Understanding dietary intake among young American Samoan children

Abstract

Overweight, obesity, diabetes and other non-communicable chronic diseases (NCDs) are among the greatest contributors to morbidity and mortality worldwide. Research that tracks and describes global and regional trends in obesity and diabetes has indicated that the Pacific Islands are disproportionately affected by NCDs. The Pacific territory of American Samoa has also been plagued with the obesity epidemic. The high prevalence of childhood overweight and obesity in American Samoa prompts a need to examine causes and consequences of obesity and highlights the need for nutrition and health monitoring as well as nutrition education programs and policies. There is little research to understand the environmental and socio-cultural determinants of child obesity in the US Affiliated Pacific (USAP) jurisdictions, including American Samoa. Poor diet quality and unhealthy dietary behavior are major risk factors for NCDs among children and adolescents. Ameliorating obesity early in life will help avert lifelong obesity and related disease (NCDs). There is a lack of published studies on dietary intake, dietary behavior and their association with diet quality of young children in American Samoa. Thus, the main objective of this research was to understand dietary intake of young American Samoan children, specifically the context and patterns of child eating, and influences on child diet quality. This dissertation used data collected from the Children’s Healthy Living (CHL) program and new data collected through qualitative interviews. This dissertation has three aims or studies. The first aim was to identify characteristics of children who have higher diet quality. This was a quantitative study using cross- sectional, data from the CHL Time 1 (2011-2013) study. This descriptive study examined energy intake and diet quality of children’s meals (N=586 participants). The dependent variables were drawn from the CHL Food Activity Logs (FALs, or food records) from children. Child diet quality was assessed using the Healthy Eating Index 2020 (HEI-2020). The independent variables were derived from child and household demographics. The main finding was that children who live in urban communities had higher diet quality and were likely to be consuming healthier foods than those living in rural communities. The second aim was to test differences in diet quality by diet context (specifically by food having been prepared and food having been consumed at home, at school, and other locations away from home). This quantitative study used data from CHL Time 1 (2011-2013). Higher consumption of foods prepared away from the home has been associated with lower diet quality among adolescents and adults. Aim 2 evaluated the association between location of food preparation and consumption and diet quality (using energy intake and HEI) among children ages 2-8 years, (N=581 participants). The main findings were that children who had meals prepared and consumed in the school had higher diet quality (especially for dairy) than those that had meals prepared and consumed at home and children who had meals prepared and consumed in the school had higher diet quality than those at other locations away from home (i.e. home of relative, restaurants, fast food, church). However, home food preparation and consumption was associated with higher (more adequate) seafood intake, compared to food prepared and consumed in other locations. The third aim was to identify caregiver attitudes and perceptions towards child diet quality and related dietary behaviors, utilizing key informant interviews. Participants for this study were drawn from households that participated in the CHL Time 3 study (2019). Twenty (20) mothers representing both rural (n=9) and urban (n=11) American Samoa participated in qualitative interviews. The study examined a healthy child and diet in American Samoa. Samoan themes and topics were derived including barriers and supports to healthy eating, and family influences. These themes showed influences of the Samoan culture and community, such as the positive role and influence of church and village programs on promoting health and nutrition. In addition, widespread availability and consumption of traditional foods is viewed as both a positive and strong influence towards health and nutrition. Meats cooked in the traditional oven were viewed as healthy while taro and other starchy vegetables were viewed as less healthy, especially when cooked with lots of coconut milk. This dissertation revealed an association between urban community living and higher diet quality and an association between consuming school meals and higher diet quality. Caregiver attitudes and perceptions (i.e. what defines a healthy child in American Samoa, barriers & supports) about child diet were influenced by family, churches, and villages, unique to the Samoan culture and community. Findings suggest that the cultural influence of church and village programs are a support and thus promote healthy eating within villages/communities. Findings from this dissertation highlight the importance of future multilevel interventions working with caregivers, schools and rural communities to improve diet and health among children and families in American Samoa. These include studies on the differences between urban and rural eating patterns of American Samoan children, and the need to further understand the differences in diet quality of food prepared and consumed in the home compared to other locations away from the home. In addition, further examination is needed to understand the differences of caregiver perceptions and understanding of child diet and health, based on additional characteristics (i.e. citizenship status, village, WIC/SNAP benefit recipient or not).