Sponsoring Institution
National Institute of Food and Agriculture
Project Status
Funding Source
Reporting Frequency
Accession No.
Grant No.
Project No.
Proposal No.
Multistate No.
Program Code
Project Start Date
Nov 5, 2014
Project End Date
Feb 15, 2017
Grant Year
Project Director
Van der Ryn, MI, GA.
Recipient Organization
Performing Department
Experiment Station
Non Technical Summary
The combined overweight and obesity prevalence in American Samoa currently stands at roughly 94%, making American Samoa the most overweight and obese country in the world. This epidemic can be largely attributed to lifestyle changes in American Samoa over the last three decades. The astoundingly high rates of overweight and obesity directly associate with the high prevalence of Type 2 Diabetes, cardiovascular disease and other chronic life-style related diseases currently plaguing American Samoa. This health crisis is debilitating to the physical, social, and economic wellbeing of American Samoa and her people. The solution can only come through persistent wide spread healthy lifestyle changes among American Samoan residents, and through developing healthier environments to support and encourage this change.A number of American Samoan agencies and programs have begun to address this major health problem, including the American Samoa Community College (ASCC) Wellness Research Center at the Division of Community and Natural Resources (CNR). Yet, as of now, no wide spread, continual health communications and social marketing campaigns to combat the problem locally have been designed nor implemented.The newly established Health Communications Research and Media (HCRM) program at CNR is posed with commitment to fulfilling this need. The proposed HCRM research project will collect valuable formative data about American Samoan audiences - their media behaviors, health beliefs and attitudes, and so forth - information that will inform the design and development of effective and culturally relevant health communication and social marketing campaigns to help combat the obesity and NCD problem in American Samoa.A specific additional objective is to measure the reach and effect of the recent broadcast on public television in American Samoa of The Weight of the Nation (TWON): To Win, We Have to Lose. In 2014 HCRM negotiated permission from HBO for American Samoa's KVZK-TV to air this documentary series (produced and released in 2012). This effort has been one of the initial steps taken by CNRs HCRM to get more messaging out in the media, television in particular, on the health consequences of obesity. Evaluation of the reach and effect of this project is necessary and informative towards future HCRM projects.
Animal Health Component
Research Effort Categories

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
Goals / Objectives
The main goal of the proposed research is to gain formative data to inform the design and development of effective and culturally appropriate healthy lifestyle promotion campaigns in American Samoa through various media communication channels (radio, television, newspaper, etc.). The data to be collected can be divided into five categories: 1) demographic attributes; 2) perceptions and knowledge about obesity and associated health issues; 3) audience usage of different communication channels (television, radio, television, etc.) by which American Samoans acquire health information; 4) data specifically about television access and viewing behavior; and 5) reach and effect of the TWON broadcast.In terms of the survey component on the reach and effect of the TWON broadcast (category 5), the survey will examine how many people watched the broadcast, why they did or did not watch it, and what effect watching it had on their perceptions, knowledge or behaviors with regards to obesity, overweight and the related health problems. Two key considerations here are: 1) the English language of the HBO TWON series (which is a second language for the most American Samoans); and 2) the extent to which American Samoan audiences could relate to the overweight, obese and ill people depicted in the programs. The survey will inform decisions about whether this type of broadcast should continue to be pursued locally in American Samoa to raise awareness and enact local actions to improve the prevalence of healthy lifestyles. It will also help us know what parts of the program can be evaluated as most useful and why.Analysis of the rest of the survey will examine any emergent patterns that emerge in terms of associations between various demographic attributes and the other categories of data sought. This effort will assist profiling and possible segmentation of targeted audiences, which will inform the design and development of effective and culturally appropriate social marketing and health communication campaigns to positively impact health outcomes in the population.
Project Methods
A bi-lingual (Samoan and English) scripted survey will be developed with five sets of questions to collect data on the various categories of information sought. It will be written in English first, tested in English, revised accordingly, then translated to Samoan, and retested. After the instrument is finalized in both languages, an interviewer will be trained to assist the conduct of the telephone survey. The two staff doing the survey will be the principle investigator and the trained interviewer.Phone survey method has been chosen as the most appropriate (over face to face interviews, mail surveys or other methods) because phone surveys minimize costs, assure high response rates, are relatively fast, and typically facilitate more frank answers from respondents than do personal interviews. Nonetheless, it will be recognized that there will be some response bias caused by not every household in American Samoa having a landline.Four hundred working residential telephone numbers will be randomly selected from the American Samoan phone directory to establish a randomly selected representative sample (based on applying the chi-square-adjusted formula with a 5% confidence interval) of the 9,688 households in American Samoa. Respondents to the telephone survey will need to be eighteen or over and be a permanent resident of the household. The interview will maintain anonymity of the respondents in all published reports, and it will not be necessary for respondents to ever mention there name.The quantitative data will be statistically tabulated to determine the reach of the broadcast in American Samoa and its effect (did it alter people's understandings or behaviors in any way). The quantitative data will also be analyzed to find any patterns between attributes of those who watched the program and those who did not. This effort contributes to the profiling of American Samoan audiences. This will help provide an axis for viewing differences in the various attributes between those who watched the program and those who did not. To determine the effect of the TWON broadcast on American Samoan audiences, those who watched any of the broadcast will be asked if it caused any change in knowledge or behavior for them, and if so, what those changes were and how sustained are they. This data will be compared with the data they provided previously in the survey in the section on health beliefs and perceptions, which all respondents will answer. This research design provides a cross reference system for understanding and validating if effects actually occurred.While the majority of the questions in the survey are closed ended aimed at getting quantitative data, about five questions will be open ended, seeking qualitative data from respondents. This qualitative information will help the interpretation of the quantitative data, and give additional insights for the study. These will be audio recorded with permission of the respondent.

