Explore the vast range of titles available.

Pacific Islanders have among the highest rates of obesity and type 2 diabetes in the world. Targeting children is critical for primary prevention. To prevent young child overweight and obesity and to improve health in the US-Affiliated Pacific region via the Children's Healthy Living Program. In this multijurisdictional, multilevel, multicomponent community randomized clinical trial, where all evaluable children were analyzed according to the random assignment of their community, hierarchical difference-in-difference models accounted for the community randomization, community clustering with jurisdictions, and these models were adjusted for the age and sex distribution of the community. The setting was 27 communities in 5 jurisdictions (Alaska, American Samoa, Commonwealth of the Northern Mariana Islands, Guam, and Hawaii). Participants were 4329 children (time 1) and 4042 children (time 2) aged 2 to 8 years in 27 selected communities from October 7, 2012, to October 25, 2015. Data analysis was completed in June 2018. Nineteen activities addressed policy, environment, messaging, training, and 6 target behaviors (sleep time, screen time, physical activity, fruits and vegetables, water, and sugar-sweetened beverages). Primary outcomes were body size measurements. Secondary outcomes were acanthosis nigricans, sleep quality and duration, dietary intake, physical activity, and other questionnaire reponses. The study included 27 communities and 8371 evaluable children (mean [SD] age, 5.4 [1.8] years; 50.9% male [n = 4264]). Data analysis included 952 children in the intervention group and 930 children in the control group aged 2 to 5 years at time 1; 825 children in the intervention group and 735 children in the control group aged 2 to 5 years at time 2; 565 children in the intervention group and 561 children in the control group aged 6 to 8 years at time 1; and 517 children in the intervention group and 560 children in the control group aged 6 to 8 years at time 2. The intervention communities showed significant improvement compared with control communities in overweight and obesity prevalence (effect size [d] = -3.95%; 95% CI, -7.47% to -0.43%), waist circumference (d = -0.71 cm; 95% CI, -1.37 to -0.05 cm), and acanthosis nigricans prevalence (d = -2.28%; 95% CI, -2.77% to -1.57%). Age and sex subgroup analysis revealed greater difference among the intervention communities in acanthosis nigricans prevalence in the group aged 2 to 5 years (-3.99%) vs the group aged 6 to 8 years (-3.40%), and the interaction was significant (d = 0.59%, P < .001), as well as the smaller difference in the group aged 2 to 5 years (-0.10%) vs the group aged 6 to 8 years (-1.07%) in screen time (d = -0.97 hour per day, P = .01). The intervention reduced the prevalence of young child overweight and obesity and acanthosis nigricans. Comprehensive, effective, and sustainable interventions are needed to improve child health in the US-Affiliated Pacific region. ClinicalTrials.gov Identifier: NCT01881373.

Translation of research advances into clinical practice for at-risk communities is important to eliminate disease disparities. Adult type 2 diabetes prevalence in the US territory of American Samoa is 21.5%, but little intervention research has been carried out there. We discuss our experience with cultural translation, drawing on an emerging implementation science, which aims to build a knowledge base on adapting interventions to real-world settings. We offer examples from our behavioral intervention study, Diabetes Care in American Samoa, which was adapted from Project Sugar 2, a nurse and community health worker intervention to support diabetes self-management among urban African Americans. The challenges we experienced and solutions we used may inform adaptations of interventions in other settings.

