U.S. Associated Pacific Islands Health Care Teams Chart a Course for Improved Health Systems: Implementation and Evaluation of a Non-communicable Disease Collaborative Model.

The burden of non-communicable disease (NCD) is increasing in the U.S. Associated Pacific Islands (USAPI). We describe the implementation and evaluation of a NCD Collaborative pilot, using local trainers, as an evidence-based strategy to systematically strengthen NCD health care quality and outcomes, focusing on diabetes preventive care across five health systems in the region.

Socioeconomic and demographic predictors of selected cardiovascular risk factors among adults living in Pohnpei, Federated States of Micronesia.

BACKGROUND: The burden of cardiovascular disease (CVD) is increasing in low-to-middle income countries (LMIC). Although strong evidence for inverse associations between socioeconomic position and health outcomes in high-income countries exists, less is known about LMIC. Understanding country-level differences is critical to tailoring effective population health policy and interventions. We examined the association of socioeconomic position and demographic characteristics in determining CVD risk factors among adults living in Pohnpei, Federated States of Micronesia. METHODS: We used data from the cross-sectional World Health Organization's STEPwise approach to surveillance 2002 Pohnpei dataset and logistic regression analyses to examine the association of socioeconomic position (education, income, employment) and demographics (age, sex) with selected behavioral and anthropometric CVD risk factors. The study sample consisted of 1638 adults (642 men, 996 women; 25-64 years). RESULTS: In general, we found that higher education (≥13 years) was associated with lower odds for daily tobacco use (odds ratio [OR]: 0.46, confidence interval [CI]: 0.29-0.75, p = 0.004) and low physical activity (OR: 0.55, CI: 0.34-0.87, p = 0.027). Men had over three times the odds of daily tobacco use than women (OR: 3.18, CI: 2.29-4.43, p < 0.001). Among women, paid employment nearly doubled the odds of daily tobacco use (OR: 1.72, CI: 1.08-2.73, p = 0.006) than unemployment. For all participants, income > $10,000 was associated with over twice the odds of high blood pressure (BP) (OR: 2.24, CI: 1.43-3.51, p = 0.003), versus lower-income (<$5,000). Men had over twice the odds of high BP (OR: 2.01, CI: 1.43-2.83, p < 0.001) than women. Paid employment nearly doubled the odds of central obesity with the magnitude of association increasing by more than 20% adjusted for sex and age. Men reporting paid employment had three times the odds of central obesity (OR: 3.00, CI: 1.56-5.78, p < 0.001) than those unemployed. CONCLUSION: Our analysis revealed associations between socioeconomic position and selected CVD risk factors, which varied by risk-factor, sex and age characteristics, and direction of association. The 2002 Pohnpei dataset provides country-level baseline information; further population health surveillance might define trends. Stronger country-level data might help decision-makers tailor population-based prevention strategies.