Publications

If you can not access any of the full publications, please contact Nicola Hawley.

1. Child, maternal, and household level correlates of nutritional status: a cross-sectional study among Samoan children.

Choy C.C., Desai, M.M., Park, J.J., Frame, E.A., Thompson A.A., Naseri, T., Reupena, M.S., Duckham, R.L., Deziel, N.C., & Hawley, N.L. (2017). Public Health Nutrition 20 (7): 1235-1247. https://www.ncbi.nlm.nih.gov/pubmed/28162141

This study aimed to document the prevalence, coexistence and correlates of nutritional status (stunting, overweight/obesity and anaemia) in Samoan children aged 24-59 months. Using a cross-section community-based survey in ten villages on the Samoan island of Upolu, we found—in a sample of 305 mother-child pairs—stunted growth in 20.3% of children, obesity/overweight status in 16.1% of children, and anaemia in 34.1% of children. These findings—observed prevalences of stunting, overweight/obesity and anaemia—suggest that it is critical to invest in nutrition and develop health programmes targeting early childhood growth and development in Samoa.

2. Dietary patterns are associated with child, maternal, and household-level characteristics and overweight/obesity among young Samoan children.

Choy, C.C., Wang, D., Baylin, A., Soti-Ulberg, C., Naseri, T., Reupena, M.S., Thompson, A.A., Duckham, R.L. & Hawley, N.L. Public Health Nutrition (in press). https://pubmed.ncbi.nlm.nih.gov/29362013/

This study aimed to identify dietary patterns among 24-59-month-old Samoan children and evaluate their association with: child, maternal and household characteristics, and nutritional status indicators (stunting, overweight/obesity, anaemia). We identified two dietary patterns: modern (loaded with “westernized foods”) and neo-traditional. Moderns diets were associated with urban residence, greater maternal educational attainment, higher socioeconomic status, lower vitamin C intake and higher sugar intake and neo-traditional diets were associated with rural residence, lower socioeconomic status, higher vitamin C intake and lower sugar intake. These findings recommend further longitudinal monitoring and evaluation of early childhood growth and development in Samoa.

3. Nutrient intake among Samoan children aged 2 to 4 years in 2015.

Choy, C.C., Thompson, A.A., Soti-Ulberg, C., Naseri, T., Reupena, M.S., Duckham, R.L. & Hawley, N.L. Annals of Human Biology (in press). https://pubmed.ncbi.nlm.nih.gov/29877157/

This study aimed to examine the adequacy of macro- and micronutrient intake among Samoan children ages 2 to 4.99. Using a 117-item food frequency questionnaire, we found most children met or exceeded recommendations for carbohydrate, fat, and protein intake, but did not meet the Recommended Dietary Allowances for calcium, potassium, and Vitamin and E. The findings show inadequate dietary micronutrient intake to be more common among older children (4-4.99 years) and those in the rural regions, and recommend interventions be targeted at those groups.

4. Gender differences in the associations of physical activity and nutritional intake with child body composition: a cross-sectional study of 3-7 year-olds in Samoa.

Thompson, A.A., Duckham, R.L, Desai, M.M., Choy, C.C., Sherar, L.B., Naseri, T., Soti-Ulberg, C., Reupena, S., Wetzel, A. & Hawley, N.L. Pediatric Obesity (in press). https://search.proquest.com/docview/2040291410

The purpose of this cross-sectional study was to examine gender differences in the impact of nutritional and physical activity factors on the body composition of Samoan children through dual energy x-ray absorptiometry (DXA.) Studying a sample of 83 children between the ages of 3 and 7, the researchers tracked physical activity, using accelerometers, and nutritional intake, via questionnaires filled out by the childrens’ mothers. The team found that body composition differed by gender at 3-7 years of age. In girls, carbohydrate intake was negatively associated with percent body fat and positively associated with percent lean mass. In boys, physical activity was negatively associated with trunk to peripheral fat ratio. Additionally, though there was a significant interaction between gender and carbohydrates, physical activity did not attenuate the effect of carbohydrate intake on body composition in either boys or girls. This study highlights important gender differences in the effect of nutrition and physical activity on body composition among Samoan children, and recommends further research on the topic.

