Children's Healthy Living (CHL) Program for remote underserved minority populations in the Pacific region: rationale and design of a community randomized trial to prevent early childhood obesity.

BACKGROUND: Although surveillance data are limited in the US Affiliated Pacific, Alaska, and Hawaii, existing data suggest that the prevalence of childhood obesity is similar to or in excess of other minority groups in the contiguous US. Strategies for addressing the childhood obesity epidemic in the region support the use of community-based, environmentally targeted interventions. The Children's Healthy Living Program is a partnership formed across institutions in the US Affiliated Pacific, Alaska, and Hawaii to design a community randomized environmental intervention trial and a prevalence survey to address childhood obesity in the region through affecting the food and physical activity environment. METHODS/DESIGN: The Children's Healthy Living Program community randomized trial is an environmental intervention trial in four matched-pair communities in American Samoa, the Commonwealth of the Northern Mariana Islands, Guam, and Hawaii and two matched-pair communities in Alaska. A cross-sectional sample of children (goal n = 180) in each of the intervention trial communities is being assessed for outcomes at baseline and at 24 months (18 months post-intervention). In addition to the collection of the participant-based measures of anthropometry, diet, physical activity, sleep and acanthosis nigricans, community assessments are also being conducted in intervention trial communities. The Freely Associated States of Micronesia (Federated States of Micronesia, and Republics of Marshall Islands and Palau) is only conducting elements of the Children's Healthy Living Program sampling framework and similar measurements to provide prevalence data. In addition, anthropometry information will be collected for two additional communities in each of the 5 intervention jurisdictions to be included in the prevalence survey. The effectiveness of the environmental intervention trial is being assessed based on the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework. DISCUSSION: The Children's Healthy Living Program environmental trial is designed to focus on capacity building and to maximize the likelihood of sustainable impact on childhood obesity-related behaviors and outcomes. The multiple measures at the individual, community, and environment levels are designed to maximize the likelihood of detecting change. This approach enhances the likelihood for identifying and promoting the best methods to promote health and well-being of the children in the underserved US Affiliated Pacific Region. TRIAL REGISTRATION: NIH clinical trial # NCT01881373.

Incidence of dog bite injuries in American Samoa and their impact on society.

INTRODUCTION: In American Samoa, a US Territory in the South Pacific, over half of reported injuries are attributed to dog bites. Despite years of public outcry, little has been done to adequately address these preventable injuries that affect all age groups of both sexes. OBJECTIVE: To describe a serious public health hazard in American Samoa that may plague other jurisdictions that tolerate a significant free-roaming dog population. METHODS: A limited data set of outpatient records from 2004 through 2010 from the Territory's only emergency department listing an ICD-9-CM E-code of E906.0 ("dog bite") in the primary E-code field provided a record of dog bite injuries. A survey of 437 adolescents documented their experiences regarding unprovoked dog attacks during the 2010/2011 school year. RESULTS: The sex/age group with the highest incidence for dog bite treatment was males 55 to 59 years of age (73.1 per 10,000 population per year) followed closely by males 10 to 14 years of age (71.8 per 10,000 population per year). Males aged 5 to 14 years accounted for 23% of all emergency department visits for dog bites. About one-third of adolescents reported having been bitten by a dog between September 2010 and May 2011. About 10% of males and 16% of females attributed the fear of being bitten as a factor preventing them from getting more physical activity. CONCLUSIONS: Children, adolescents, and the elderly are the most vulnerable to dog bite injuries. Emergency room records may reflect only about a quarter of all such injuries. IMPLICATIONS: Unprovoked attacks by aggressive, free-roaming dogs degrade quality of life by placing an untenable burden on the health care system and imposing physical and psychological barriers toward a more healthful lifestyle that includes walking, jogging, and bicycling.