Community-Based Participatory Research and Obesity among Pacific Islander Youth

Vaka Faletau, MSLos Angeles County, Dept of Children & Family Services

Sora Park Tanjasiri, DrPH, MPHCalifornia State University, Fullerton

Asian Pacific Islander Obesity Prevention AllianceMay 20, 2010

123.5

175.2

75.2

70.6

205.6

187.6

201.8

124.8

0 50 100 150 200 250

Hispanic

Afr American

White

Asian American

Pacific Islander

Guamanian

Hawaiian

Samoan

Rate (per 100,000)

Disparities in Diabetes Mortality in California

Denotes Healthy People 2010 Target (45.0 per 100,000)* Data from the California Department of Health Services, Sentinel Health Indicators for California’s Multicultural Populations, 1991-2001, CA: Center for Health Statistics, May 2004.

2006 NHDR Findings: Considerable Data Gaps Remain for NHPIs

33%

93%

47%

79%

12%

60%

7%

2%

2%

10%

2%

5%

2%

0%

20%

40%

60%

80%

100%

Black Asian NHOPI AI/AN >1 Race Hispanic Poor

No estimate Poor power

Agency for Healthcare Research and Quality. 2006 National Healthcare Disparities Report. Rockville, MD: U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality; December 2006. AHRQ Pub. No. 07-0012.

California is home to over 221,458 Pacific Islanders*

2000 California Population

Alone Inclusive < HS deg< 100%

FPL< 200%

FPLPublic Assist.

Limited English

Native Hawaiian 20,571 60,048 14% 11% 27% 5% 3%

Samoan 37,498 49,804 22% 20% 45% 12% 17%Chamorro/ Guamanian 20,918 33,849 20% 10% 29% 6% 9%

Tongan 12,111 15,252 40% 18% 44% 10% 32%

NH Whites 15,816,790 16,538,491 10% 8% 20% 3% 3%

* U.S. Census, 2000

• NCI Community Network Program (U01CA114591)

• Five year effort to increase cancer education, research and training for Pacific Islanders in Southern California

Population Sizes of Pacific Islanders in Southern California, 2000

WINCART community partners WINCART university partners

50,682

9,567

7,785

25,262

17,113

University ResearchersCommunity Organizations

Ainahau O Kaleponi Hawaiian Civic Club

CA Chamorro Breast Cancer Survivors Alliance

Guam Communications NetworkOrange County Asian and Pacific

Islander Community AlliancePacific Islander Health PartnershipSamoan National Nurses AssocSons and Daughters of Guam ClubTongan Community Service

Center/SSGUnion of Pan Asian Communities

California State University, Fullerton

Claremont Graduate UniversityUniversity of California, Los

AngelesUniversity of California, RiversideUniversity of California, San

DiegoUniversity of Southern California

Community-Based

Participatory Research

CBPR Principles*

• Shared participation

• Cooperative engagement of community and university researchers in processes of co-learning

• Systems and capacity development

• Empowering processes that involve both research and action for community change

* Israel, Parker, Becker (1998)

Physical Activity and Nutrition among Pacific Islander Youth

(PANPY)• 2 year study to assess the feasibility of a

CBPR collaborative to identify obesity risk factors among Marshallese, Samoan and Tongan youth in Southern California

• Funded by the National Institute on Child Health and Human Development (NICHD)

Protocol: DAY 1Informed Consent/Assent

Measure Height & Weight

Complete Food Frequency Questionnaire

Distribute Activity Monitors

DAY 2Collect Activity Monitors

Complete the “Attitudes Toward Physical Activity” questionnaires

Methods: Food Frequency Questionnaire

Provides information on “usual” Provides information on “usual” dietary intakedietary intake

Our version was developed by the Our version was developed by the Cancer Research Center at the Cancer Research Center at the University of Hawai’iUniversity of Hawai’i

160 food items listed160 food items listed

Generally the most useful purpose Generally the most useful purpose is NOT to describe the diet of a is NOT to describe the diet of a group, but rather to compare low to group, but rather to compare low to medium to high intakesmedium to high intakes

Methods: Accelerometers

Sample Graph: Intensity Levels

Methods: Psychosocial Predictors of Physical Activity Questionnaire

“Am I Able?”Physical Self-Worth Scale

(Whitehead, 1995)