Progress 11/05/14 to 02/15/17

Target Audience:There were two target audiences reached during this reporting period. The first are health communication professionals working in American Samoa. Here, I refer first to CDC health communication specialists sent to American Samoa to assist in addressing the ZIKA outbreak in American Samoa. These health communication specialists consulted with the principle investigator regarding most commonly used health communication channels in American Samoa and also on audience segmentation profiles for American Samoa. The data from the SAM-044 project provided this data and related insights to the CDC health communication specialists that the CDC deployed to American Samoa to assist American Samoa's Department of Health in addressing this public health hazard. The total number of CDC health communication specialists that consulted for results from the study to assist them develop their health communication strategies was six. The information from this study also reached a second audience in American Samoa during the reporting period - that was the intersectoral staff of many American Samoan agencies that participated in American Samoa's Medicaid SIM (State Innovation Model) Project in 2016.The Health Communications Researcherwas selected to be a member of the SIM Environment & Education Design Team and in this capacity was able to communicate findings of the SAM-044 project to assist in the making of useful and strategic recommendations from this team to the SIM project toward improving American Samoa's health care system in terms of population health, peatient health outcomes and experience, and cultural compentence. The Health Communications Researcher developed an informative power point presentation to present the SAM-044 NIFA Study at the Two-Samoa Health Summit in November 2016 in American Samoa, but the program was unfortunately too full. (Note, the Two-Samoa Health Summit is an annual three day event where all agencies of both independent Samoa and American Samoa concerned with public health issues meet together and formally share their work and discuss collaborative ways forward to help each other improve hour health care systems. During the 2016 2-Samoa Health Summit meetingsthe Health Communications Researcherwas able to have a meeting with the keynote speaker for the summit who spoke on "Return on Investments" in health prevention, especially focussing on young people. The key theme of the meeting was on how investments in evidence based, well researched, and culturally competent health communications and promotion is absolutely strategic, and can provide very good "returns" in health and reduced health costs in public health. Findings from the SAM-044 project were used to help inform this discussion and the speaker was enthusiastic about supportive collaboration and inputs to help further this cause in American Samoa, which suffers the highest rates of obesity and metabolic syndromes in the whole world, and stands the most to win from investing in strategically developed health communications, to which the data from the SAM-044 makes a valuable contribution. The final audience reached during this reporting period was at the 2016 National Conference on Health Communications, Marketing and Media in Atlanta, August 23 - 25, 2016. The Health Communications Researcher presented on the SAM-044 Project using a powerpoint presentation that takes the audience through all stages of the study from conception, through design, implementation, findings and conclusions. The abstract was sent in advance and accepted for inclusion along with other formal presentations in a half day session entitled, "Community is the Key to Discovering Meaningful Health In-Roads". The session was attended by approxiamately 80 health communication professionals from throughout the United States, and was also filmed. In addition, the Health Communications Researcher is currently engaged in writing an article about this research for a peer reviewed journal. Most importantly, this project provides very useful information to support further work in health communications interventions and research in American Samoa. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?This random sample survey of households in American Samoa involved opportunities for training and professional development, particularly of many American Samoan college students, who were trained as surveyers. The principle investigator trained forty five students at the College to conduct the survey. Students were organized into teams of two to four students, who would work together to conduct their portion of they total surveys done. One student would introduce the project and receive consent, another would ask the questions, and a third would fill out the answer sheet according to the answers given. The college's Nursing Department students, the Health Science Department's students, and Social Science Department students were all recruited and trained to participate and contribute to this project. The project was discussed first with the department chairs then course teachers, and in many cases, the students received course credit for the training and their work in conducting surveys. The principle investigator provided survey packages with maps, lists of households to visit, and the reserach instruments. The principle investigator also assisted transport and conduct of surveys for about 24% of the surveys conducted. There was a very positive response from most of the students regarding the experience, as it offered real world experience, going into people's homes, interacting with people to get important information about their lives and knowledge related to health. How have the results been disseminated to communities of interest?The results will continue to be disseminated to communities of interest, which includes both in American Samoa, in the Pacific Island region, and health communication professionals working internationally. Most importantly, it will be distributed to American Samoa's Department of Public Health. The final report is in process now of being distributed. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

