Source: UNIVERSITY OF GUAM UOG STATION submitted to NRP
CHILDRENS HEALTHY LIVING NETWORK (CHLN) IN THE U.S. AFFILIATED PACIFIC REGION
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
COMPLETE
Funding Source
HATCH
Reporting Frequency
Annual
Accession No.
1011461
Grant No.
(N/A)
Cumulative Award Amt.
(N/A)
Proposal No.
(N/A)
Multistate No.
W-1194
Project Start Date
Oct 20, 2016
Project End Date
Sep 30, 2021
Grant Year
(N/A)
Program Code
[(N/A)]- (N/A)
Recipient Organization
UNIVERSITY OF GUAM UOG STATION
(N/A)
MANGILAO,GU 96913
Performing Department
Experiment Station
Non Technical Summary
The Children's Healthy Living Program for Remote Underserved Minority Populations in the Pacific Region (CHL) is a partnership among remote Pacific states and other jurisdictions of the US: Alaska, American Samoa, the Commonwealth of the Northern Mariana Islands (CNMI), Guam, Federated States of Micronesia (FSM), Hawai'i, Republic of Palau, and the Republic of the Marshall Islands (RMI). All jurisdictions have US Land Grant Colleges. CHL is a partnership among land grant colleges and public health partners that share a purpose to build capacity to address health issues through research, training and outreach. Partnership among land grants, components of land grants, and public health and other partners that affect policies, systems and environments that affect health is explicitly called for in the recent USDA Healthy Food Systems, Healthy People (2016) call to action, and the USDA Cooperative Extension Framework for Health and Wellness (Braun et al. 2014). Partnership is also called for in the new Interagency Committee on Human Nutrition Research (2016). The goal of the CHL Program collaboration among Pacific Region states/jurisdictions was to build social/cultural, physical/built, and political/economic environments that will promote active play and intake of healthy food to prevent young child obesity in the Pacific Region. To do this, CHL engages the community, and focuses on capacity building and sustainable environmental change.The Pacific region has some of the highest rates of non-communicable disease in the world. FSM and RMI are in the top three of rates of diabetes in the world (35%, International Diabetes Federation 2013). Diabetes, heart diseases, strokes, cancer and other NCDs are affecting Pacific peoples at a disproportionate rate compared to other populations, placing a significant burden on their daily functionality, and threatening the national security of these island countries and territories (PIHOA 2010). All of these conditions have a primary causal factor: obesity. Adult obesity is among the highest in the world in these countries, especially among women (FSM 58%, RMI 48%, Ng et al 2013). Pacific lifestyles continue to transition from native crops to imported foods, and from active forms of work and play to sedentary ones, as in most of the world (World Health Organization, 2015, http://www.who.int/mediacentre/factsheets/fs311/en).Data are limited on children of the region. Childhood obesity is an important determinant of adult obesity. Obese children have a higher chance of obesity, premature death and disability in adulthood. Obese children have breathing difficulties, increased risk of fractures, hypertension, early markers of cardiovascular disease, insulin resistance and psychological effects. Contributors to obesity occur across the life course and include both early undernutrition and nutrition excess. Obesity is associated with social and health problems. Prevention is the best long term solution.This multistate project will support and extend the CHL network, training, intervention activities and research programs initiated through CHL, which has demonstrate feasability of the approach. The land grant institutions held stakeholder meetings that resulted in the CHL application. Land grant colleges in the Pacific have been an organizing mechanism for CHL. This multistate project will continue to be an important mechanism to maintain a stable partnership and coordinated activity. Without this tool the group will need to rely on grant opportunities that are now smaller and will likely result in smaller less coordinated subsets of the partners working together. This project has the potential to model multistates as platforms for coordinated health extension coalitions to facilitate and support broad sector partnership for health.
Animal Health Component
100%
Research Effort Categories
Basic
(N/A)
Applied
100%
Developmental
(N/A)
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
7246020101035%
7036099117035%
7046099302030%
Knowledge Area
703 - Nutrition Education and Behavior; 724 - Healthy Lifestyle; 704 - Nutrition and Hunger in the Population;

Subject Of Investigation
6020 - The family and its members; 6099 - People and communities, general/other;