Perceived Physical Competence (Harter, 1985)

““Is It Worth It?”Is It Worth It?”Liking of Games and Sports Liking of Games and Sports (Brustad, 1996; Smith, 1999)(Brustad, 1996; Smith, 1999)

Fun of Physical Exertion Fun of Physical Exertion (Brustad, 1996; Smith, 1999)(Brustad, 1996; Smith, 1999)

Liking of Vigorous Exercise Liking of Vigorous Exercise (Brustad, 1996; Smith, 1999)(Brustad, 1996; Smith, 1999)

““Reinforcing Factors”Reinforcing Factors”Peer Acceptance Scale Peer Acceptance Scale (Brustad, 1996)(Brustad, 1996)

Parent Encouragement Parent Encouragement Scale Scale (Brustad, 1996)(Brustad, 1996)

Methods: Psychosocial Predictors of Physical Activity

Results: Participant Profiles

CommunityCommunity Sample Sample SizeSize AgeAge GenderGender

Total SampleTotal Sample 118118x = 15.98x = 15.98

SD = 1.85SD = 1.85

52% 52% malemale

48% 48% femalefemale

TonganTongan 5252x = 15.53x = 15.53

SD = 1.54SD = 1.54

48% 48% malemale

52% 52% femalefemale

MarshalleseMarshallese 2828x = 16.07x = 16.07

SD = 1.86SD = 1.86

54% 54% malemale

46% 46% femalefemale

SamoanSamoan 3838x = 16.26x = 16.26

SD = 2.16SD = 2.16

58% 58% malemale

42% 42% femalefemale

Results: Body Mass Index (BMI)

CommuniCommunityty

MINMIN MAXMAX MeanMean SDSD

Total Total SampleSample 16.5316.53 56.4956.49 30.6430.64 8.758.75

TonganTongan 18.2918.29 55.3055.30 32.8232.82 8.528.52

MarshallesMarshallesee

16.5316.53 42.3842.38 23.8023.80 5.245.24

SamoanSamoan 18.5918.59 56.4956.49 32.0732.07 8.718.71

Results: Average Duration of Physical Activity

Total Males Females

Sedentary (min/day) 508.1 + 120.5 487.8 + 95.2 529.3 + 140.4

Light (min/day) 226.5 + 71.0 283.4 + 68.2 248.2 + 70.4

Moderate (min/day) 35.3 + 24.9 45.4 + 25.9 24.7 + 18.9

Hard (mid/day) 2.1 + 5.3 2.0 + 3.9 2.1 + 6.4

Results: Food Frequency Questionnaire

Results: Psychosocial Predictors of Physical Activity

What We LearnedParticipants should be encouraged to Participants should be encouraged to reduce overall caloric intake and % energy reduce overall caloric intake and % energy from fat and saturated fat from fat and saturated fat

Participants generally over-reported dietary Participants generally over-reported dietary intakes, including large portions (where as intakes, including large portions (where as previous studies have shown under-previous studies have shown under-reporting)reporting)

What We Learned•Feasibility of Assessments With PI Youth

What We Learned•Feasibility of Assessments With PI Youth

Water-proof accelerometers should be designed to assess activities popular with P.I. such as surfing and water polo

A shorter diet questionnaire should be considered to ensure accuracy

A culture-specific questionnaire on physical activity attitudes is also needed

What We Learned•Barriers to Physical Activity Involvement

Limited access to SAFE, open areas

Transportation is a barrier to getting places after school

“We watch TV ‘cause it’s there…”

Include physical activity at cultural or church events (volleyball, football, etc.)

PI youth respect dedicated individuals, regardless of background

Many PI youth are embarrassed by their body size (males)

Acknowledgements• California State University, Fullerton

– Jan Eichenauer– Colleen Kvaska– Archana McEligot– Lianne Nacpil– Sora Park Tanjasiri– Lenny Wiersma

• Pacific Islander Health Partnership– Greta & George Briand– Donny Faaliliu– Vaka Faletau– Joshua Finau– Ka’ala Pang

• Union of Pan Asian Communities– Jonathan “Tana” Lepule

• San Diego State University– Karen Moy

This study was funded by the National Institute on Child

Health and Human Development (grant R21

HD055192)

Thank you!