What was accomplished under these goals? All of the goals of this project were accomplished. First, formative data was gained which can inform the design and development of effective and culturally appropriate healthy lfiestyle promotion campaigns in American Samoa. For example, the study helped us now know which communication channels are most freuqently used and by what segments of the total population. The formative data also informs our knowledge of audience knowledge and attitudes regarding the health risks of obesity and their understandings about healthly diets and lifestyles. We know for example fromn this study that TV is the most frequently used media communication channel in American Samoa, followed closely by the internet (including social media) and then radio, and we know that 25% of the population states that KVZK-TV, American Samoa Public Television Station is the station they watch the most, but this audience tends to be an older generation (50s and up) and their primary language of communication is Samoan. We also learned that 54% of those with televisions also have cable TV, and that for the younger adult generation (18 -30) the most frequent communication channel they use is social media. Yet, the majority of respondents stated they get most of their health information from doctors or other medical professionals at the hospital or clinics, followed by media messages, then family members. As far as the reach and effect of the TWOTN broadcast some important information was gained. First, there is a challenge to broadcast an English based program on public television in American Samoa, which prioritizes bi-lingual (Samoan and English) programming. While the cable TV is full of English, as well as Filipino, Korean, and other language based programming, it is only the public television station that offers bi-lingual programming with Samoan language, and Samoan language is still the primary language spoken for the majority of the American Samoan population. Thus, using American based public health campaign television materials that are copyrighted in the USA is challenging. While HBO gave rights for the broadcast, they could not give rights to insert Samoan based subtitling. While there is a large part of American Samoa's population that does speak also English, these audiences are also more likely to also choose other English only based cable based television to watch. While KVZK-TV ran the full broadcast of the series on the first run, some audience members complained about the English. As a result, KVZK-TV could not re-broadcast the entire series or use primetime slots as they had the first time for the broadcast, which resulted in largely reduced reach of the program. The most popular TWOTN program broadcast was one produced for children (Kabreea's Salad Days), and focussed on a teenager on crusade to improve the healthfulness of food on offerat her high school in a southern USA state. This program was the most popular because it had less advanced medical language than other programs, (thus more understandable), but more importantly, because it followed a narrative story structure with a positive ending (Kabreeya was successful in getting a salad bar and better food at her school cafeteria), and many of those who did watch the program reported immediately making a change of diet in their households, with an emphsis on having salads (which generally are not very popular in American Samoan households). The survey confirmed that most people of American Samoa are aware that obesity is a big problem in American Samoa, and is associated as a risk for other NCD, and reported that the newly developed sedentary lifestyles based on wage jobs whereas in the past the lifestyle had lots of physical activity and better quality fresh local food built in was a major challenge to address through legislation to improve the supply of "healthy options" in the food and physical environment and to develop effective social marketing strategies using multiple communication channels to increase the demand for these healthy options. As ASCC's Division of Agriculture, Community and Natural Resources is promoting the highly nutritious edible hibiscus (laupele) as an easy to grow home vegetable, the survey also included questions about households who grow and eat this vegetable on a regular basis. Almost fourty seven pervent of the population claimed they grew and harvested laupele on their land, and this could be confirmed by the surveyers simply by looking at the laupele patch next to the houses.