If you can not access any of the full publications, please contact Nicola Hawley.

1. Barriers to adequate prenatal care utilization in American Samoa.

Hawley, N.L., Brown, C., Nu’usolia, O., Ah-Ching, J., Muasau-Howard, B. & McGarvey, S.T. (2014) Maternal and Child Health 18 (10): 2284-2292.

In the study, we used data from the prenatal clinic records of 692 women in American Samoa to describe the utilization of prenatal care and to identify socio-demographic predictors of inadequate prenatal care utilization. The study found that, between 2001 and 2008, 85.4% of women received inadequate prenatal care and that the introduction of a prenatal care incentive scheme led to earlier initiation of prenatal care and to improved adequacy of received services. These findings recommend improvements in accessibility and prenatal care incentive programs in order to increase prenatal care utilization in the population.

2. The contribution of feeding mode to obesogenic growth trajectories in American Samoan infants.

Hawley, N.L., Johnson, W.O., Nu’usolia, O. & McGarvey, S.T. (2014). Pediatric Obesity 9 (1): e1-e13.

This study aimed to examine the prevalence of excess weight and obesity and to determine the contribution of feeding mode to obesogenic growth trajectories in American Samoan infants. Using the data of 715 Samoan infants aged 0–15 months, we found 23.3% of boys and 16.7% of girls to be obese at 15 months. Formula-fed infants were also seen to gain weight and length faster than breastfed infants. These findings show that obesity in American Samoa is not confined to adults and recommend obesity prevention efforts targeted at early life and the promotion of breastfeeding as interventions.

3. Gestational weight gain among Samoan women and its impact on delivery and infant outcomes.

Hawley, N.L., Johnson, W.O., Hart, C.N., Triche, E.W., Muasau-Howard, B., & McGarvey, S.T. (2015). BMC Pregnancy and Childbirth 15: 10-17.

This paper described gestational weight gain (GWG) among American Samoan women and examines the association between GWG and four adverse pregnancy and infant outcomes: cesarean delivery, small- and large-for-gestational age (SGA/LGA), and infant overweight/obesity. The findings show 86% of women studied were overweight or obese in early pregnancy and greater GWG in the 2nd trimester and early pregnancy weight were independently associated with increased odds of a c-section. This paper recommend that physicians in American Samoa encourage women into prenatal care early and begin education about appropriate GWG and the potential risks of excess weight gain for both the mother and baby.

4. Hospital practices and concerns about infant satiety are barriers to exclusive breastfeeding in American Samoa.

Hawley, N.L., Holmdahl, I., Strait, E.A., Freeman, J.R., Muasau-Howard, B.T., Solaita, A. & McGarvey S.T. (2015) Pacific Journal of Reproductive Health 1 (1): 14-24.

This study aimed to understand the influences on infant feeding in American Samoa and to identify potential barriers to exclusive breastfeeding. We followed 44 Samoan women, their partners, and their infants from late pregnancy until 8 weeks postpartum, and found that barriers to breastfeeding included lack of skin-to-skin contact after delivery, delays in the initiation of breastfeeding, pain during breastfeeding, and a lack of education about infant satiety cues. The study concludes structural, rather than individual, level barriers to breastfeeding were identified by participants, and recommends that existing evidence-based interventions to promote exclusive breastfeeding could be adapted for use in this setting.

5. Mothers’ attitudes and beliefs about infant feeding highlight barriers to exclusive breastfeeding in American Samoa.

Hawley, N.L., Rosen, R.K., Strait, E.A., Ruffuci, G., Holmdahl, I., Freeman, J.R., Muasau-Howard, B.T., & McGarvey, S.T. (2015) Women and Birth 28 (3): e80-86.

This study examined American Samoan mothers' feeding experiences, attitudes, and beliefs about infant feeding and to identify potential barriers to exclusive breastfeeding. Through 18 semi-structured interviews with American Samoan mothers several weeks postpartum, we found that intention to breastfeed did not predict practice. The identified barriers to exclusive breastfeeding included: the convenience of formula, perceptions among mothers that they were not producing enough breast milk, and pain while breastfeeding. The study highlights barriers to exclusive breastfeeding can be immediately addressed by providers of breastfeeding support services.

