Open Access Study protocol

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

Lynne R Wilken1, Rachel Novotny2, Marie K Fialkowski2*, Carol J Boushey1, Claudio Nigg3, Yvette Paulino4, Rachael Leon Guerrero5, Andrea Bersamin6, Don Vargo7, Jang Kim8 and Jonathan Deenik9

Author Affiliations

1 Cancer Research Center of Hawaii, University of Hawaii, (701 Ilalo St #600), Honolulu, HI (96813), USA

2 Department of Human Nutrition, Food, and Animal Sciences, University of Hawaii at Manoa, (1955 East-West Rd), Honolulu, HI (96822), USA

3 Office of Public Health Sciences, University of Hawaii at Manoa, (1960 East-West Rd), Honolulu, HI (96822), USA

4 School of Nursing & Health Sciences, University of Guam, (UOG Station), Mangilao, Guam (96923), USA

5 Guam Cooperative Extension Service, College of Natural & Applied Sciences, University of Guam, (UOG Station), Mangilao, Guam (96923), USA

6 Center for Alaska Native Heath Research, University of Alaska Fairbanks, 311 Irving I, Box 757000, Fairbanks, AK(99775), USA

7 Community and Natural Resources, American Samoa Community College, (PO Box 5319), Pago Pago, American Samoa (96799), USA

8 Cooperative, Research, Extension and Education Service, Northern Marianas College, (PO Box 501250), Saipan, MP (96950), USA

9 Department of Tropical Plant and Soil Sciences, University of Hawaii at Manoa, (3190 Maile Way), Honolulu, HI (96822), USA

For all author emails, please log on.

BMC Public Health 2013, 13:944  doi:10.1186/1471-2458-13-944

Published: 9 October 2013



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.


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.


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