retail Food Store Environment: Findings from the Children's Healthy Living Program. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.382.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Fenfang Li
- HNFAS University of Hawaii atManoa HonoluluHawaiiUnited States
| | | | | | - Jang Kim
- CREES Northern Marianas CollegeSaipanMPUnited States
| | - Rachel Novotny
- HNFAS University of Hawaii atManoa HonoluluHawaiiUnited States
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Greenberg J, Luick B, Barber R, Bersamin A, Coleman P, Ettienne R, Fleming T, Hollyer J, Johnson E, Li F, Nelson R, Novotny R, Remengesau S, Riklon J, Roberts K, Wilkens L. Comparison of food prices in the US Affiliated Pacific Region based on the 2002 USDA Food Security Toolkit and the Thrifty Food Plan. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.585.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Dela Cruz‐Talbert E, Li F, Fialkowski M, Wilkens L, Leon‐Guerrero R, Kim J, Bersamin A, Novotny R. Fast Food Environment among Low‐Income Communities in the Pacific Region: Findings from the Children's Healthy Living Program. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.903.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Fenfang Li
- Human Nutrition, Food and Animal SciencesUniversity of HawaiiUnited States
| | - Marie Fialkowski
- Human Nutrition, Food and Animal SciencesUniversity of HawaiiUnited States
| | - Lynne Wilkens
- Human Nutrition, Food and Animal SciencesUniversity of HawaiiUnited States
| | | | - Jang Kim
- Northern Marianas CollegeNorthern Mariana Islands
| | | | - Rachel Novotny
- Human Nutrition, Food and Animal SciencesUniversity of HawaiiUnited States
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Ettienne R, Boushey C, Yonemori K, Fialkowski M, Leon Guerrero R, Bersamin A, Coleman P, Fleming T, Novotny R. “Your Child Ate What?” Frequently Consumed Foods among Young Children in the U.S. Affiliated Pacific (USAP): The Children's Healthy Living (CHL) Program. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.404.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Power J, Bersamin A, Uliassi D, Braccio C. Txt4HappyKids: Using text messaging to promote fruit and vegetable intake among low‐income families with young children, a pilot study. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.lb392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Julianne Power
- Center for Alaska Native Health Research University of AlaskaFairbanks
| | - Andrea Bersamin
- Center for Alaska Native Health Research University of AlaskaFairbanks
| | - Daniel Uliassi
- Center for Alaska Native Health Research University of AlaskaFairbanks
| | - Courtney Braccio
- Department of Epidemiology and Community HealthUniversity of MinnesotaSchool of Public Health
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Boushey C, Yonemori K, Novotny R, Fialkowski M, Wilkens L, Nigg C, Leon Guerrero R, Bersamin A, Kim J, Johnson K. Intakes of key dietary indicators among children 2‐8 years participating in the Children's Healthy Living (CHL) Program. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.381.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- C Boushey
- Epi/Nutr/Pub HealthUniv of HIHonoluluHIUnited States
| | - K Yonemori
- Epi/Nutr/Pub HealthUniv of HIHonoluluHIUnited States
| | - R Novotny
- Epi/Nutr/Pub HealthUniv of HIHonoluluHIUnited States
| | - M Fialkowski
- Epi/Nutr/Pub HealthUniv of HIHonoluluHIUnited States
| | - L Wilkens
- Epi/Nutr/Pub HealthUniv of HIHonoluluHIUnited States
| | - C Nigg
- Epi/Nutr/Pub HealthUniv of HIHonoluluHIUnited States
| | | | - A Bersamin
- Center for AK Native Health Research Univ of AK FairbanksFairbanksAKUnited States
| | - J Kim
- Cooperative Extension Northern Marianas CollegeSaipanMPUnited States
| | - K Johnson
- Epi/Nutr/Pub HealthUniv of HIHonoluluHIUnited States
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Li F, Nigg C, McGlone K, Fialkowski M, Wilkens L, Paulino Y, Belyeu‐Camacho T, Bersamin A, Areta A, Novotny R. Young Children's Screen Time and Obesity in the U.S. Affiliated Pacific: The Children's Healthy Living Program. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.902.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Fenfang Li
- Human Nutrition, Food, and Animal SciencesUniversity of HawaiiUnited States
| | - Claudio Nigg
- Human Nutrition, Food, and Animal SciencesUniversity of HawaiiUnited States
| | - Katalina McGlone
- Human Nutrition, Food, and Animal SciencesUniversity of HawaiiUnited States
| | - Marie Fialkowski
- Human Nutrition, Food, and Animal SciencesUniversity of HawaiiUnited States
| | - Lynne Wilkens
- Human Nutrition, Food, and Animal SciencesUniversity of HawaiiUnited States
| | | | | | | | | | - Rachel Novotny
- Human Nutrition, Food, and Animal SciencesUniversity of HawaiiUnited States
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Ettienne R, Boushey C, Yonemori K, Nigg C, Leon Guerrero R, Bersamin A, Castro R, Martin U, Novotny R. Young Children's Physical Activities (PA) in the US Affiliated Pacific (USAP): The Children's Healthy Living (CHL) Program. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.732.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | | | - Andrea Bersamin
- Center for Alaska Native Health Research University of Alaska FairbanksUnited States
| | - Rose Castro
- Cooperative Research, Extension, and Education ServiceNorthern Marianas CollegeUnited StatesMinor Outlying Islands
| | - Ursula Martin
