ACCESSION NO: 1011733  SUBFILE: CRIS 

PROJ NO: HAW02048-R AGENCY: NIFA HAW 

PROJ TYPE: HATCH PROJ STATUS: REVISED  MULTISTATE PROJ NO: W-1194 
START: 05 DEC 2016 TERM: 30 SEP 2021 FY: 2018

INVESTIGATOR: Novotny, RA, .; Deenik, JO, .; Esquivel, MO, .

PERFORMING INSTITUTION: 
UNIV OF HAWAII 
3190 MAILE WAY 
HONOLULU, HAWAII 96822

CHILDREN'S HEALTHY LIVING NETWORK (CHLN) IN THE U.S. AFFILIATED PACIFIC

REGION

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). 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. This multistate project will support and extend the CHL network, training,
intervention activities and research programs initiated through CHL. CHL evolved from past
collaborations among its participants. The largest collaboration was from a USDA NIFA CAP
grant (Grant number 2011-68001-30335), and most recent was the Child Health Assessment of
the Pacific (CHAP) USDA NIFA ELI fellowship grant (Grant number 2016-67032-24989). The
resulting CHL grant solidified a management structure, developed PSE-oriented multi-level
intervention research, built capacity and course work in PSE-oriented work to prevent child
obesity, gathered data that filled the gap of missing nutrition surveillance systems in the region,
and continues to use those systems to develop understanding through peer reviewed research
and publication and to inform programs and policies relevant to the underserved population of
the Pacific, not served by NHANES. Since NHANES does not sample the Pacific region, nor
present data on Native Hawaiian, Native Alaskan or Pacific Islander race/ethnic groups,
measured data on obesity, dietary intake and physical activity are not available without CHL,
and are critical to guide programs and policies. Further, since Pacific foods are not identified in
these surveys, they will not be analyzed by national labs for nutritional properties, to guide
nutrition guidance and programs in the region. CHL conducted a meta-analysis of available
research and agency data of the child obesity problem in the Pacific and showed the overweight
plus obesity level to be 21% at 2y to 39% at 8y (Novotny et al. 2015). Obesity prevalence went
from 10% and age 2y to 23% at 8y. CHL gathered data on 51 communities in 11 jurisdictions on
over 5,000 children, their households, and their communities. 27 of these communities in 5
jurisdictions were involved in a multilevel community randomized controlled trial (Wilkens et al
2014) and the other 25 communities collected the same data in a one-time prevalence survey.
Data include acanthosis nigricans screening, weight, height and waist circumference
assessment, 2 randomly selected days of 6,453 food and activity logs (food records and
physical activity logs) from 2-8yo children throughout the region, community environment
assessments (store, park, church, walkability and food and utility cost assessments), data which
will be evaluated to help fill the void in data for policy and program planning, and which will
provide a foundation from which ongoing monitoring systems will be developed and sustained.
Further, CHL has developed a community based intervention program (Braun et al. 2014,
Fialkowski et al. 2013, Wilken et al 2013) and is disseminating it and continuing to serve as a
data hub and a facilitator of coalition building and training in the community (Fialkowski et al
2015). The CHL work was conducted through a community engaged process (Fialkowski et al
2013) that involved development of Local Advisory Committees (LAC's) in each jurisdiction, that
included all sectors and provide groups identified that might influence child health. These LAC's
meet at least annually and evolved into community and jurisdiction level coalitions that
organized and sustained key efforts. CHL was recognized as a backbone organization that
facilitates the work and provides a key evaluation and training role that we aim to sustain with
this multistate project; this role suited to the land grant mission of facilitation of community work
(extension), evaluation (research) and training (instruction). The CHL Network will extend the
work of two other multistate projects (W2005 and W2003) that are related to child obesity by
focusing on the Pacific Region and the policy, systems and environmental approaches to
obesity prevention and support of child health and wellness.

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. Build and sustain a child health and nutrition monitoring system in
the Pacific. Promote partnership and coalition building and strengthening in and among Pacific
communities and the region around child health.

APPROACH: 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, Novotny et al. 2013).The CHL
Multistate Network 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: 2018/10 TO 2019/09
Target Audience:Pacific region children, families, communities. Changes/Problems: Nothing
Reported What opportunities for training and professional development has the project
provided?CHL Dietetics Scholarship program awarded - 5 Native Hawaiian undergraduates
enrolled. In partnership with the Western Region Public Health training center - developed
online training on acanthosis nigricans. How have the results been disseminated to communities
of interest?Results have been disseminated through the CHL-pacific.org website maintained
with publications and reports. What do you plan to do during the next reporting period to
accomplish the goals?Analysis of the mulitlevel effect of the environment on child behavior and
health.

IMPACT: 2018/10 TO 2019/09
What was accomplished under these goals? The Children's Health Living Program (CHL)
Center is active and is providing data for ongoing analyses of influences on child food, nutrition
and obesity in the region.

PUBLICATIONS (not previously reported): 2018/10 TO 2019/09

1. Type: Journal Articles Status: Published Year Published: 2019 Citation: Butel, J., Braun, K.L.,
Nigg, C.R., Davis, J., Boushey, C., Leon Guerrero, R., Bersamin, A., Coleman, P., Fleming, T.,
and Novotny R. 2019. Implementation Strategies and Barriers to Native Hawaiian and Other
Pacific Islanders Community Interventions: A Cross-Case Study of the Children�s Healthy
Living Program. Asian American Journal of Psychology. Vol. 10, No. 3, 282�2911948-1985/19
2. Type: Journal Articles Status: Published Year Published: 2019 Citation: Butel, J., Braun, K.L.,
Nigg, C.R., Leon Guerrero, R., Fleming, T., Bersamin, A., Coleman, P., and Novotny R. 2019.
Estimating intervention dose of the multilevel multisite children�s healthy living program
intervention. TBM 2019:1�9, doi: 10.1093/tbm/ibz073
3. Type: Journal Articles Status: Published Year Published: 2019 Citation: Gittelsohn, J.,
Novotny, R., Trude, A.C.B., Butel, J., and Mikkelsen, B.E. 2019. Challenges and lessons
learned from multi-level multi-component interventions to prevent and reduce child obesity. Int J
Environ Res Public Health. 2018 Dec 24;16(1). pii: E30. doi: 10.3390/ijerph16010030