6. An evaluation of gestational diabetes mellitus screening practices in American Samoa.

Freeman, J., Thompson, K., Muasau-Howard, B., McGarvey, S.T. & Hawley, N.L. (2015) Pacific Journal of Reproductive Health 1 (2): 68-73

The study evaluated the adequacy of gestational diabetes screening among pregnant women in American Samoa through the review of 622 clinical records to determine: whether or not the patient was screened, the week of gestation in which the screening occurred, and the type of screening the patient received. According to the findings, only 16.2% of women received adequate gestational diabetes screening. This study highlights the critical need for improved screening in this high risk population and urges that the causes of inadequate screening be identified and that interventions be targeted at both patients and clinicians.

7. Predictors of prenatal care satisfaction among pregnant women in American Samoa.

Adeyinka S., Jukic A.M., McGarvey, S.T., Faiai, M., Muasau-Howard, B.T. & Hawley, N.L. (2017). BMC Pregnancy and Childbirth 17 (1): 381.

This study aimed to identify the predictors of prenatal care satisfaction in American Samoa through analysis of data collected from 165 pregnant women receiving prenatal care at the Lyndon B Johnson Tropical Medical Center, Pago Pago. We identified three domains of satisfaction: satisfaction with clinic services, clinic accessibility, and physician interactions. These findings indicate the three domains of satisfaction all contribute to prenatal care satisfaction, and suggest prenatal care clinics should focus on making it easier for women to reach clinics, improving waiting times, and increasing time with providers.

8. Conceptions of pregnancy health and motivations for healthful behavior change among women in American Samoa.

Kocher, E., Sternberg-Lamb, J., McGarvey, S.T., Faiai, M., Muasau-Howard, B.T. & Hawley, N.L. (2017) Women and Birth 31: e32-e41.

This study aimed to understand American Samoan women's conceptions of health during pregnancy, their motivations for pregnancy behavior change, and the role of their family in both enabling and preventing these changes. Using eighteen postpartum women’s semi-structured interviews, we found participants expressed a Westernized conception of health during pregnancy that focused on eating a balanced diet and exercising regularly and described external motivations for adopting healthy behaviors, most notably the perceived benefit to their baby. These findings show pregnancy is an opportune moment for health behavior intervention and suggest future efforts should capitalize on external motivations for behavior change and encourage the development of internal motivators.

9. Knowledge of Gestational Diabetes Mellitus among pregnant women in American Samoa.

Hawley, N., Tripathi, R., Muasau-Howard, B., Howells, M., Faiai, M., & Van der Ryn, M. (2019). Pacific Journal Reproductive Health, 1(8), 410-422. doi:10.18313/pjrh.2019.902

The aim of this study was to examine the knowledge of Gestational Diabetes Mellitus, or GDM, among pregnant women in America. Using an 86-item survey completed by women attending a prenatal care clinic during a cross-sectional study, we tabulated and normalized scores for five domains including: general knowledge, risk factors, maternal complications, infant complications, and testing and treatment. We found the mean total knowledge scores were low—25.8 out of 100—and mean scores were highest for the testing and treatment domain and lowest for the knowledge of risk factors domain. The findings show a lack of GDM knowledge reported by pregnant woman in American Samoa and suggest a critical need to develop effective and wide-reaching health communications interventions to address knowledge deficits and potentially improve utilisation of GDM screening.

10. "It’s free, it’s available, and it’s healthy”: a cross-sectional, qualitative study of fathers’ preferences for breastfeeding in American Samoa and their desire for father-specific, practical breastfeeding education.

Hawley, N., Freeman, J., Wetle, T., Strait, E., Holmdahl, I., Muasau-Howard, B., Suisala, M., To'oto'o-Solaita, A., Rosen, R., & McGarvey, S. (2019). Pacific Journal Reproductive Health, 1(8), 447-461.doi:10.18313/pjrh.2019.905

This study aimed to understand American Samoan fathers’ current roles in infant feeding and to determine whether there is a need/desire for additional infant feeding education specifically targeted to fathers in this setting. Using longitudinal semi-structured interviews (before and after the infant’s birth), we spoke with 15 fathers about their roles in infant care and feeding, knowledge and beliefs about breast- and formula feeding, preferences for infant feeding, and interest in further infant feeding education. Fathers reported a high level of involvement in infant care and ‘partnership’ with their child’s mother, and requested further infant feeding education and ways in which they could support their partners to begin and continue breastfeeding. These findings suggest providing targeted infant feeding education for fathers could be an important health promotion strategy.

