Progress 02/01/04 to 01/31/08
Outputs
OUTPUTS: In an effort to reduce health disparities in its predominantly Native Hawaiian population, The Waianae coast comprehensive Health Center (WCCHC) developed and implemented the Hawaii Community Resource Obesity Project (HCROP), a community-wide, agriculturally-based healthy food initiative. The program connected food producers, consumers, and vendors in a network creating a systems change that improved both the health and socioeconomic viability of the community. HCROP sought to increase the production of fruits, vegetables, and seafood along the Waianae coast and to enhance availability of these healthy agricultural products throughout the community, in an effort to improve obesity outcomes among a community comprised of socio-economically disadvantaged Native Hawaiians. To increase awareness regarding locally-produced agriculture, healthy food messages were developed and publicized via community presentations, fliers, and newspaper articles. A pamphlet featuring a local
artist "Buy Local: Eat Fresh" encouraged eating in color, buying locally and supporting the community's agriculture industry. A public service announcement was also produced "I Am I Will", featuring an HCROP team member,a Native Hawaiian fitness trainer who has been extremely successful at weight loss and maintenance. A second PSA was also produced entitled "Locally Grown Family" which featured a local extended family fishing, harvesting and preparing healthy fresh foods. Both of these PSA's were produced by Waianae High School's SeaRider Productions. Newspaper columns, professional presentations, and poster sessions in Hawaii as well as on the Mainland have supported spreading the work on the project. The HCROP team has effectively networked among Waianae community producers, increasing agricultural production from 106.1 to 742.5 total purchases among three primary vendors supplying the WCCHC Dining Pavilion. Total sales revenue more than tripled. Among fishermen, the annual yield
increased from 380,000 pounds to over 550,000 poinds. In addition, WCCHC became the largest purchaser of ogo or edible seaweed in Waianae with 66% of the sales being attributed to WCCHC. Extremely severe weather, consisting of heavy wind and rain for over 40 days in early 2006 resulted in the total annihilation of one large community farm, much of WCCHC's on-site garden and greenhouse. One farm rebuilt but had to shut down a subsidiary restaurant. Fishermen temporarily moved to calmer waters. The community is rebuilding, however, torrential rains and heavy winds in late 2007 have wreaked additional devastation, again destroying large sections of the community's remaining agricultural farms and making it necessary for restaurants statewide to purchase vegetables from out of state. The model was shared on the island of Hawaii (Big Island) among the Bay Clinic and Health Wroks Under the Banyan (an educational center with a vegan focus). On the island of Kauai, the model was shared among
Waipa Farm (a traditional Hawiaian educational and cultural center), Hanalei Poi Company and Kauai Community College.
PARTICIPANTS: Bryan Talisayan, Project Manager Anuenue Washburn, RN, BSN, Nurse Educator Jasmin Galicinao Wachendorf, MPH, MS, RD, Cardiac Rehabilitation Specialist John Cheung, MPH, RD, Clinical Exercise Specialist/Clinical Dietitian Christy Inda, MS, RD, Wellness Manager Brenda Yamasato, Program Assistant Hoa Aina Farm MAO Farm Waianae High School SeaRider Productions Waianae High School Department of Hawaiian Studies Jim Davis, statistician
TARGET AUDIENCES: Native Hawaiians and other Asian-Pacific Islanders residing on the Waianae Coast, an area of disparate socioeconomic risk and high prevalence of obesity related chronic conditions.