Stress and how individuals cope with it can have substantial implications for health. As the socio-cultural environment influences individual perceptions of stress and coping behavior, differences between cultural groups may have different effects on physical and mental health. Using qualitative interviews and questionnaires, this study examined cultural differences in stress coping and their interplay with perceived stress (Perceived Stress Questionnaire, Trier Inventory for Chronic Stress), BMI (normal-weight, obesity), and depressive symptoms (Beck Depression Inventory Short Form) in young adults from Germany (individualistic society, n  = 120) and American Samoa (collectivistic society, n  = 56). Stress coping strategies were assessed through interviews, after which the data were quantified as problem-focused, emotion-focused, or avoidance coping. Group differences in coping strategies were analyzed using Gamma generalized linear models, group differences in perceived stress and depressive symptoms were analyzed using univariate ANCOVAs. The results showed that the German group used more problem-focused coping, while the Samoan group used more avoidance coping. The use of avoidance coping was associated with higher perceived stress in the German group but with lower perceived stress in the Samoan group. In general, depressive symptoms were higher among participants from the Samoan than the German group. However, Samoan individuals with obesity who used avoidance coping had lower depressive symptoms than Samoan individuals with obesity who did not. This difference was not observed in the German group. Irrespective of cultural background, individuals with obesity tended to use more avoidance and less emotion-focused coping, and to report eating more during stress compared to individuals with normal-weight. On the one hand, our findings may contribute to a better understanding of how the cultural environment influences stress coping and its potential adaptive effects on perceived stress and depressive symptoms, highlighting the need for culturally appropriate stress management interventions. On the other hand, the association between weight status and avoidance coping might be relatively stable across cultures, offering opportunities for intervention.

This study presents a modeling framework for quantifying human impacts and for partitioning the sources of contamination related to water quality in the mixed-use landscape of a small tropical volcanic island. On Tutuila, the main island of American Samoa, production wells in the most populated region (the Tafuna-Leone Plain) produce most of the island’s drinking water. However, much of this water has been deemed unsafe to drink since 2009. Tutuila has three predominant anthropogenic non-point-groundwater-pollution sources of concern: on-site disposal systems (OSDS), agricultural chemicals, and pig manure. These sources are broadly distributed throughout the landscape and are located near many drinking-water wells. Water quality analyses show a link between elevated levels of total dissolved groundwater nitrogen (TN) and areas with high non-point-source pollution density, suggesting that TN can be used as a tracer of groundwater contamination from these sources. The modeling framework used in this study integrates land-use information, hydrological data, and water quality analyses with nitrogen loading and transport models. The approach utilizes a numerical groundwater flow model, a nitrogen-loading model, and a multi-species contaminant transport model. Nitrogen from each source is modeled as an independent component in order to trace the impact from individual land-use activities. Model results are calibrated and validated with dissolved groundwater TN concentrations and inorganic δ 15 N values, respectively. Results indicate that OSDS contribute significantly more TN to Tutuila’s aquifers than other sources, and thus should be prioritized in future water-quality management efforts.

Background As obesity has increased worldwide, so have levels of obesity during pregnancy and excess gestational weight gain (GWG). The aim of this paper was to describe GWG among American Samoan women and examine 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. Methods Data were extracted from prenatal care records of 632 Samoan women. Mixed-effects growth models were used to produce individual weight-for-gestational week curves from which second and third trimester weight gain was estimated. Binary logistic regression was used to examine associations between GWG and the outcomes of interest. Results Most women were overweight/obese in early pregnancy (86%) and 78% exceeded the Institute of Medicine GWG guidelines. Greater GWG in the second trimester and early pregnancy weight were independently associated with increased odds of a c-section (OR 1.40 [95% CI: 1.08, 1.83]) and OR 1.51 [95% CI: 1.17, 1.95], respectively). Risk of delivering a LGA infant increased with greater third trimester weight gain and higher early pregnancy weight, while second trimester weight gain was negatively associated with SGA. Risk of infant overweight/obesity at 12 months increased with early pregnancy weight (OR: 1.23 [95% CI: 1.01, 1.51]) and infant birthweight. Conclusions The high levels of pregnancy obesity and excessive GWG in American Samoa suggest that it is important for physicians to 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.