11. Fathers’ roles in infant feeding in American Samoa: a qualitative study.

Hawley, N.L., Freeman, J.R., Wetle, T., Holmdahl, I., Strait, E.A., Suisala, M.J.E., Muasau-Howard, B. & McGarvey, S.T. (2019). Pacific Journal of Reproductive Health 1 (8): 447-461.

In this study, the researchers sought to understand American Samoan fathers’ current roles in infant feeding. There is existing research on the relationship between mothers’ knowledge, attitudes, and beliefs and infant feeding practices, but little is known about the fathers’ role in this setting. Using a qualitative approach, the researchers conducted longitudinal semi-structured interviews with fifteen fathers prior to and six-weeks after their infant’s birth. The questions focused on fathers’ roles in infant care and feeding, knowledge about breast- and formula- feeding, and interest in further infant feeding education. After conducting a thematic analysis, the researchers found that fathers reported a high level of involvement in infant care, and had strong preferences for breastfeeding, but were also cognizant of the associated challenges for their partners. According to the study, given the benefits of sustained exclusive breastfeeding, giving fathers targeted infant feeding education could help promote health strategy.

12. Scaling up breastfeeding policy and programs in Samoa: application of the Becoming Breastfeeding Friendly Initiative.

Soti-Ulberg, C., Hromi-Fiedler, A., Hawley, N.L., Naseri, T., Manuele-Magele, A., Ah Ching, J. & Perez-Escamilla, R. International Breastfeeding Journal (in press).

The purpose of this study was to implement the Becoming Breastfeeding Friendly (BBF) initiative in Samoa. A 20 member committee of breastfeeding experts collected and utilized national level data to score the degree of friendliness of Samoa’s breastfeeding environment, identify gaps, and propose policy recommendations to address those gaps. The overall BBF Index score for Samoa indicated a moderate breastfeeding friendly environment for scaling up policies and programs that protect, promote, and support breastfeeding. The six prioritized recommendations were: to develop and implement a National Breastfeeding Policy and Strategic Action Plan; to strengthen the monitoring and evaluation of all breastfeeding activities; to ratify the International Labour Organization’s Maternity Protection Convention 2000; to identify high-level advocates to champion and serve as role models for breastfeeding; to create a national budget line for breastfeeding activities; and to hire a national breastfeeding coordinator and trainer. The researchers conclude that implementation of BBF in Samoa yielded important policy recommendations that will address current gaps in national level breastfeeding support, and that this consultation process can be successfully applied to other countries within the Western Pacific region.

If you can not access any of the full publications, please contact Nicola Hawley.

1. Long term trends in food availability, food prices, and obesity in Samoa.

Seiden, A., Hawley, N.L., Schulz, D., Raifman & S., McGarvey, S.T. (2012) American Journal of Human Biology 24 (3): 286-295 https://pubmed.ncbi.nlm.nih.gov/22371334/

In this study, to describe long-term food availability and prices from 1961 to 2007 and body mass index (BMI) trends from 1980 to 2010 in Samoa, we analyzed data from the open access database FAO. They found that total energy availability increased by 47%, or by more than 900 calories per capita per day, from 1961 to 2007, and that many of the additional calories come from increased availability of dietary fat in the form of meat and vegetable oils. The mean BMI for men and women aged 35–44 also rose by 18% from 1980 to 2010. These long-term trends in food availability and prices, and the temporal pattern of BMI provide national level data for understanding the process of the nutritional transition in Samoa.

2. A protocol for the development and validation of an instrument to measure household water insecurity across cultures: the Household Water InSecurity Experiences (HWISE) Scale.

