Addressing Childhood Obesity through Novel Assessments, Enhancement of Summer Enrichment Programs and Surveillance in Guam

Abstract

Childhood obesity is increasing in all ethnic groups especially in nonwhite populations. Inadequate intake of fruits and vegetables (FV) has been associated with childhood obesity. FV were a prominent part of traditional diets of Pacific Islanders as in Guam. Intake of FV, among children, is lower than recommendations by national guidelines. Culture provides the context of meaning for individual behaviors and is, therefore, a critical element to influential behavioral interventions, such as FV intake, mediated by FV preference. A natural experiment was conducted where children were recruited from preexisting summer camp programs in Guam: a cultural immersion camp (CIC), university day camp (UDC), and a recreational sport camp (RSC). The objectives were to examine the influence of cultural immersion on willingness to try FV and FV intake among children, ages 3-12 y, in Guam. Outcomes were assessed before and after camp using previously validated assessment tools completed by children: the Adapted WillTry tool and the 2-day mobile food record (mFR), respectively. The Adapted WillTry and mFR were tested in advance for validity and feasibility among children in Guam and are described in this dissertation. Multiple linear regression analyses were performed to examine if differences in the Adapted WillTry local novel FV score and local common FV score after experiences at each summer camp were present. These analyses were adjusted for pre- assessment, sex, age, ethnicity, body mass index, lesson and camp dose, and parent’s cultural affiliation. Data (e.g., heights, weights) from the Guam Head Start Program were analyzed to determine early childhood overweight and obesity prevalence in Guam. This dissertation informs approaches to promoting FV intake among children in the Pacific that can easily be integrated into existing childhood programs. Improving children’s diets holds promise for reducing obesity rates. The ability to assess these outcomes will come closer to reality with the initiation of publicly available systems to monitor obesity rates.