Field Of Science
3020 - Education; 1010 - Nutrition and metabolism; 1170 - Epidemiology;
Goals / Objectives
Adapt and disseminate CHL child obesity policy, systems and environmentally focused multi-level prevention training and social marketing materials for the Pacific region. Facilitate use of CHL data, findings related to child obesity and its multilevel (policy, system, and environmental) determinants. Promote partnership and coalition building and strengthening in and among Pacific communities and the region around child health. Build and sustain a child health and nutrition monitoring system in the Pacific.
Project Methods
The multistate project will use existing core CHL infrastructure (Coordinating Center, Data Center, Training Center) and guidelines (Data Use, Publication, Core Values) to share data, tools, training and intervention materials among Pacific jurisdictions. The CHL infrastructure includes data coordination, training in child obesity prevention, and leadership on obesity measurement and standardization (Li et al 2015, Fialkowski et al. 2015, Novotny et al. 2013).The CHLN will have available data from the CHL prevalence and intervention studies, tools used to collect those data (accelerometers, stadiometers, scales, measuring tapes, Pacific Tracker diet and activity software), training material developed (Pacific Food Guide, CHL Summer Institute), and CHL intervention materials (Role Model Training Guide, Master Gardening and Food Preservation Materials). Materials not covered by privacy rules (HIPAA and IRB) will be publically available, mostly through the CHL website (www.chl-pacific.org).These resources, data, and collaborations will form the basis of new grant proposals, training programs, extension and outreach activities and capacity building within each jurisdiction.

Progress 10/20/16 to 09/30/21

Outputs
Target Audience:Community stakeholders in various villages throughout Guam, Non-Communicable Disease Coalition members, Guam Department of Education Food and Nutrition Services, teachers, parents, and Guam Head Start Program, and Guam Farm to School Network. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?Through Extension & Outreach, training was conducted for teachers, families, adults, and farmers on healthy eating, home and school gardens, and phsyical activity. CHLN continues to provide professional development opportunities from the experts that are members through colalborations, publications, and annual training. How have the results been disseminated to communities of interest?Publications have been used in community presentations and have been shared in press releases to multiple local news outlets. Results have also been shared with prograns, like SNAP-Ed, EFNEP, and GDOE, to inform strategic planning and future projects to be implemented in Guam. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? For Goal 1, local fruit and vegetable promotional materials were printed and will be disseminated to twenty-nine early childhood learning centers to supplement nutrition and physical activity curricula being implemented. The Guam Farm to School Network members, which include CHLN, support school garden (and local produce) activities that complement the curricula. The enforcement of the local produce procurement policy-level strategy efforts were paused related to the pandemic. For Goal 2, three publications in peer-reviewed journals and one conference poster presentation were completed. The poster presentation, "Food Insecurity and the Food Environment in the US Affiliated Pacific," was at the Food Insecurity , Neighborhood Food Environment, and Nutrition Health Disparities: State of the Science Virtual Workshop in September 2021. Collaborations on publications and presentations has been CHLNs main mechanism to maintain partnerships (Goal 3) and active membership in the NCD Coalition and Guam Farm to School Network continues. Also for Goal 3, the multi-state network developed a SAS grant proposal, Food System Resiliency for Children's Healthy Living (CHL Food System), which was awarded September 1, 2021. This proposal will expand and strenthen our understanding of Pacific food systems on child health (Goal 4). For Goal 4, the CHLN collaborative submitted a renewal application to continue CHLN, which was awarded (W2194).

Publications

  • Type: Journal Articles Status: Published Year Published: 2021 Citation: Butel, J., Braun, K. L., Davis, J., Bersamin, A., Fleming, T., Coleman, P., ... & Novotny, R. (2021). Community social network pattern analysis: Development of a novel methodology using a complex, multi-level health intervention. Gateways: International Journal of Community Research and Engagement, 14(1).
  • Type: Journal Articles Status: Published Year Published: 2021 Citation: Yamanaka AB, Davis JD, Wilkens LR, Hurwitz EL, Fialkowski MK, Deenik J, et al. Determination of Child Waist Circumference Cut Points for Metabolic Risk Based on Acanthosis Nigricans, the Childrens Healthy Living Program. Prev Chronic Dis 2021;18:210021. DOI: http://dx.doi.org/10.5888/pcd18.210021external
  • Type: Journal Articles Status: Published Year Published: 2021 Citation: Novotny, R., Earle, M. E., Jung, Y. O., Julian, G. J., Hill, E., Leon Guerrero, R. T., ... & Wilkens, L. R. (2021). Pacific Tracker (PacTrac) Version 3.1 Diet and Physical Activity Assessment Tool for the Pacific Region. Hawai'i Journal of Health & Social Welfare, 80(7).
  • Type: Conference Papers and Presentations Status: Accepted Year Published: 2021 Citation: Esquivel, M., Yamanaka, A., Aflague, T., Butel, J., Coleman, P., Deenik, J., Fleming, T., Shallcross, L., Novotny, R.(2021). Food Insecurity and the Food Environment in the US Affiliated Pacific. National Institute of Health, Food Insecurity, Neighborhood Food Environment, and Nutrition Health Disparities: State of the Science Virtual Workshop.