Young, S.L., Collins, S.M., Boateng, G.O., Neilands, T.B., Jamaluddine, Z., Miller, J.D., Brewis, A., Frongillo, E.A., Jepson, W.E., Melgar-Quinonez, H., Schuster, R.C., Stoler, J., Wutich, A. & HWISE Consortium Authors. (2019). BMJ Open 9 (1): e023558. https://pubmed.ncbi.nlm.nih.gov/30782708/

This study aimed to develop the Household Water Insecurity Experiences (HWISE) Scale to measure household-level water insecurity in multiple contexts. Items on the scale were assessed for both content and face validity and the surveys developed from these items are being utilized in 28 sites globally (with approximately 250 participants from each site.) Once the scale is approved, completed, and available for open-access publication, the findings will be disseminated to public health professionals, scientists, practitioners and policymakers through peer-reviewed journals, scientific presentations and meetings with various stakeholders.

3. Diabetes prevention and care programs in the US-affiliated Pacific Islands: challenges, successes, and recommendations for effective scale-up.

Hawley, N.L., Suss, R., Cash, H.L., Aito’oto, N., Samoa, R. & McElfish, P.A. (2019). Current Diabetes Reports 19 (5): 26. https://link.springer.com/article/10.1007/s11892-019-1139-0

The purpose of this review is to describe some of the unique challenges faced by the US-Affiliated Pacific Islands (USAPIs) in addressing diabetes prevention and care and to present innovative population-level strategies that have been employed to address them. Although the USAPIs are uniquely challenged by environmental, structural, and health system barriers, there have been a number of innovative and successful strategies employed that highlight the resilience of these island nations in addressing their current disease burden when provided with the opportunity and resources to do so. Innovations in addressing these challenges include attempts to modify the food environment, a focus on early life prevention, and task shifting among the health workforce. Health policies to protect, support, and promote diabetes prevention and care are essential and may be informed by the interventions described.

4. Diabetes disparities and promising interventions to address diabetes in Native Hawaiian and Pacific Islander populations.

McElfish, P.A., Purvis, R.S., Esquivel, M.K., Sinclair, K.A., Townsend Ing, C., Hawley, N.L., Haggard-Duff, L.K. & Kaholokula, J.K. (2019). Current Diabetes Reports 19 (5): 19. https://pubmed.ncbi.nlm.nih.gov/30887399/

The purpose of this review is to identify promising culturally-adapted interventions for diabetes designed specifically for Native Hawaiian and Pacific Islanders (NHPIs.) The interventions found to be the most successful utilized a community-based approach that honored NHPI’s collectivist culture, addressed social determinants of health that influence disease control and prevention, and employ NHPI community health workers to implement the chosen interventions. The review concludes that further investment is needed to scale these interventions for regional and national implementation.

5. Exploring the paradoxical relationship of a CREBRF missense variant with body mass index and diabetes among Samoans: study protocol for the Soifua Manuia (‘Good Health’) observational cohort study.

Hawley. N.L., Pomer, A., Rivara, A.C., Rosenthal, S.L., Duckham R.L., Carlson, J.C., Naseri, T., Reupena, M.S., Selu, M., Lupematisilia, V., Unasa, F., Vesi, L., Fatu, T., Unasa, S., Faasalele-Savusa, K., Wetzel, A., Soti-Ulberg, C., Prescott, A., Siufaga, G., Penaia, C., To, S., LaMonica, L., Lameko, V., Choy, C.C., Crouter, S., Redline, S., Deka, R., Kershaw, E.E., Urban, Z., Minster, R.L., Weeks, D.E., McGarvey, S.T. JMIR Research Protocols (in press)

The purpose of the Soifua Manuia (‘Good Health’) study was to precisely characterize the association of the CREBRF genetic variant—rs373863828—with metabolic (body composition, glucose homeostasis) and behavioral traits (dietary intake, physical activity, sleep, weight control behaviors) that influence energy homeostasis. In 2010, a cohort of Samoan adults participated in a genome-wide association study (GWAS) of adiposity in Samoa. A follow-up, which was based on the absence of the CREBRF gene variant in participants, took place between August 2017 and March 2019. Over a period of 7-10 days, the research team collected anthropomorphic measurements; body composition assessments; point-of-care glycated hemoglobin measurements; fasting blood draw and oral glucose tolerance tests; urine collections; blood pressure, hand grip strength, objective physical activity and sleep apnea monitoring assessments; and questionnaire measures from each participant. In January 2019, a sub-sample of the study participants (n=118) also completed a buttock fat biopsy procedure for collection of subcutaneous adipose tissue samples. A total of 519 participants were enrolled as of March 2019, and data analyses are currently ongoing. According to the research team, this study will provide insights into how the genetic variant rs373863828, in CREBRF, functions on a whole-body level. These results could provide novel targets to prevent or treat obesity, diabetes, and associated metabolic disorders.