    Progress 11/05/14 to 09/30/15

    Target Audience:The specific target audiences reached in the efforts of this project over the reporting period may be divided into three groups. The first are the 255 randomly chosen respondents who participated in the interviews of the survey. Theyrepresenta representative randomsample of Tutuila Island householders inAmerican Samoa. The second group consists of the 45 students who were trained to conduct and participate as interviewers in the conduct of the survey. The third group are the four American Samoa Community College instructors of the Nursing Derpartment, the Health Science Department, the Social Science Department, and the Communicty and Natural Resources Divisionwith whom a partnership was formed to incorporate this project into their class curriculums.College students in these instructors classes received class credit to be trained toassist this project as interviewers for the household based survey. This training and experinece added an important educational value to this project, and also faciliated the project's ability to shift from a phone based survey to a more valuable face to face household to household survey. It may be noted that the primary target audience of this project will be the professional health care providers in American Samoa who may use the data from this study to help design effective health communication interventions to promote healther disease reducing behaviors in the population. This target audience will start being reached once the dissemination of the results from the project begins in the second year of the project. Changes/Problems:The biggest change in the project was a beneficial one - which was to change from doing the survey using telephone to doing the survey face to face at the site of each household. Doing it this way was seen as particularly better in American Samoa where residents generally value face to face communication much more then any other type, thus providing the opportunity for more accurate and thoughtful answers to the questions in the survey. It also provided the opportunity to gain additional visual understandings of the environments of every household, observations which could be noted. We were able to do the survey face to face through the use of training student teams to help conduct the survey (which has already been described in the section on "Training opportunities provided"). This change is not one of approach, but only methodology. Reaching the full target sample of 264 households was a challenge, but with 255 household interviews conducted, the study did come close the reaching this sample size. In more remote villages, we found that sometimes a number of the houses that were randomly selected were abandoned houses. The project experienced also some delays as it is concurrent with other projects, but given that all the data is collected, and results are almost completed, it is now to the stage of final analysis, conclusions and final write up, which can all be finalized wtihin the next reporting period. What opportunities for training and professional development has the project provided?A beneficial addition to the original project was the training of American Samoan Community College students to assist the conduct of the survey as interviewers. For this purpose ASCC instructors were consulted in advance to incorporate both the training and the experienceof conducting the survey into the course syllabi resulting inthree 2 hour training sessions held for four ASCC courses in four differentASCC Departments and Divisions: Nursing, Health Science, Social Science, and Community and Natural Resources. Students were familiarized with the films series, The Weight of the Nation, with the problems of obesity in American Samoa, they were trained in the methods of doing the survey - using the research instruments, and each research team had to perform a mock up interview, including going through the consent process before going to the field.They were formed into teams of two to four students each to carry out the research under the supervision of the principal investigator. Most students noted that this was a very valuable experience for them from which they learned a lot. They also gained many insights about the American Samoan public and their attitudes about obesity, health and lifestyle. They gained skills as social science interviewers. How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals?The plan over the next reporting period is to diseminate the results of this project into the commujity and especially to the target audience of American Samoan health service providers,such as employees of American Samoa Department of Public Health, and others working on NCD prevention in American Samoa by promoting healthier lifestyles and choices in the population. This will be done through two methods - presentation of a powerpoint presentation multiple times to this target audience and the publication of a final report describing the project and its results. This publication will also generally promote an increased development of evidenced basedhealth communiations interventions and media campaigning in American Samoa together with evaluative systems that foster effective development of such programs. The other goal to accomplish over the next reporting period is the production of a manuscript for peer reviewed journal about this research.

    What was accomplished under these goals? The collection of data on five areas of inquiry listed in the initiation proposal were accomplished. A six component of inquiry in the survey was added, which was self-reporting assessments by each resondent about their own level of health, and the healthfulness of their lifestyle, with specific sets of questions about their dietary habits and physical activity, and perceptions about challenges to practicing healthy behaviors in American Samoa. One important result found in the research was that television is an important channel for health communications in American Samoa, and KVZK-TV is a popular channel watched. However, broadcasting English language based program, such as The Weight of the Nation, even after we have broadcast rights to do so, on KVZK-TV is problematic, since this station must prioritize broadcast of Samoan or bi-lingual based programming. This channel is, however, essentially, the only public access television station in American Samoa. This means that more channels need to be opened up to use for health communication programming, and a variety of other effective and creatively produced televsion programming in health communications areas need to be produced in Samoan or bi-lingual to be shown on KVZK-TV.