PROJECT MODIFICATIONS: none
Impacts
A primary component of this project was the Lifestyle Enhancement Program (LEP), a multidisciplinary team-led, moderate lifestyle modification initiative designed for adult patients with a BMI >35. Two hundred twelve individuals participated in the LEP program. Fifty-eight were of Native Hawaiian ethnicity; 73% female and 27% male. Participants were tracked from January 2005 through July 2007. In order to provide comparative data, a demographically matched usual care cohort was tracked as well, consisting of 89 obese adult individuals with primary care visits between November 2005 and March 2007. These individuals received weight loss advice from their primary care physician but did not receive additional intervention. Anhropometric measures of weight, BMI, body fat and girth were compared initially and at 1,3,6,9,12 and 18 months. Average initial weight among females=106.02 kg (range 61.51-205.75 kg) and among males=127.18 kg (range 61.05-220.77 kg).. Average BMI among
females=39.74; among males=40.29. Twenty percent of participants lost more than five percent of their baseline weight by the third month, (p=.01) with a sustained loss at six and nine months post intervention. Expressed as an absolute weight, 30% of participants lost 4.5 kilograms or more by six months post intervention. Average weight loss among all participants was 1.82 kg. Average BMI decreased significantly in females by three months and remained lower than baseline throughout the program. BMI's also decreased among males but were not statistically significant. Attrition rates were very high, with 43% (66) of females and 31% (18) of males dropping out of the LEP at the end of the first month. Attrition at year end was 58% (89) among females and 47% (27) among males. Average initial weight among controls (for which gender specificity was not available) was 114.11 kg (range 74.84-174.91 kg). Average BMI=46.35 (range 28-221.00). Average weight loss at 3 months among controls was also
significant (p=.004) but results were not sustained past 6 months. Average annual visits per participant varied by program component as follows: 34.27 visits for fitness; .07 visits with the physician; 4.75 visits to the registered dietitian; and 4.73 visits to the psychologist. Based on these encounter data, the average cost per participant per encounter was $34.56 or $1655 per participant per year.
Publications
- Beckham S, Bradley S, Washburn A. One Health Centers Response to the Obesity Epidemic. An Overview of Three Innovative, Culturally Appropriate, Community-Based Strategies. Hawaii Medical Journal. Vol 64. June 2005. P. 151-168.
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Progress 02/01/06 to 01/31/07
Outputs
The Hawaii Community Resource Obesity Project (HCROP) implemented by the Waianae Coast Comprehensive Health Center, focuses on increasing the production of fruits, vegetables, and seafood along the Waianae Coast and increasing the availability of these healthy agricultural products throughout the community in an effort to improve obesity outcomes among a community comprised of socio-economically disadvantaged Native Hawaiians. Two hundred sixty-five individuals consented to participate in an obesity intervention between January 2005 and December 2006. The quasi-experimental design is comprised of three self-selected cohorts. Forth-nine individuals participated in one of three 2-day diet programs (cohort 1); 29 of whom voluntarily participated in the lifestyle enhancement (LEP) component where a multidisciplinary team of physicians, registered dietitians, fitness trainers, health educators and a psychologist assist the participants with weight management (cohort 2).
The remaining 205 voluntarily chose to participate in LEP only (cohort 3). When stratified for duration in the program thus far: WEIGHT Cohort Initial 3 mo 6 mo 12 mo Wt loss 1 194.78 (20) 190.65 (12) 191.03 (7) 184.28 (6) 10.47# 2 215.51 (29) 210.01 (7) 197.84(18) 213.78(8) 1.73# 3 247.23 (205) 245.01 (76) 237.93 (45) 220 (19) 27.23# The HCROP team has effectively networked among Waianae community producers, increasing agricultural production from 106.1 to 742.5 total purchases among three primary vendors supplying the WCCHC Dining Pavilion. Total sales revenue more than doubled for the same period. In addition, WCCHC became the largest purchaser of ogo or edible seaweed in Waianae with 66% of sales being attributed to WCCHC. Extremely severe weather, consisting of heavy wind and rain for over 40 days in early 2006 resulted in the total annihilation of one large community farm, much of WCCHC's on-site garden and greenhouse. One farm rebuilt but had to shut down a subsidiary
restaurant. Fishermen temporarily moved to calmer waters. The community is rebuilding with approximately 150 lb of fish, 200 lb of mescaline/lettuce, 40# of ogo, 2# of taro, and 95-100# of miscellaneous herbs, fruits and vegetables being used at the Dining Pavilion through November 2006. Efforts continued throughout 2006 to increase availability of healthy produce among community markets and specialty stores. Additional funding was obtained to enable patients at the Center diagnosed with diabetes, to establish, tend, and harvest their own vegetable and fruit gardens; learn to pick limu (seaweed), fish (with pole or net), and learn healthy ways of cooking their produce. Buy Local; Eat Fresh a pamphlet focused on healthy eating, was produced supporting the community's agriculture industry. A public service announcement was also produced, Locally Grown, featuring an HCROP team member--a Native Hawaiian fitness trainer who has been extremely successful at weight loss and maintenance.