If you can not access any of the full publications, please contact Nicola Hawley.

1. Cardiovascular disease risk factors and DNA methylation at the LINE-1 repeat region in peripheral blood from Samoan Islanders.

Cash, H., McGarvey, S.T., Housemann, E.A., Marsit, C.J., Hawley, N.L., Lambert-Messerlian, G.M., Viali, S., Tuitele, J. & Kelsey, K.T. (2011) Epigenetics 6 (10): 1257-1264 https://pubmed.ncbi.nlm.nih.gov/21937883/

We sequenced DNA in peripheral blood samples from men and women in American Samoa and Samoa to study the relationship between LINE-1 methylation and factors associated with cardiovascular and metabolic diseases, like LDL and HDL. The findings confirm that DNA “global” loss of methylation, which was previously observed in cardiovascular disease, is associated with altered levels of HDL and LDL, and indicate the need for further research in understanding the relationship between LINE-1 methylation and risk factors for cardiovascular disease.

2. Genome-wide association study of adiposity in Samoans: Prevalence of non-communicable disease and associated risk factors.

Hawley, N.L., Minster, R.L., Weeks, D.E., Viali, S., Reupena, M.S., Deka, R., & McGarvey, S.T. (2014). American Journal of Human Biology 26: 491-501. https://pubmed.ncbi.nlm.nih.gov/24799123/

This study described the prevalence of obesity-related noncommunicable diseases and associated risk factors in a sample of 3,475 Samoan adults aged 24 to <65 as part of a genome-wide association study for obesity-related traits. Findings show that obesity was highly prevalent in the sample studied—64.6% of females and 41.2% of males were obese according to Polynesian cutoffs—and also address the prevalence of diabetes, hypertension and dyslipidemia. The study concludes phenotypic characteristics of this sample provide further evidence previously reported trends toward obesity and its associated disorders.

3. Cutoff levels for hyperandrogenemia among Samoan women: an improved methodology for deriving normative data in an obese population.

Maredia, H., Lambert-Messerlian, G., Palomaki, G.E., Viali, S., Hawley, N.L., & McGarvey, S.T. (2016) Clinical Biochemistry 49 (10-11): 782-786. https://pubmed.ncbi.nlm.nih.gov/26908216/

This study aimed to define biochemical hyperandrogenemia (HA) among a sample of 464 Samoan women, aged 25–39, who were a part of a larger genome-wide association study of adoposity. We analyzed the distribution of free androgen index to establish normative androgen data among Samoan women and defined HA as free androgen index greater than the 95th percentile. According to this HA definition, 14% of women were classified as hyperandrogenemic. This study is the first to define normative androgen values among Samoan women quantitative assessment of the relationship between adiposity and androgen levels.

4. A thrifty variant in CREBRF strongly influences body mass index in Samoans.

Minster R.L.*, Hawley N.L.*, Su, C., Sun, G., Kershaw E.E., Chen, H., Buhule, O.D., Lin, J., Reupena, M.S., Naseri, T., Urban, Z., Deka, R., Weeks, D.E. & McGarvey, S.T. (2016) Nature Genetics 48 (9): 1049-54. *Co-First Authors. https://pubmed.ncbi.nlm.nih.gov/27455349/

This study conducted a genome-wide association study in 3,072 Samoans and discovered a variant, rs12513649, strongly associated with BMI. We replicated this association in another 2,102 Samoans and identified a strongly associated missense variant, rs373863828, in CREBRF. The variant is rare in other populations but is common in Samoans, and in comparison to the wild-type CREBRF, shows decreased energy use and increased fat storage in adipocyte cells. The findings from the data, alongside evidence of positive selection of the allele encoding the missense variant, support a thrifty' variant hypothesis as a factor in human obesity.