- Community & Natural Resources Division American Samoa Community CollegeAmerican Samoa
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Affiliation(s)
- Bret Luick
- Institute of Arctic Biology University of Alaska FairbanksFairbanksAlaskaUnited States
| | - Andrea Bersamin
- Institute of Arctic Biology University of Alaska FairbanksFairbanksAlaskaUnited States
| | - Judith Stern
- NutritionUniversity of California, DavisDavisCaliforniaUnited States
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Novotny R, Fialkowski MK, Li F, Paulino Y, Vargo D, Jim R, Coleman P, Bersamin A, Nigg CR, Leon Guerrero RT, Deenik J, Kim JH, Wilkens LR. Systematic Review of Prevalence of Young Child Overweight and Obesity in the United States-Affiliated Pacific Region Compared With the 48 Contiguous States: The Children's Healthy Living Program. Am J Public Health 2015; 105:e22-e35. [PMID: 25393168 DOI: 10.2105/ajph.2014.302283] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We estimated overweight and obesity (OWOB) prevalence of children in US-Affiliated Pacific jurisdictions (USAP) of the Children's Healthy Living Program compared with the contiguous United States. We searched peer-reviewed literature and government reports (January 2001-April 2014) for OWOB prevalence of children aged 2 to 8 years in the USAP and found 24 sources. We used 3 articles from National Health and Nutrition Examination Surveys for comparison. Mixed models regressed OWOB prevalence on an age polynomial to compare trends (n = 246 data points). In the USAP, OWOB prevalence estimates increased with age, from 21% at age 2 years to 39% at age 8 years, increasing markedly at age 5 years; the proportion obese increased from 10% at age 2 years to 23% at age 8 years. The highest prevalence was in American Samoa and Guam.
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Affiliation(s)
- Rachel Novotny
- Rachel Novotny, Marie Kainoa Fialkowski, Fenfang Li, and Rally Jim are with the Department of Human Nutrition, Food, and Animal Sciences, University of Hawaii at Manoa, Honolulu. Claudio R. Nigg is with the Department of Public Health Sciences, University of Hawaii at Manoa. Jonathan Deenik is with the Department of Tropical Plants and Soil Science, University of Hawaii at Manoa. Lynne R. Wilkens is with Cancer Center, University of Hawaii at Manoa. Yvette Paulino is with the Department of Nursing and Health Sciences, University of Guam, Mangilao. Rachael T. Leon Guerrero is with the College of Agriculture, University of Guam. Donald Vargo is with the Land Grant Program, American Samoa Community College, Pago Pago. Patricia Coleman and Jang Ho Kim are with the Cooperative Research, Extension, and Education Service Department Northern Marianas College, Saipan. Andrea Bersamin is with the Center for Alaska Native Health Research at the University of Alaska
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Braun KL, Nigg CR, Fialkowski MK, Butel J, Hollyer JR, Barber LR, Bersamin A, Coleman P, Teo-Martin U, Vargo AM, Novotny R. 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. Child Obes 2014; 10:474-81. [PMID: 25369548 PMCID: PMC4267707 DOI: 10.1089/chi.2014.0102] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
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.
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Affiliation(s)
- Kathryn L. Braun
- Office of Public Health Studies, University of Hawaii at Mānoa, Honolulu, HI
| | - Claudio R. Nigg
- Office of Public Health Studies, University of Hawaii at Mānoa, Honolulu, HI
| | - Marie K. Fialkowski
- College of Tropical Agriculture and Human Resources, University of Hawaii at Mānoa, Honolulu, HI
| | - Jean Butel
- College of Tropical Agriculture and Human Resources, University of Hawaii at Mānoa, Honolulu, HI
| | - James R. Hollyer
- College of Tropical Agriculture and Human Resources, University of Hawaii at Mānoa, Honolulu, HI
| | | | | | | | | | | | - Rachel Novotny
- College of Tropical Agriculture and Human Resources, University of Hawaii at Mānoa, Honolulu, HI
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Ritter TL, Lopez EDS, Goldberger R, Dobson J, Hickel K, Smith J, Johnson RM, Bersamin A. Consuming untreated water in four southwestern Alaska Native communities: reasons revealed and recommendations for change. J Environ Health 2014; 77:8-52. [PMID: 25619021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In this article, the authors provide the first in-depth account of why some Alaska Native people drink untreated water when treated water is available. Their qualitative research was conducted in four Alaska Native village communities that have treated water available from a centralized distribution point. Most respondents (n = 172; 82%) reported that some of their household's drinking water came from an untreated source. Motives for drinking untreated water emerged from analysis of open-ended questions about drinking water practice and could be categorized into six themes: chemicals, taste, health, access, tradition, and cost. Importantly, some residents reported consuming untreated water because they both liked untreated water and disliked treated water. As such, interventions to increase safe water consumption should address this dichotomy by providing education about the benefits of treated water alongside the risks involved with drinking untreated water. Based on the findings, the authors provide specific recommendations for developing behavior change interventions that address influences at multiple social-ecological levels.
