https://cris.nifa.usda.gov/cgi-bin/starfinder/3547/crisassist.

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ACCESSION NO: 0213100 SUBFILE: HNRIMS; CRIS

PROJ NO: HAWR-2007-04557 AGENCY: NIFA HAWW
PROJ TYPE: NRI COMPETITIVE GRANT PROJ STATUS: TERMINATED
CONTRACT/GRANT/AGREEMENT NO: 2008-55215-18821 PROPOSAL
NO: 2007-04557
START: 15 FEB 2008 TERM: 14 FEB 2013 FY: 2009
GRANT AMT: $1,490,000 GRANT YR: 2008
AWARD TOTAL: $1,490,000
INITIAL AWARD YEAR: 2008

INVESTIGATOR: Novotny, R.; Nigg, C.; Grove, J. S.; Murphy, S. P.; Karanja,

N.; Yuen, S.; Takahashi, R.

PERFORMING INSTITUTION:
KAISER FOUNDATION HOSPITALS
HONOLULU, HAWAII 96817

PACIFIC KIDS DASH FOR HEALTH

NARRATIVE: The goal of this project is to develop and evaluate a

community-based health center intervention that targets children of Pacific
Islander and Asian descent who are overweight, in order to slow and prevent
further weight gain (for children to "grow into their weight"). Pacific Islanders
are among the world's most obese populations while Asians, although of
relatively low body mass index (BMI), carry much of their body fat in the upper
body and exhibit greater health risk at the same BMI. Childhood offers an
opportunity to develop and support health-promoting behaviors. This project
will extend and apply the nationally recommended DASH (Dietary Approaches
to Stop Hypertension) diet, developed for White, African American and
Hispanic adults, to children and to the growing population of Asians and
Pacific Islanders. We will incorporate culturally-preferred foods, recipes, and
physical activities that meet DASH and other national guidelines, with
adaptations for children. Linking food with health systems can prevent obese
and overweight children. This intervention will include a food and physical
activity prescription and other targeted guidance, delivered by a physician at a
community-based health center, in partnership with farmers' markets that are
based at the health center. The intervention approach supports child food
behaviors and social and environmental cues, which are important to making
healthy food and physical activity choices. Linking physicians and health with
farmers and food will support increased intake of nutrient-rich, less energy
dense foods among children of understudied ethnic groups who are at high
risk for being obese or overweight.

OBJECTIVES: 1. To develop and evaluate the impact of the PacDASH

intervention on preventing overweight and improving blood pressure in
children of the Pacific Region. a. To further develop and test the Pacific
Tracker (PacTrac) diet and PA assessment and education tool by
incorporating updated MyPyramid reference data and educational output. b.
To enhance PacTrac with an expert system (ES) of behaviorally-tailored
messages and output. c. To evaluate the effect of the PacDASH intervention
on nutrition and physical activity behavior of children. 2. To describe
environmental, social, economic and cultural factors associated with body size
and composition of children of the Pacific Region, for whom there are few
national data. a. To examine body size and composition of children according
to several measures. b. To examine the influence of individual ethnic groups
on body size and composition.

APPROACH: This study is a randomized controlled trial of the PacDASH

intervention. Children will be randomized to the intervention or attention
control (usual care) group and selected according to the following criteria: 1.
Children with primary care provider (PCP) at one of four Health Centers with
active Farmers' Markets 2. Age 5 - 8 years old 3. >= 85th percentile BMI-for-
age We will recruit eligible children from the Electronic Medical Record and
project the following distribution of children: 180 children in each of the
intervention and control groups = 360 children total. Using a socio-ecological
approach, this 19-month intervention consists of working with overweight
children, their PCP, and caregiver to link food and health in order to slow and
prevent further weight gain. Demographics, diet, physical activity (PA),
anthropometrics, and behavior (self-efficacy and stage of change) will be
assessed. We will use the DASH eating pattern as an educational approach to
healthful eating. A unique aspect of this project is the use of the PacTrac
computer-based diet and PA data entry and analysis tool that can be used to
analyze diets and provide nutrition and PA education through summary
reports. Current nutritional and PA status, diet and PA recommendations, and
behavioral messages based on self-efficacy and stage of change will be
provided to the PCP in the form of a summary report, food and PA
prescription, and tip sheets to be reinforced at the well care visit. In a simple
format, food and PA prescriptions will state diet and PA recommendations. Tip
sheets with suggestions on how to fulfill their prescription considering the
child's social and physical environments will be given to child and caregiver
during the well care visit. Supplemental mailings, designed to motivate and
enhance self-efficacy while featuring food and PA topics, will be sent between
visits to the child and caregiver. A PacDASH toolkit, featuring DASH
educational materials will be provided to support the intervention. A process
evaluation of the intervention will include examination of physician use of
intervention information provided. Children that are randomized into the
attention control group will have similar assessments and receive the same
incentives as the intervention group.

PROGRESS: 2008/02 TO 2013/02
Target Audience: Children 5-8 years old, their parents and primary care
providers; Asian and Native Hawaiian, and Pacific Islander ethnic groups;
children at risk for overweight and obesity; Hawaii. Changes/Problems:
Nothing Reported What opportunities for training and professional
development has the project provided? Caryn ES Oshiro, PhD, Biomedical
Sciences-Epidemiology, University of Hawaii at Manoa, University of Hawaii.
Dissertation:Birth Size, Infant Growth, and Child BMI at 5y in a Multiethnic
Population.. Joanne Avila, MS Nutritional Science, University of Hawaii at
Manoa. Thesis: Dietary Added Sugar and Overweight and Obesity in
Multiethnic Children in Hawaii. Obesity. May 2013. Masako Matsunaga, PhD
candidate in Biomedical Sciences-Epidemiology, University of Hawaii.
Dissertation topic:Development, Application and Evaluation of a dietary index:
the DASH index. How have the results been disseminated to communities of
interest? Results have been disseminated to the scientific community and to
Kaiser Permanente health care community. What do you plan to do during the
next reporting period to accomplish the goals? Nothing Reported

IMPACT: 2008/02 TO 2013/02
What was accomplished under these goals? 1. The PacDASH intervention
program resulted in both intervention and attention control groups maintaining
their BMI level, with no significant difference between the two groups. The
PacDASH intervention group decreased diastolic blood pressure by 12.7
points more than the attention control group. The Pacific Tracker version 2
was developed, incorporating MyPyramid equivalent units and the Healthy
Eating Index 2005. An Expert System for fruit and vegetable intake and
physical activity tailored messages was developed based on stage of
readiness and self efficacy by stage.The PacDASH intervention increased fruit
and vegetable intake, but not physical activity intake. 2. Kaiser Permanente
electronic medical data (n=4608) showed that mean overweight & obesity
prevalence of 5-8 year old children was 326% (12.9% overweight and 19.7 %
obese). Samoan, Native Hawaiian, Filipino, and those of mixed ethnic
ancestry had higher levels of overweight and obesity compared to Asian and
White children. Those with higher neighborhood education level, higher
maternal education level, and older maternal age had generally lower risk for
overweight and obesity, except for mothers who were 21 to 30 years old.

PUBLICATIONS (not previously reported): 2008/02 TO 2013/02

Type: Journal Articles Status: Published Year Published: 2013 Citation:
Novotny R, Oshiro CS, Wilkens LR. Prevalence of Childhood Obesity among
Young Multiethnic Children from a Health Maintenance Organization In
Hawaii. Childhood Obesity. Feb. 2013;9(1) DOI: 10.1089/chi.2012.0103.