5. Dietary patterns are associated with metabolic outcomes among adult Samoans in a cross-sectional study.

Wang D., Hawley, N.L., Thompson A.A., Lameko V., Reupena M.S., McGarvey S.T. & Baylin, A. (2017). Journal of Nutrition 147 (4): 628-635. https://pubmed.ncbi.nlm.nih.gov/28202634/

This study aimed to identify dietary patterns in Samoa and to evaluate their associations with metabolic outcomes. We studied dietary patterns using a 104-item food questionnaire and identified a modern pattern (high intake of imported and processed foods), a mixed-traditional pattern (high intake of neotraditional foods), and a mixed-modern pattern (loaded with imported and processed foods but also with neotraditional foods.) The study’s findings indicate mixed dietary patterns containing healthier foods, rather than a largely imported and processed modern diet, may help prevent metabolic syndrome in Samoa.

6. Reproductive health, obesity, and cardiometabolic risk factors among Samoan women.

Maredia, H., Hawley, N.L., Lambert-Messerlian, G., Fidow, U., Reupena, M.S., Naseri, T. & McGarvey, S.T. American Journal of Human Biology (in press). https://pubmed.ncbi.nlm.nih.gov/29663637/

This study estimated the prevalence of menstrual irregularity and of polycystic ovarian syndrome (PCOS) in Samoan women (with high obesity prevalence) and explored the association of these reproductive health conditions with adiposity, cardiometabolic risk factors, and androgen levels. Studying a cross-sectional sample of 470 Samoan women, ages 25–39, we found the prevalence of menstrual irregularity and PCOS to be less than hypothesized, but confirmed Samoan women with menstrual irregularity and other features of PCOS have significantly poorer metabolic health.

7. Nonmydriatic fundus photography in a high-risk population of Samoans with diabetes: the Soifua Manuia Eye Screening Program.

LaMonica, L., Hawley, N.L., Bhardwaj, M., Naseri, T., Reupena, M.S. & Ramsey, D. (2019). Clinical and Experimental Ophthalmology 47 (7): 954-956. https://pubmed.ncbi.nlm.nih.gov/31034672/

In this study, the research team piloted a low-cost, smartphone-based remote retinal diagnosis system to screen for diabetic retinopathy in a high-risk population of Samoans with diabetes and elevated blood glucose levels. Their objective was to determine the percentage of radable images that could be obtained using the PanOptic iExaminer System. This study was undertaken alongside an ongoing longitudinal study of the genetics of obesity and diabetes among Samoans, the Soifua Manuia (“Good Health”) study, and 206 of the approximately 700 adults in the overall study partook. A total of 393 eyes, or 95.4%, from these 206 participants were successfully imaged using the PanOptic iExaminer. The researchers found that clinically useful fundus images could be successfully obtained in the majority of participants and that the durability and maintainability of the PanOptic iExaminer System in the field proves promising as a cost-effective device for use in low- to middle-income countries.

8. The Household Water InSecurity Experiences (HWISE) Scale: development and validation of a household water insecurity measure using data from 23 low- and middle-income countries.

Young, S.L., Collins, S.M., Boateng, G.O., Neilands, T.B., Jamaluddine, Z., Miller, J.D., Brewis, A., Frongillo, E.A., Jepson, W.E., Melgar-Quinonez, H., Schuster, R.C., Stoler, J., Wutich, A. & HWISE Consortium Authors. (2019). BMJ Global Health 4:e001750. https://gh.bmj.com/content/4/5/e001750

The purpose of this study is to develop the Household Water Insecurity Experiences (HWISE) Scale to measure household water insecurity in an equivalent way across disparate cultural and ecological settings. The researchers implemented cross-sectional surveys in 8127 households across 28 sites in 23 low-income and middle-income countries. They collected data related to water insecurity in the prior month; sociodemographics; water acquisition, use, and storage; household food insecurity and perceived stress. The research team retained twelve items about experiences of household water insecurity for the HWISE Scale, and concluded that the scale will have the ability to quantify the prevalence, causes, and consequences of household water insecurity.