Newspaper columns, professional presentations, and poster sessions in Hawaii as well as on the Mainland have supported spreading the word on the project.
Impacts
The project is expected to increase socio-economic viability through creating a demand for resources and jobs in the community. It is expected to reduce obesity risk factors, improving health and quality of life among its participants. In addition, the project is expected to create a community-based health network.
Publications
- No publications reported this period
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Progress 02/01/05 to 01/31/06
Outputs
The Waianae Coast Comprehensive Health Center, through the Hawaii Community Resource Obesity Project (HCROP), is focusing on increasing production and availability of healthy agricultural products, in an effort to positively improve obesity outcomes among a community comprised of socio-economically disadvantaged Native Hawaiians. The HCROP team has effectively networked among Waianae community producers, resulting in an association that includes: 24 farmers, 2 dairies, 3 pig farmers, 4 chicken/egg farmers, and 4 grocery stores. In 2005 (January-August) agricultural production increased from 106.1 to 742.5 total purchases among the three primary vendors supplying the WCCHC Dining Pavilion. Total sales revenue more than doubled for the same period. In addition, we have become the largest purchaser of ogo, or edible seaweed, in Waianae with 66% of sales being attributed to WCCHC. The Health Center's on-site vegetable garden has been supplying the Dining Pavilion with
approximately 20 lbs. of vegetables per week. The vegetables are used to prepare various healthy dishes. Recently, the Center's greenhouse has been growing manoa lettuce, a local variety, which has been made available through the Health Center in 1 and 2 lb. bags. In addition, the Health Center has cleared approximately 300 square feet of land for diabetic patients to tend, increasing physical activity and fresh produce availability. Currently, there are 12 participants and their families participating in the garden workshop. 'Buy Local; Eat Fresh' a pamphlet, focused on healthy eating, was produced, featuring the works of a local artist. The theme of the pamphlet was to eat in color, buy locally, and support the community's agriculture industry. This educational vehicle was printed and distributed throughout the Health Center and at various community sites such as restaurants, grocery stores, and the food stamp office. Additional venues for educating the community include a monthly
health/nutrition column in the Westside Stories newspaper, newspaper advertisements, presentations at a professional obesity conference and presentations for physician continuing medical education at various facilities in the area. Two mini diet programs were implemented during 2005 among 37 individuals. These participants were served healthy meals consisting of local produce for two days. They participated in educational sessions, group interaction, and clinical measurements. Twenty-four of the 37 diet program participants are now participating in the Center's Lifestyle Enhancement Program (LEP) where a multidisciplinary team of physicians, registered dietitians, fitness trainers, behavioral specialists and health educators assist the participants with weight management. Clinical outcomes will be compared among three groups: 1. Diet program only 2. Diet program + LEP 3. LEP only. Currently there are 13 individuals in group one, 24 in group two, and 52 in group three. At the end of
the project, weight, BMI, body fat, and girth will be compared among each cohort.
Impacts
The HCROP has already made a positive impact in a number of areas. The opening of the Dining Pavilion with its breathtaking view of the leeward coast offers a rare opportunity to eat healthy foods at extremely affordable prices. The development of healthy recipes has increased the need for vegetables and fruits, which in turn, has begun a relationship between the Waianae Coast Comprehensive Health Center and various community agricultural producers. The weekly farmers market allows employees to purchase healthy produce for use at home with their families,again expanding the demand for community products. The potential agricultural and culinary collaborations will provide students with unique training opportunities and will provide the WCCHC with additional volunteer support in the dining room and throughout the gardens. Creation of a market within the WCCHCs dining pavilion will enable local farmers and fishermen to generate a greater profit than that obtained in
Honolulu, will enable the dining room manager to purchase these products at a cheaper rate than that available in the retail market. By regularly publicizing nutrition and health related articles in the Waianae Coasts own newspaper, residents will increase their knowledge about the relationship of healthy foods to obesity. The multidisciplinary team is available to tackle the multifactorial aspects of obesity. This allows the patient in conjunction with the team, to focus on areas where he or she might have the greatest motivation and also highlights the interconnectedness of healing the whole person.
