Progress 05/01/09 to 04/30/12
Outputs
OUTPUTS: We conducted eight focus groups between January 2010 and February 2011 with 74 ethnic Samoan adults at the American Samoa Community College, Tutuila Island, American Samoa. The purpose was to identify barriers to healthful living in the Territory and to suggest culturally acceptable policies and interventions for improving lifestyles. Focus group participants were selected by gender, age group, and language preference. We used stratified sampling by gender and age group in order to match these proportions in the population at large based on Census 2000. Ratios of participants by gender and age group from the census versus our samples were, respectively, males:females, 1:1 vs. 1:1.2; and ages 18-25: 26-54: 55+, 1:2:1 vs. 1:1.9:1.2. Their prevalence for overweight and obesity were comparable to those of a sample of the Territory's population measured in 2004. In our study, 93.2% were overweight or obese and 82.4% obese. PARTICIPANTS: Project staff received training on conducting focus groups and also completed a Collaborative Institutional Training Institute course, Social and Behavioral Responsible Conduct of Research. TARGET AUDIENCES: Our target audience is the entire population of American Samoa. In 2007, the World Health Organization published the prevalence of overweight in 194 countries during 2005. The top seven countries with overweight populations were in the Pacific Basin. Although located in the South Pacific, as a US Territory and not a country, American Samoa was not included on that list. But a 2004 survey of American Samoan adults aged 25 to 64 years found that 93.5% were either overweight or obese. This would have placed the Territory at the second highest ranking in the prevalence of overweight behind Nauru at 94.5%. That same survey found that 47.3% of the population were diabetic, 29.9% were regular smokers, and 86.7% consumed less than five servings of fruit and vegetables daily. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.
Impacts
Although nearly all focus group participants were overweight and most actually obese, they tended to dismiss this to "large bones." They expressed feeling healthy, even if they suffered from hypertension and diabetes. Many held misconceptions about what contributed to a healthful lifestyle. Yet they easily identified unhealthy practices by others. The most immediate impact was a recognition that they share similar circumstances, especially family pressure for inexpensive menu items high in fat and salt, i.e., processed meats. One surprising outcome was to learn that in this very traditional and conformist Samoan society, it was the eldest participants who attributed unhealthful lifestyles to individual choice rather than to communal expectations.
Publications
- No publications reported this period
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Progress 05/01/10 to 04/30/11
Outputs
OUTPUTS: The last of eight focus group sessions was completed in February 2011. Data are now being coded (NVivo 8), and a oneyear, no-cost extension of the project was granted in order to complete the data analysis and to publish the findings. PARTICIPANTS: Nothing significant to report during this reporting period. TARGET AUDIENCES: Nothing significant to report during this reporting period. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.
Impacts
Barriers to healthful living appear to fall into four categories: physical, economical, cultural, and political, with the latter two receiving the most comments.
Publications
- No publications reported this period
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Progress 05/01/09 to 04/30/10
Outputs
OUTPUTS: Owing to confusion concerning a change of PI and, as a result, a change in the proposal, budget, and budget narrative, our submission was not accepted until mid-September 2009. This delay was compounded by serious disruption to routine life in the Territory due to a magnitude 8 earthquake and devastating tsunami on the morning of September 29. Consequently, registration for on-line courses on the protection of human research subjects and a workshop on conducting focus groups were delayed until mid-December. After supporting equipment and supplies, such as digital recorders and NVivo qualitative analysis software, arrived in early January 2010, we conducted our first focus group on January 23. Participants were culled from a list of 112 applicants who previously completed a 3-page recruitment questionnaire. A second focus group was held February 20. Transcriptions are nearly completed, after first having to be translated into English from Samoan. Because of our late start, we have requested a no-cost, one-year extension for this project. PARTICIPANTS: Mr. Kevin Cassell of the University of Hawaii Cancer Research Center presented our workshop on focus groups. Several agencies and churches helped us recruit potential focus group participants: Dept. of Health, Community College, Territorial Office of the Aged, National Olympic Committee, and Women Infants and Children (WIC) Program. On-line training courses in working with human research subjects was through the University of Miami's Collaborative Institutional Training Initiative, or CITI. TARGET AUDIENCES: Focus group participants are self-selected adults recruited on the basis of gender, age group (18-25, 26-54, and 55+ years), education level (no high school, high school diploma, post high school), and preferred language (Samoan or English). For a stratified sample reflecting the Territory's population, male and female are equally represented, and the ratio of the number of focus groups by age group is 1:4:1, respectively. PROJECT MODIFICATIONS: Participants acknowledged that overweight and obesity are serious problems in the Territory. While several barriers to healthful living were identified, such as a lack of sidewalks and the high cost of fresh fruits and vegetables, few culturally acceptable suggestions were offered that might lead to a better diet or more physical activity. Subsequent focus groups will concentrate on eliciting more suggestions.
Impacts
Based on notes taken during the first two focus groups, there is general agreement that overweight and obesity are serious problems and the underlying cause of several noncommunicable diseases common in the Territory. Participants acknowledge less demand for physical activity and a wider range of foods available--particularly fast foods--than in the past. While several barriers to healthful living were identified, such as a lack of sidewalks the comparitively higher cost of foods deemed healthful, few ideas were offered that would encourage a more healthful lifestyle. Subsequent focus groups will try to elicit more suggestions that might be culturally appropriate in promoting balanced diets and increased physical activity.
Publications
- No publications reported this period
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