9. Tobacco smoking patterns in Samoa in 2010: Implications for interventions.

Adia, A.C., Hawley, N.L., Naseri, T., Reupena, M.S. & McGarvey, S.T. Tobacco Prevention and Cessation (in press). http://www.tobaccopreventioncessation.com/Tobacco-smoking-patterns-in-Samoa-in-2010-Implications-for-ninterventions,114093,0,2.html

In this study, the researchers describe current smoking and daily tobacco use in adults from Samoa, with a focus on sex and age stratified analyses of the influence of occupation, education, census region, household asset ownership, and alcohol use in order to help develop targeted interventions. The nationwide survey included 3745 adults, aged 25–65 years from 33 villages, and was completed in Samoa in 2010. Interviews were used to assess current smoking status, daily tobacco use, current alcohol use, and a variety of sociodemographic factors. The team found that more than half of men, or 51.3%, and 21.8% of women were current tobacco users. On average, men and women smoked on average 10.9 and 8.7 cigarettes each day, respectively. In men, being married, a subsistence farmer/laborer, an alcohol user, and having low household assets were all independently associated with being a tobacco smoker. In women, not completely secondary education, being 25–34 years old, residing in urban atypia, and being an alcohol user were all independently associated with being a tobacco smoker. The researchers conclude that the high rates of tobacco usage in Samoa warrant the development of interventions for cessation that are specific to sex, age, education, and household socioeconomic status.

If you can not access any of the full publications, please contact Nicola Hawley.

1. Modernization and cardiometabolic risk in Samoan adolescents.

Hawley, N.L., Weir, L.M., Viali, S., Tuitele, J. & McGarvey, S.T. (2012) American Journal of Human Biology 24 (4): 551-557 https://pubmed.ncbi.nlm.nih.gov/22430949/

We analyzed data collected from 436 adolescents—ages 12 to 17.9— from Samoa and American Samoa in order to describe the prevalence of cardiovascular risk factor clustering, which was indicated by the presence of three or more risk factors (factors included high waist circumference, high blood pressure, high triglyceride level, low-high-density lipoprotein cholesterol, and high fasting serum glucose.) The findings show that American Samoan adolescents have greater cardiovascular risk clustering than Samoan adolescents and that the frequency of risk factor clustering varied according to body mass index status. The study suggests screening and intervention within the adolescent age group in order to reduce the burden of non-communicable disease.

If you can not access any of the full publications, please contact Nicola Hawley.

1. Social and economic influences on infant and child feeding practices in a Marshallese community.

Ayers B., Hawley, N.L. & McElfish, P.A. (2019). Public Health Nutrition 22 (8): 1461-1470. https://pubmed.ncbi.nlm.nih.gov/30793680/

In this study, the researchers aimed to publish the first study examining the key influences on infant and child feeding practices with Marshallese immigrant women in the U.S. The study took place in a Marshallese community in Arkansas, U.S., and included twenty-seven participants that took part in four qualitative focus groups. These participants included Marshallese women with children between 1–3 years of age, and/or caregivers for children of this age range. The researchers identified five primary themes within the multiple levels of the Social Ecological model: at the intrapersonal level, mothers’ and caregivers’ autonomy emerged; at the interpersonal level, child-led and familial influences emerged; at the organizational level, health-care provider influences emerged; and at the policy level, the Special Supplemental Nutrition Program for Women, Infants, and Children emerged. The researchers concluded that understanding the multidimensional influences impacting infant and child feeding practices is necessary to create culturally relevant interventions to reduce health disparities.

2. Maternal health beliefs, perceptions, and experiences in a U.S. Marshallese Community.

Ayers B., Purvis R.A., Bing W., Rubon-Chutaro J., Hawley N.L., Delafield R., Adams I.K. & McElfish P.A. Journal of Transcultural Nursing. doi: 10.1177/1043659619854525 (online ahead of print). https://pubmed.ncbi.nlm.nih.gov/31184295/

The purpose of this study was to review the beliefs, perceptions, and experience of maternal health among Marshallese women. Using a qualitative descriptive design, the research team surveyed forty-three participants. The team focused on four themes: family planning beliefs and experiences, prenatal beliefs and experiences, birthing beliefs and experiences, and postpartum beliefs and experiences. The researchers were able to identify new information related to these themes that has implications for policy and practice related to culturally congruent health care for Marshallese mothers.