Publications
- Beckham SB, Bradley S, Washburn A. One Health Center's Response to the Obesity Epidemic: An Overview of Three Innovative, Culturally Appropriate, Community-Based Strategies. Hawaii Medical Journal 2005;54:151-168.
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Progress 10/01/03 to 09/30/04
Outputs
The Hawaii Community Resource Obesity Project 2004 team has compiled a list of community producers and surveyed these individuals to obtain a baseline of items produced, expansion potential, and current markets. Contacts made included large and small vegetable farmers, chicken farmers, dairies, piggeries, a mango producer, Waianae High School Marine Science Learning Center, independent fishermen and divers, University of Hawaii CTAHR, Leeward Community College, Kaiser Clinic Nanakuli, Waianae Harbormaster, Waianae Harbor Ice House, and local markets. An initial network meeting featured how to improve soil and increase production and a potential community-based retail market at a dinner and talk story. A second network meeting highlighted a pest management workshop. An inventory tool was created, however, only ten individuals attending agreed to complete the tool. A weekly farmers market was established at WCCHC and discussions are underway to establish community
supported agriculture. Collaborations are underway to establish agricultural and culinary opportunities for students at both the high school and community college level. The HCROP team has been involved in marketing through the development of two pamphlets: Eat More Weigh Less and Eat in Technicolor, presentation of two community seminars, and publication of three brief newspaper articles focusing on healthy messages i.e. Colors in your Diet are Good for You, Eat More Weigh Less, and Fitness Fun. In addition, the grant award was featured in the Honolulu Advertiser and in a press release announced by Congressman Ed Case. 30 new recipes have been created and are now available to the public Monday through Friday in the WCCHC dining pavilion. The new facility is open for breakfast and lunch, and features three affordable entrees daily. In addition, a list of agricultural producers & fishermen interested in supplying the dining room was provided to the dining room manager. A list of the
agricultural products currently being cultivated at the WCCHC was also provided with a site map of the location. The initial logistical planning and recruitment have occurred for implementation of the first diet program, however, it was necessary to postpone the program scheduled for November due to unforeseen circumstances. The infrastructure is in place for implementation of the multidisciplinary weight management clinic. The cardiac rehabilitation specialist has developed fitness flow sheets to assist in monitoring individual patients while performing individual fitness regimens; the behavioral therapist has established an obesity support group to provide a variety of behavior modifications; the secretary has established a clinical database and provides clerical support to project; and the team continues to meet monthly to plan all facets of the project.
Impacts
The HCROP has already made a positive impact in a number of areas. The opening of the dining pavilion with its breathtaking view of the leeward coast offers a rare opportunity to eat healthy foods at extremely affordable prices. The development of healthy recipes has increased the need for vegetables and fruits, which in turn, has begun a relationship between the Waianae Coast Comprehensive Health Center and various community agricultural producers. The weekly farmers market allows employees to purchase healthy produce for use at home with their families,again expanding the demand for community products. The potential agricultural and culinary collaborations will provide students with unique training opportunities and will provide the WCCHC with additional volunteer support in the dining room and throughout the gardens. Creation of a market within the WCCHCs dining pavilion will enable local farmers and fishermen to generate a greater profit than that obtained in
Honolulu, will enable the dining room manager to purchase these products at a cheaper rate than that available in the retail market. By regularly publicizing nutrition and health related articles in the Waianae Coasts own newspaper, residents will increase their knowledge about the relationship of healthy foods to obesity. The multidisciplinary team is available to tackle the multifactorial aspects of obesity. This allows the patient in conjunction with the team, to focus on areas where he or she might have the greatest motivation and also highlights the interconnectedness of healing the whole person.
Publications
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