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Health literacy is understudied in the US-Affiliated Pacific (USAP), where local populations have historically experienced social marginalization and disproportionate health inequities caused by the social determinants of health (SDOH). This cross-sectional study analyzed several SDOH indicators—acculturation, use of food assistance programs and demographic characteristics (race and ethnicity, household income, primary language spoken at home and educational attainment)—and their relationship to health literacy among 1305 parents/caregivers of young children ages 2–8 years old who participated in the Children's Healthy Living (CHL) program in Alaska, American Samoa, Commonwealth of the Northern Mariana Islands (CNMI), Guam, and Hawai'i. Significantly increased odds of low health literacy were found among parents/caregivers with households where a language other than English was the primary language compared to English-only households (OR = 1.86, 95% CI = 1.22, 2.82), household income of <$35 000 compared to ≥$35 000 (OR = 2.15, 95% CI = 1.13, 4.07), parents/caregivers of Asian children compared to parents/caregivers of White children (OR = 2.68, 95% CI = 1.05, 6.84), parent/caregivers with less than or some high school education compared to high school completion (1st- to 8th-grade OR = 4.46, 95% CI = 2.09, 9.52; 9th- to 11th-grade OR 1.87, 95% CI = 1.06, 3.30) and parent/caregivers with acculturation status defined as marginalized as compared to integrated (OR = 2.31, 95% CI = 1.09, 4.86). This study indicates that some USAP parents/caregivers may lack the capacity to acquire health information, utilize health resources, and navigate health decision making. Future efforts to understand and improve health literacy in the USAP should be population specific, thoroughly assess personal and organizational health literacy, and inventory community health care capacity. [ABSTRACT FROM AUTHOR]

Childhood diet can impact health outcomes over the life course. Few studies have assessed dietary quality among infants and children in the US-Affiliated Pacific (USAP) region. The aim of this study was to examine the differences in diet quality among Pacific children in the Children's Healthy Living (CHL) program by Pacific jurisdiction and by their World Bank Income Group (WBIG) level. This cross-sectional study used dietary records collected from 2012 to 2015. Data were collected on 2- to 8-year-old children (n = 3,529) enrolled in the Children's Healthy Living Program for Remote Underserved Minority Populations in the Pacific region, conducted in the USAP jurisdictions of Alaska, Hawai'i, American Samoa, Commonwealth of the Northern Mariana Islands (CNMI), Guam, Federated States of Micronesia (FSM islands include Chuuk, Kosrae, Pohnpei, Yap), Republic of the Marshall Islands (RMI), and Republic of Palau. Diet quality was assessed using the Healthy Eating Index-2005 (HEI-2005). This HEI version was commensurate with the time of dietary data collection for the CHL project and previous studies, thus allowing cross-study comparisons. Means of total HEI-2005 scores between jurisdictions and their WBIG level were compared using linear models, with and without adjustment for age, sex, and dietary energy. Differences in mean HEI-2005 scores among children were found between jurisdictions and their WBIG level. Alaska had the highest adjusted mean score (63.3). RMI had the lowest adjusted mean score (50.1). By WBIG, lower-middle income jurisdictions had the lowest adjusted mean HEI-2005 score (56.0), whereas high income jurisdictions had the highest adjusted mean HEI-2005 score (60.5). Variation in children's diet quality was found between USAP jurisdictions, notably between jurisdictions of different WBIG levels. Future research is needed to deepen understanding of these differences in diet quality by WBIG level, such as whether differences may be attributable to the jurisdictions' varying food systems, and possibly explained by the nutrition transition. Understanding childhood diet quality in this region can inform approaches for nutrition programs in the Pacific region. [ABSTRACT FROM AUTHOR]

Examine differences in dietary intake of children aged 2–5 years in early care and education (ECE) setting in the US Affiliated Pacific (USAP). Secondary analysis of cross-sectional data collected by the Children's Healthy Living program. Children (n = 1,423) with complete dietary records and information on the ECE setting. Dietary intake by ECE setting; Head Start (HS), other ECE (OE), and no ECE. Comparison of mean dietary intake across ECE settings and multivariate logistic regression to evaluate ECE setting and likelihood for meeting dietary reference intake (DRI). Children in HS and OE settings had a significantly higher intake of several food groups and nutrients, compared with no ECE; vegetables (0.4 cup-equivalents per thousand kcals [CETK] vs 0.3 CETK; P < 0.001), fruits (0.8 CETK vs 0.6 CETK; P = 0.001), milk (0.9 CETK for HS and 1.0 CETK for OE vs 0.8 CETK; P < 0.001). Sixty-five percent of the HS group met DRI and had greater odds of meeting calcium DRI (odds ratio, 1.8; 95% confidence interval, 1.2–2.7) compared with other groups. The OE group had the lowest proportion of children meeting recommended intakes for 19 out of 25 nutrients. Mean intakes of foods and nutrients for children across the USAP meet some, but not all, recommendations and intakes vary across children attending various ECE setting types. Additional research on the clinical importance of these differences and the impact of the complex food systems in the USAP may identify systematic strategies for improving diet among children. [ABSTRACT FROM AUTHOR]

