Overweight and at-risk for overweight among Hawai'i public school students entering kindergarten, 2002-2003.

Recent studies have pointed to an increasing problem of overweight and obesity in children in Hawai'i, but all of these studies have been conducted in specific communities or special population groups. No broad population-based studies have been conducted to document the extent of overweight in the general population of children in Hawai'i. To provide a population based estimate of overweight in Hawai'i's children, this study examined Student Health Records for 10, 199 children entering kindergarten in public schools during 2002-2003. Data on age, gender, height, and weight were used to calculate BMI (body mass index) scores. Because records for all students entering public school kindergarten were available for analysis, the data presented here represents the broadest estimates of overweight and at risk for overweight in Hawai'i's children published to date. The results illustrate that almost one-third of the children aged 4-6 years old entering Hawai'i public schools are either overweight or at risk for overweight. Rates are higher in rural school complexes than urban ones. Compared to a 1984 study that found 'no significant under or over nutrition' in Hawai'i's school children, our results suggest that almost one-third of children aged 4-6 entering Hawai'i public schools are either overweight or at risk for overweight. Physicians should be aware of this growing problem, and seek to implement practices to combat overweight among their pediatric patients and families.

The healthy Hawaii initiative: A social ecological approach promoting healthy communities.

PURPOSE: The tobacco settlement has provided the opportunity for the state of Hawaii to implement the Healthy Hawaii Initiative (HHI), targeting smoking, poor nutrition and physical inactivity. The purpose of this paper is to describe and document preliminary findings. METHODS: The social ecological model is translated into practice through school and community grants to create systems, environmental and policy changes, teacher training on health and physical education standards, continuing education for the medical community in behavioral health, and a public education campaign. A comprehensive evaluation provides ongoingfeedback for program improvement and progress on the effects of psychosocial mediators, behaviors, and long-term chronic diseases. RESULTS AND DISCUSSION: Preliminary process results presented here are promising. The components are thought to interact synergistically to bring about behavior changes statewide. The HHI is one example of how to implement a multilevel initiative to target the three major behavioral determinants of chronic disease (tobacco use, physical inactivity, and poor nutrition) and build healthier communities.

Setting objectives for community and systems change: an application of concept mapping for planning a statewide health improvement initiative.

The Hawaii Department of Health (HDOH) used concept mapping techniques to engage local stakeholders and national subject area experts in defining the community and system factors that affect individuals' behaviors related to tobacco, nutrition, and physical activity. Over eight working days, project participants brainstormed 496 statements (edited to a final set of 90), which were then sorted and rated for their importance and feasibility. A sequence of multivariate statistical analyses, including multidimensional scaling and hierarchical cluster analysis, generated maps and figures that were then interpreted by project stakeholders. The results were immediately incorporated into an official plan, approved by the governor and state legislature, recommending how Hawaii's tobacco settlement resources could be used to create sustainable changes in population health. The results also provide empirical support for the premise that both community and systems factors ought to be considered when planning comprehensive health improvement initiatives.