ABSTRACT
The objective of this study was to quantify the cost and availability barriers to obtaining healthy foodstuffs in the Republic of the Marshall Islands (RMI). A validated food environment survey procedure was adopted to assess the cost and availability of healthy foods in the larger, but more difficult to access grocery stores, compared to smaller, but more easily accessible, convenience stores in the RMI. Stores were scored based on food availability, price, and quality. Availability score of healthy foods in grocery stores was much higher than in convenience stores (15.6 vs 2.9). Grocery stores also tended to have fresher produce (quality score = 6.7 vs 1.2), but they generally had a higher cost score (price score = -1.1 vs -0.2). Furthermore, healthy alternatives to commonly purchased staples of the RMI diet were limited and trended towards being more costly in all stores surveyed. Grocery stores in the RMI scored substantially lower than stores in economically disadvantages areas of the United States. In the RMI, there are significant barriers of access and cost to healthy diets. This makes it difficult for average Marshallese families to make alterations to their eating habits, even with educational and community outreach efforts.
ABSTRACT
<b>Background</b><br>The Pacific Islands is an area with one of the world's highest prevalence of obesity and diabetes. The Republic of the Marshall Islands (RMI) is an independent country of the Micronesian that extends along latitude 4 to 18 degrees north. In the past, several studies reported regarding the prevalence of diabetes among the people of the Pacific Islands. However, there is no report yet with respect to diabetes in Majuro, the capital of RMI. In RMI, diabetes and obesity are also recognized to be a serious problem, but the present state of affairs prevents an understanding of the situation.<br><b>Objectives</b><br>The purpose of the present study was to investigate the present situation and the prevalence of diabetes and obesity in Majuro. <br><b>Methods</b><br>The participants were Marshallese visited our thyroid cancer-screening program. Among those participants who undertook thyroid cancer screening, the Body Mass Index (BMI) and hemoglobinA1c (HbA1c) levels were taken of 850 participants. Participants with an HbA1c level of 6.5% or more were put into the diabetes group and participants with a BMI of 30 and over were the obese group. Prevalence was adjusted using the Majuro population based on 1999 national census and using world standard population of Segi. <br><b>Results</b><br>The age-adjusted prevalence of diabetes in aged 20 years and over in Majuro was 22.1%. After standardization, the prevalence was 31.0%.<br><b>Conclusion</b><br>The results suggest there is a high rate of diabetes in RMI similar to other pacific islands. It could be concluded, based on this research, that there is a crisis situation with regards to diabetes in the RMI. There is also a need for epidemiological research to be on a random sample of the population.