Progress 10/01/19 to 09/30/20

Outputs
Target Audience:Community stakeholders in various villages throughout Guam, Non-Communicable Disease Coalition members, Guam Department of Education Food and Nutrition Services, teachers, parents, and Guam Head Start Program, and Guam Farm to School Network. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?Through Extension & Outreach, training was conducted for teachers, families, adults, and farmers on healthy eating, home and school gardens, and phsyical activity. CHLN continues to provide professional development opportunities from the experts that are members through colalborations, publications, and annual training. How have the results been disseminated to communities of interest?Publications have been used in community presentations and have been shared in press releases to multiple local news outlets. Results have also been shared with prograns, like SNAP-Ed, EFNEP, and GDOE, to inform strategic planning and future projects to be implemented in Guam. What do you plan to do during the next reporting period to accomplish the goals?Continue to disseminate results and data resources to stakeholders and the community at large. Publish case study and/or manuscripts in-progress. Identify stakeholders to conduct anthropometric training for monitoring and surveillance of child health and create training plan. Investigate existing and new evaluation methods in Extension & Outreach infrastructions, like SNAP-Ed and EFNEP, to expand monitoring and surveillance of child health and associated risk factors (e.g., food security).

Impacts
What was accomplished under these goals? For Goal 1, "5-2-1-Almost None" marketing material was disseminated in collaboration with Guam SNAP-Ed, Guam Department of Education (GDOE), partner food stores, and partner municipalities. Programs supported the community-level social marketing approaches, like the Walk-to-Wellness and community garden training programs. These were supported by community stakeholders, like the NCD Coalition Action Teams. School-level interventions continue with the support of SNAP-Ed and EFNEP with the direct education of youth and parent education, specifically the Food Friends Mighty Moves preschool curriculum and Smart Snack workshops. The Guam Farm to School Network members, which include CHLN, support school gardens and local produce. The enforcement of the local produce procurement is a policy-level strategy within schools that is advancing with the support of CHLN. The same policy and support is influencing senior meal programs and the hospital cafeteria meals and has generated a new farmer program in Guam. For Goal 2, three publications in peer-reviewed journals werecompleted with more manuscripts in-progress. The content of these findings have been presented locally to influence changes related to CHLN by existing and new stakeholders. Presentations has been our role in maintaining partnerships (Goal 3) and active membership in the NCD Coalition and Guam Farm to School Network continues. An interactive CHL Data page has been added to the CHL webiste that will display CHL Prevalence Data using Tableau and users can view results using different filters. Stakeholders have been informed of this site to use for program planning. For Goal 4, the Children's Healthy Living Center of Excellence Anthropometric Measurement Manual was completed and planning is underway to incorporate this protocol into existing infrastructures of CHL jurisdictions with training and continued monitoring of child health in the Pacific.

Publications

  • Type: Journal Articles Status: Accepted Year Published: 2020 Citation: Leon Guerrero R, Barber LR, Aflague T, Paulino Y, Hattori-Uchima M, Acosta M, Wilkens L, Novotny R. Prevalence and Predictors of Overweight and Obesity Among Young Children in the Childrens Healthy Living Study on Guam. Nutrients. 2020 August; 12, 2527 doi:10.3390/nu12092527
  • Type: Journal Articles Status: Accepted Year Published: 2020 Citation: Greenberg J, 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 Journal of Health and Social Welfare. 2020 July; 79(7): 217-223.
  • Type: Journal Articles Status: Accepted Year Published: 2019 Citation: Aflague TF, Leon Guerrero RT, Delormier T, Novotny R, Wilkens LR, Boushey CJ. Examining the Influence of Cultural Immersion on Willingness to Try Fruits and Vegetables Among Children in Guam: the Traditions pilot study. Nutrients. 2019 Dec 20;12(1). pii: E18. doi: 10.3390/nu12010018.