To describe the quality of food and physical activity (PA) environments by World Bank Income level in jurisdictions from the Children's Healthy Living Program. Baseline cross-sectional community data were analyzed from 11 jurisdictions categorized by World Bank Income levels to describe exposure to different food and PA outlets. The Children's Healthy Living Program was a multilevel, multijurisdictional prevalence study and community intervention trial that reduced child obesity in the US-Affiliated Pacific region. US-Affiliated Pacific region. Food (n = 426) and PA (n = 552) Outlets. Physical activity and food scores that reflect the quality of the outlets that support being physically active and healthy eating options, respectively. Descriptive statistics are presented as means ± SD or percentages. High-income-income level jurisdictions had higher food and PA scores than middle-income level jurisdictions. The US-Affiliated Pacific region has limited quality food and PA outlets in underserved communities at risk for obesity. The findings in this paper can be used to develop tools and design interventions to improve the food and PA environment to increase a healthier, active lifestyle. [ABSTRACT FROM AUTHOR]

Background The Children's Healthy Living study provided dietary intake information for understudied Native Hawaiian and Other Pacific Islander (NHOPI) young children. Objectives Our objective was to describe food group and macronutrient intakes of NHOPI children in the US-Affiliated Pacific region (USAP), overall and by jurisdiction, income level, and metabolic status. Methods We evaluated 2–8-y-olds (n  = 3520) in a cross-sectional cluster sampled study using 2 d of dietary records completed by caregivers using provided tools, quantified by a specially developed food composition table and compared with US dietary recommendations. Overweight and obesity (OWOB) and acanthosis nigricans (AN) assessment (metabolic status) was completed by trained evaluators using standard tools. Demographic data were collected by questionnaire. Regression analysis identified differences in dietary component means by jurisdiction, World Bank income groups (WBIGs), and metabolic status, adjusted for age and sex. Results Few children met US recommendations for vegetable (2.4%) and milk (4.1%) food groups. US macronutrient recommendations were generally met. Food group and macronutrient intakes were significantly different by jurisdiction and WBIG. Means for food groups, except meats, and macronutrients, except protein, were higher in overweight/obese (OWOB) compared with healthy-weight children. Grain intake of 7.25 (SE: 0.08) oz was higher (P  < 0.05) and milk intake of 0.90 (SE: 0.05) cups was lower (P  < 0.05) in children with OWOB compared with those without OWOB [grains: 7.17 (SE: 0.07) oz; and milk: 0.96 (SE: 0.04) cups]. Monounsaturated fat intake of 11.68 (SE: 0.10) % energy was higher in those with OWOB, compared with healthy-weight children [11.56 (SE: 0.08) % energy, P  < 0.05]. Conclusions Young children's diets in the USAP did not meet milk, vegetable, or fruit intake recommendations. There was variability in dietary patterns across the USAP and by WBIG. Grain intake and monounsaturated fat intake were lower and milk intake was higher in children with better metabolic status. [ABSTRACT FROM AUTHOR]

To serve as a Center of Excellence to further build capacity and new knowledge for collective impact on child health in the US Affiliated Pacific Region. CHL Center continues to strengthen capacity with the Child Health in the Pacific (CHAP) Summer Fellowship Program and the CHL Dietetics Scholarship Program (CHLD), the CHL Summer Institute. Ten fellows from CNMI, Guam and Hawai'i completed the CHAP Summer Fellowship program and the CHL Summer Institute had a total of 123 students completing online courses (nine offered) related to childhood obesity. To examine the CHL intervention's long-term impact, retraining and standardization workshops are being conducted; and data collection has begun. Eighteen community reports provide a comprehensive compilation of data already collected, and CHL data are available for continued analysis to fill the void in basic nutrition and health information of children in the region. A CHL network multistate project (W1194) has expanded CHL's reach, with members from Arizona and West Virginia. The published CHL intervention effect showed significant improvement in intervention communities compared with control in overweight and obesity prevalence (effect size [d] = −3.95%; 95% CI, −7.47% to −0.43%), waist circumference (d = −0.71 cm; 95% CI, −1.37 to −0.05 cm), and acanthosis nigricans prevalence (d = −2.28%; 95% CI, −2.77% to −1.57%). Greater differences existed among intervention communities in acanthosis nigricans prevalence in the group aged 2 to 5 years (−3.99%) vs the group aged 6 to 8 years (−3.40%), and the interaction was significant (d = 0.59%, P <.001). There was a smaller difference in the group aged 2 to 5 years (−0.10%) vs the group aged 6 to 8 years (−1.07%) in screen time (d = −0.97 hour per day, P =.01). Further analysis of intervention levels, activities and child behaviors that influenced the intervention effect continues to be investigated. Year one built on efforts established by the CHL program to build the CHL Center of Excellence. [ABSTRACT FROM AUTHOR]