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Bersamin A, Wolsko C, Luick B, Boyer B, Lardon C, Hopkins S, Stern JS, Zidenberg-Cherr S. Enculturation, perceived stress, and physical activity: implications for metabolic risk among the Yup'ik--the Center for Alaska Native Health Research Study. Ethn Health 2014; 19:255-69. [PMID: 23297688 PMCID: PMC3644025 DOI: 10.1080/13557858.2012.758691] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVES American Indians and Alaska Natives (ANs) report among the lowest levels of physical activity in the USA, but there is very little systematic research examining the determinants of physical activity patterns in these populations. This study investigated the relationships between enculturation (or cultural traditionality), psychosocial stress, and physical activity in a community-based sample of Yup'ik women and men living in rural AN communities. Associations between these variables and several metabolic risk factors were also examined. DESIGN A sample of 488 Yup'ik participants (284 women and 204 men) from six villages in the Yukon-Kuskokwim Delta region completed a wellness survey and an array of physiological assessments [e.g., body mass index (BMI), blood pressure]. A subset of 179 participants also completed a 3-day pedometer assessment of physical activity. RESULTS Multivariate linear regression models indicated that participants who were more enculturated (i.e., living more of a traditional lifestyle) and who experienced lower levels of psychosocial stress were significantly more physically active. In turn, both lower levels of psychosocial stress and higher levels of physical activity were associated with lower BMI, lower percent body fat, and lower waist circumference. CONCLUSIONS Findings underscore the importance of gaining a culturally specific understanding of physical activity patterns in indigenous groups in order to inform effective health promotion strategies.
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Affiliation(s)
- Andrea Bersamin
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, Alaska
| | | | - Bret Luick
- Natural Resource Management, University of Alaska Fairbanks, Fairbanks, Alaska
| | - Bert Boyer
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, Alaska
| | - Cecile Lardon
- Psychology Department, University of Alaska Fairbanks, Fairbanks, Alaska
| | - Scarlett Hopkins
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, Alaska
| | - Judith S. Stern
- Department of Nutrition, University of California, Davis, Davis, California
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Li F, Wilkens L, Novotny R, Fialkowski M, Paulino Y, Nelson R, Bersamin A, Martin U, Jim R, Deenik J, Boushey C. Anthropometric standardization in the U.S. Affiliated Pacific: The Children’S Healthy Living Program (1024.6). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.1024.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Fenfang Li
- Department of Human Nutrition, Food, and Animal SciencesUniversity of HawaiiHonoluluHIUnited States
| | - Lynne Wilkens
- Hawaii Cancer Research CenterUniversity of HawaiiHonoluluHIUnited States
| | - Rachel Novotny
- Department of Human Nutrition, Food, and Animal SciencesUniversity of HawaiiHonoluluHIUnited States
| | - Marie Fialkowski
- Department of Human Nutrition, Food, and Animal SciencesUniversity of HawaiiHonoluluHIUnited States
| | - Yvette Paulino
- School of Nursing and Health SciencesUniversity of GuamMangilaoGUUnited States
| | - Randall Nelson
- CREES CHL Northern Marianas College SaipanNorthern MarianaIslands
| | - Andrea Bersamin
- Center for Alaska Native Health Research University of AlaskaFairbanksAKUnited States
| | - Ursula Martin
- Community & Natural ResourcesAmerican Samoa Community College PagoPagoAmerican Samoa
| | - Rally Jim
- University of HawaiiHonoluluHIUnited States
| | - Jonathan Deenik
- Department of Tropical Plant and Soil SciencesUniversity of HawaiiHonoluluHIUnited States
| | - Carol Boushey
- Hawaii Cancer Research CenterUniversity of HawaiiHonoluluHIUnited States
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Novotny R, Fialkowski M, Li F, Vargo D, Paulino Y, Coleman P, Bersamin A, Nigg C, Leslie J, Leon Guerrero R, Deenik J, Kim J, Wilkens L. Prevalence of young child overweight and obesity in the U.S.‐affiliated Pacific region: a meta analysis from the Children's Healthy Living Program (621.6). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.621.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Fenfang Li
- University of Hawaii at ManoaHonoluluHIUnited States
| | - Donald Vargo
- American Samoa Community CollegePago PagoAmerican Samoa
| | | | - Patricia Coleman
- Northern Marianas College Saipan United States MinorOutlyingIslands
| | | | - Claudio Nigg
- University of Hawaii at ManoaHonoluluHIUnited States
| | - Jodi Leslie
- University of Hawaii at ManoaHonoluluHIUnited States
| | | | | | - Jang Kim
- Northern Marianas College Saipan United States MinorOutlyingIslands
| | - Lynne Wilkens
- University of Hawaii at ManoaHonoluluHIUnited States
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