Progress 10/01/18 to 09/30/19

Outputs
Target Audience:Community stakeholders in CHL villages, SNAP-Ed implementing agencies that serve Pacific populations, undergraduate students in health or nutrition-related fields, Guam Department of Education and Guam Head Start nurses, teachers, and/or health counselors, and the Non-Communicable Disease consortium Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?During the annual meeting, all subgroups train mutli-state members and stakeholders in the focus areas. How have the results been disseminated to communities of interest?Community stakeholders access CHLN multi-state products on the CHL and SNAP-Ed Toolkit websites. What do you plan to do during the next reporting period to accomplish the goals?Increase project activities and communication through regular subgroup meetings, publish CHL diet-related papers, implement BMI monitoring system, continue training.

Impacts
What was accomplished under these goals? The Children's Healthy Living Network (CHLN) multi-state is building and sustaining activities developed in the CHL program. Publications and presentations from the CHL program can be found on the CHL web site at www.chl-pacific.org. For Goal 1, the CHL program was successfully submitted and is now found on the SNAP-Ed Toolkit website for SNAP-Ed implementing agencies and other Extension programs to inform their work with Pacific populations to prevent obesity. For Goals 2 and 3, partnerships continue to strengthen and develop to support policy, systems, and environmental changes. Specifically, Guam continues to be an active member of the Non-Communicable Disease consortium that has released the 2019-2023 Strategic Plan including policy-level action items. For Goal 4, the draft of the standardization manuals are complete and will be finalized in the next year to build capacity across the Pacific region to establish a monitoring system. In addition, we resubmitted "CHL FACT" proposal, which is the Children's Healthy Living (CHL) Food and Agriculture Cyberinformatics and Tools (FACT) program that leverages existing partnerships, data, and academic resources related to childhood nutrition and health in the Pacific to offer University of Hawai'i at M?noa (UHM) and University of Guam (UOG), undergraduate students, a two-year experiential learning opportunity in research and extension.

Publications

  • Type: Other Status: Accepted Year Published: 2019 Citation: UNC Center for Health Promotion and Disease Prevention (2019) The Children' Healthy Living Program. SNAP-Ed Toolkit Obesity Prevention and Intervention Evaluation Framework. Available at https://snapedtoolkit.org/interventions/programs/the-childrens-healthyliving- chl-program/


Progress 10/01/17 to 09/30/18

Outputs
Target Audience:Community stakeholders in CHL villages, Non-Communicable Disease Coalition members, UOG students in health or nutrition-related fields (training), Partners of the Cooperative and Extension Services in regional Land-Grant institutions, and Guam Department of Education Nurses, Teachers, and Counselors. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?Continue to conduct standardization training in collaboration with PIHOA and expand trainers. The opportunity to train SNAP-Ed State and Implementing Agencies on using the CHL approach in populations similar to those reached in the CHL jurisdictions is possible if USDA, FNS approves the CHL intervention for the SNAP-Ed toolkit. 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?Continue to build upon the accomplishments of 2017-2018. Draft the Community Report for stakeholders to build, maintain, and develop new partnerships to sustain CHL intervensions. Publish CHL data for dissemination.

Impacts
What was accomplished under these goals? For Goal 1, the Children's Healthy Living Network (CHLN) multi-state: Submitted the CHL intervention to the USDA, FNS for review and consideration for the SNAP-Ed Toolkit; For Goal 2, the Children's Healthy Living Network (CHLN) multi-state: Created Community Impact Reports to CHL disseminate baseline and intervention findings to CHL village residents, as well as, recruit CHL-Center participants. Create research partnerships to continue to publish CHL data For Goal 3, the Children's Healthy Living Network (CHLN) multi-state: Expand the network of people trained to health leaders in the US Affiliated Region to increase quality of measures. Partnership with PIHOA and Health Departments For Goal 4, the Children's Healthy Living Network (CHLN) multi-state: Continue to complete Phase I of the Anthropometry Manual for all ages (birth to <2 years; 2 to <10 years; and >10 years and older) to include components for the measurer and trainer. For Phase I will include activities to identify potential jurisdiction trainers and partners for Phase II, which is to establish a monitoring system.

Publications

  • Type: Journal Articles Status: Published Year Published: 2018 Citation: 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 (2018). Effect of the Childrens Healthy Living Program on Young Child Overweight, Obesity, and Acanthosis Nigricans in the US-Affiliated Pacific Region: A Randomized Clinical Trial. JAMA Network Open, 1(6), e183896-e183896.
  • Type: Journal Articles Status: Published Year Published: 2018 Citation: Novotny, R., F. Li, L. Wilkens, M. Fialkowski, T. Fleming, P. Coleman, R. Leon Guerrero, A. Bersamin, and J. Deenik. Chapter 3. Economic Influences on Child Growth Status, from the Childrens Healthy Living Program in the US-Affiliated Pacific Region. In: WEALTHY BUT UNHEALTHY: Overweight and Obesity in Asia and the Pacific: Trends, Costs, and Policies for Better Health. Edited by Matthias Helble and Azusa Sato. 2018 Asian Development Bank Institute.


