The goal is to build social/cultural, political/economic, and physical/built environments that will promote active play and intake of healthy food to prevent young child obesity in the Pacific Region. Our methods will support local culture in order to achieve this goal in these remote, underserved native populations. CHL will engage the community, and focus on capacity building and sustainable environmental change. The focus of the CHL community-based program is to promote healthy eating and to increase physical activity. In order to demonstrate effectiveness, the investigators will recruit and measure children in six communities selected in each of our jurisdictions in the Pacific. These represent intervention communities, comparison communities, and temporal communities.
The specific objectives of our study are as follows. Objective. Decrease the prevalence of young child overweight and obesity; and its functional outcomes (decrease acanthosis nigricans, and increase sleep; increase moderate to vigorous physical activity and decrease sedentary behavior (screen time); increase healthy eating (fruit and vegetable intake, water intake; decrease sweetened beverage intake), through community-based primary prevention environmental interventions in the Pacific region. Objective. Measure 2-8-year-old children at baseline and 24 months in selected communities to track behaviors and anthropometry that indicate healthy eating, physical activity, and BMI. Objective. Measure 2-8 year old children at 78 months in the selected communities to determine the long term effect of the CHL program.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
9,840
Multiple component environmentally focused program designed with community engagement.
CHL programs with fewer component and shorter duration.
University of Hawaii
Honolulu, Hawaii, United States
Change in Prevalence of Overweight and Obesity Using Body Mass Index Percentile for Age and Sex
Body mass index is weight in kg divided by height in meters squared. Overweight is \> = 85th percentile to \< 95th percentile BMI for age and sex according to CDC 2000. Obesity is \> = 95th percentile BMI for age and sex according to CDC 2000. Change from baseline to 24 months in prevalence of overweight plus obesity in selected communities. Comparison group is healthy weight \>= 5th percentile to \< 85th percentile for age and sex according to CDC 2000. Underweight (\<5th percentile) were excluded.
Time frame: Baseline, 24 months
Change in Waist Circumference
Waist circumference measured in centimeters at umbilicus.
Time frame: Baseline, 78 months
Prevalence of Acanthosis Nigricans
Scale title: Burke Acanthosis nigricans Score, minimum 0, maximum 4. Higher score is worse. Analysis was dichotomized as present (1-4) or absent (0). A Screening on back of neck for Acanthosis nigricans according to Burke, J., D. Hale, H. Hazuda, and M. Stern. 1999. A quantitative scale of acanthosis nigricans. Diabetes Care. 22(10):1655-1659. Epub 1999/10/20. PubMed PMID: 10526730. Scale varies from 0 to 4 with 0 as not present and 4 most severe. Analysis was done on absent (0) or present (1-4).
Time frame: Baseline, 24 months
Change in Prevalence of Overweight and Obesity Using Body Mass Index Percentile for Age and Sex
Body mass index is weight in kg divided by height in meters squared. Overweight is \> = 85th percentile to \< 95th percentile BMI for age and sex according to CDC 2000. Obesity is \> = 95th percentile BMI for age and sex according to CDC 2000. Change from baseline to 78 months in prevalence of overweight plus obesity in selected communities. Comparison group is healthy weight \>= 5th percentile to \< 85th percentile for age and sex according to CDC 2000. Underweight (\<5th percentile) were excluded.
Time frame: Baseline, 78 months
Change in Waist Circumference
Waist circumference measured in centimeters at umbilicus.
Time frame: Baseline, 24 months
Prevalence of Acanthosis Nigricans
Scale title: Burke Acanthosis nigricans Score, minimum 0, maximum 4. Higher score is worse. Analysis was dichotomized as present (1-4) or absent (0). A Screening on back of neck for Acanthosis nigricans according to Burke, J., D. Hale, H. Hazuda, and M. Stern. 1999. A quantitative scale of acanthosis nigricans. Diabetes Care. 22(10):1655-1659. Epub 1999/10/20. PubMed PMID: 10526730. Scale varies from 0 to 4 with 0 as not present and 4 most severe. Analysis was done on absent (0) or present (1-4).
Time frame: Baseline, 78 months
Change in Sugar Sweetened Beverage Intake
cups per day, determined from 2 random days of food records and weighted for weekend and weekday
Time frame: Change from baseline to 24 months
Change in Mean of Moderate and Vigorous Activity Per Day in Minutes
number of minutes per day within bouts of 5 minutes averaged over 4 to 6 days of accelerometer usage
Time frame: Baseline, 24 months
Change in Sedentary and Light Physical Activity
number of minutes per day within bouts of 5 minutes averaged over 4 to 6 days of accelerometer usage
Time frame: Baseline, 24 months
Change in Screen Time
Hours per day spent in screen activity
Time frame: Change from Baseline to 24 months
Sleep Disturbance Score
Tayside sleep scale; minimum is 1, maximum is 9, where higher is worse. lower score is less disturbance (range is 1-9) Tayside Children's Sleep Questionnaire by McGreavey JA, Donnan PT, Pagliari HC, Sullivan FM.The Tayside children's sleep questionnaire: a simple tool to evaluate sleep problems in young children. Child Care Health Dev. 2005 Sep;31(5):539-44.
Time frame: Change from Baseline to 24 months
Change in Water Intake
cups per day, determined from 2 random days of food records and weighted for weekend and weekday. The children from each community recruited each time were NOT the same children. The number of communities is consistent across time.
Time frame: Change from Baseline to 24 months
Change in Fruit Intake
cups per day, determined from 2 random days of food records and weighted for weekend and weekday
Time frame: Change from baseline to 24 months
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Change in Vegetable Intake
cups per day, determined from 2 random days of food records and weighted for weekend and weekday
Time frame: Change from baseline to 24 months
Change in Metabolic Equivalents (METs) Per Day
number of minutes per day within bouts of 5 minutes averaged over 4 to 6 days of accelerometer usage
Time frame: Baseline, 24 months
Change in Hours of Sleep Per Day
Sleep hours per day measure by questionnaire as reported by caregiver.
Time frame: change from baseline to 24 months
Change in Sugar Sweetened Beverage Intake
cups per day, determined from 2 random days of food records and weighted for weekend and weekday
Time frame: change from baseline to 78 months
Change in Screen Time
Hours per day spent in screen activity
Time frame: change from Baseline to 78 months
Sleep Disturbance Score
Tayside sleep scale; minimum is 1, maximum is 9, where higher is worse. lower score is less disturbance (range is 1-9) Tayside Children's Sleep Questionnaire by McGreavey JA, Donnan PT, Pagliari HC, Sullivan FM.The Tayside children's sleep questionnaire: a simple tool to evaluate sleep problems in young children. Child Care Health Dev. 2005 Sep;31(5):539-44.
Time frame: Change from baseline to 78 months, The children from each community recruited each time were NOT the same children. The number of communities is consistent across time.
Change in Water Intake
cups per day, determined from 2 random days of food records and weighted for weekend and weekday
Time frame: change from baseline to 78 months.The children from each community recruited each time were NOT the same children. The number of communities is consistent across time.
Change in Fruit Intake
cups per day, determined from 2 random days of food records and weighted for weekend and weekday
Time frame: change from baseline to 78 months
Change in Vegetable Intake
cups per day, determined from 2 random days of food records and weighted for weekend and weekday
Time frame: change from baseline to 78 months
Change in Hours of Sleep Per Day
Sleep hours per day measure by questionnaire as reported by caregiver.
Time frame: change from baseline to 78 months