Progress 10/20/16 to 09/30/17

Outputs
Target Audience:Community stakeholders in various villages, Non-Communicable Disease Coalition members, UOG Health Science students (training), Guam Department of Education Nurses, Teachers, and Health Counselors. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?see above How have the results been disseminated to communities of interest?CHL Baseline Community Reports have been completed as of June 2017 and posted on CHL Website. Next step is to disseminate reports to village mayors and key stakeholders in community. What do you plan to do during the next reporting period to accomplish the goals? Meet with mayors to disseminate CHL Baseline reports. continue anthropometric standardization training on Guam, particularly with UOG students and Guam Department of Education Nurses. Continue publication of CHL results.

Impacts
What was accomplished under these goals? The Children's Healthy Living Network (CHLN) multi-state is building and sustaining activities developed in the CHL program. Each of the CHLN subgroups (Monitoring, Training, Research, and Extension and Policy have a published CHL paper, for reference. Publications and presentations from the CHL program can be found on the CHL web site at www.chl-pacific.org. Multi-state members influencing and promoting PIHOA resolution to continue train and standardize anthropometric measures to improve the quality of data and reporting. Increasing usefulness of the information for decision making related to non-communicable and communicable diseases critical to the region. Building the system for regional standardization for anthropometric measures for all age groups. Expanding appropriate measures for the various age groups. Draft training and standardization manual for all age groups. Expanding the network of people trained to health leaders in the US Affiliated Region to increase quality of measures. Partnership with PIHOA and Health Departments In addition, we submitted "CHL Center Grant (USDA-NIFA-AFRI-006346) -- CHL's goal is to serve as a Center of Excellence to continue to build capacity in a partnership among 11 jurisdictions of the US Affiliated Pacific - to provide training, research and extension/outreach to maintain and extend the CHL network, examine long-term effects of the multilevel CHL intervention and provide access to best practices in policy, systems and environmental approaches for prevention of child obesity. CHL addresses the USDA NIFA priority areas of 1) food safety, nutrition and health 2) agricultural systems and technology and 3) agricultural economics and rural communities. CHL supports long-range improvement in and sustainability of agriculture and food systems in remote underserved (EPSCOR) US jurisdictions of the Pacific Region that are not represented in National Nutrition and Health Monitoring (NHANES).

Publications

  • Type: Books Status: Published Year Published: 2017 Citation: Novotny, R., F. Li, L. Wilkens, M. Fialkowski, T. Fleming, P. Coleman, R. Leon Guerrero, A. Bersamin, and J. Deenik. 2017. Economic Influences on Child Growth Status, from the Childrens Healthy Living Program in the US-Affiliated Pacific Region. ADBI Working Paper 698. Tokyo: Asian Development Bank Institute.
  • Type: Journal Articles Status: Published Year Published: 2017 Citation: Rachel Novotny, Fenfang Li , Rachael Leon Guerrero , Patricia Coleman, Aifili J. Tufa , Andrea Bersamin , Jonathan Deenik and Lynne R Wilkens. Dual burden of malnutrition in US Affiliated Pacific jurisdictions in the Childrens Healthy Living Program. Novotny et al.BMC Public Health (2017) 17:483 DOI 10.1186/s12889-017-4377-6.
  • Type: Journal Articles Status: Published Year Published: 2016 Citation: Esquivel MK, Fialkowski MK, Aflague T, Novotny R (2016) Engaging Head Start Teachers on Wellness Policy Implementation to Improve the Nutrition and Physical Activity Environment in Head Start Classrooms: A Qualitative Study of the Childrens Healthy Living Program (CHL) in Hawaii. J Family Med Community Health 3(5): 1094.
  • Type: Journal Articles Status: Published Year Published: 2016 Citation: Nigg, C.R., Ul Anwar, M.M., Braun, K.L., Mercado, J., Fialkowski, M.K., Areta, A., Belyeu Camacho, T., Bersamin, A., Leon Guerrero, R., Castro, R., DeBaryshe, B., Vargo, A.M., Braden, K.W., Novotny, R. A review of promising multicomponent environmental child obesity prevention intervention strategies by the childrens healthy living program. Journal of Environmental Health. 2016; 79(3): 18-26.