Ecological restoration of forests, meadows, reefs, or other foundational ecosystems during climate change depends on the discovery and use of individuals able to withstand future conditions. For coral reefs, climate-tolerant corals might not remain tolerant in different environments because of widespread environmental adjustment of coral physiology and symbionts. Here, we test if parent corals retain their heat tolerance in nursery settings, if simple proxies predict successful colonies, and if heat-tolerant corals suffer lower growth or survival in normal settings. Before the 2015 natural bleaching event in American Samoa, we set out 800 coral fragments from 80 colonies of four species selected by prior tests to have a range of intraspecific natural heat tolerance. After the event, nursery stock from heat-tolerant parents showed two to three times less bleaching across species than nursery stock from less tolerant parents. They also retained higher individual genetic diversity through the bleaching event than did less heat-tolerant corals. The three best proxies for thermal tolerance were response to experimental heat stress, location on the reef, and thermal microclimate. Molecular biomarkers were also predictive but were highly species specific. Colony geno-type and symbiont genus played a similarly strong role in predicting bleaching. Combined, our results show that selecting for host and symbiont resilience produced a multispecies coral nursery that withstood multiple bleaching events, that proxies for thermal tolerance in restoration can work across species and be inexpensive, and that different coral clones within species reacted very differently to bleaching.

Since the 1970s, Samoan participation in American gridiron football has grown exponentially. In American Sāmoa (and other transpacific Samoan communities), football has come to represent both a real and imagined \"way out\" of what appears to many as a strangled field of possibility. The visibility and vibrancy of football in American Sāmoa is rooted in Samoan histories of migration to the United States, Samoan cultural sensibilities, the changing market of the American football industry, and narrowing economic opportunities. The transnational nature of football migration is key to understanding the appeal of playing football, the rewards that accrue to successful players, and how these resources have continued to transform conditions of possibility (materially and ideologically) for young people in the islands. This article explores the layered and complex motivations for football participation as shaped by prospective forms of capital, transnational sporting institutions, and historical contingency. Focused on history, economy, and a transformed vision of the future, it offers a critical genealogy of football in (American) Sāmoa and Samoans in football.

As climate change poses an ever increasing threat to coral reefs globally, understanding why particular corals are resistant to bleaching is paramount to their continued survival. The coral reefs of Ofu Island, American Samoa, provide a living laboratory to examine mechanisms of coral adaptation to extreme thermal conditions and serve as an analog for a future environment impacted by climate change. Three backreef pools exhibit remarkably different temperature regimes, which consequently results in varying levels of coral thermal tolerance. In pool 300, temperatures can reach 35 °C and fluctuate up to 6 °C throughout the day. Pools 400 and 500 are less variable, with temperatures rarely exceeding 32 °C. Yet, the pools contain a highly diverse community of corals, including an abundance of thermally sensitive species. This review summarizes the results of nearly two decades of research into the mechanisms contributing to differential bleaching resistance among pools. Factors examined include the effects of intermittent water flow, previous exposure to subbleaching temperatures, Symbiodinium genotype, modifications of genetic expression within the polyp, and the associated bacterial microbiome. Corals within the highly variable pool 300 appear to be more adequately adapted to thermal extremes by retaining chlorophyll concentrations during frequent heat pulses, associating with thermally tolerant endosymbionts, upregulating gene expression associated with heat acclimatization, and potentially possessing an advantageous microbiome composition. Though encompassing a small geographic area, the findings from Ofu’s reefs have widespread implications for coral conservation as they serve to elucidate the impacts of these many confounding factors and their contributions to bleaching resistance.

By contrast, the World Bank lists the Independent State of Samoa as a low TB incidence jurisdiction with a reported TB incidence rate of 6.8 in 2021, comparable to that of New Zealand. Unlike the common rectangular domiciliary and institutional structures found in other Pacific Island groups and introduced to the Samoan Islands by the Europeans in the 19th century, often with airtight or insulated building shells, the traditional fale both lacking walls and being buffeted consistently by wind would provide housing space that was naturally ventilated and cooled. Recent World Health Organization estimates for the many Pacific Island jurisdictions show a wide range of TB incidence, no doubt the results of a multiplicity of factors; however, few Pacific Island jurisdictions report low TB incidence rates comparable to those of the Samoas (e.g., Tonga and the Cook Islands, both of which have near omnipresent wind similar to that in the Samoas and traditionally have had open and airy domestic architecture made of bamboo, wood, and palm fronds, with walls often omitted to enable easy passage of the trade winds in an extremely humid environment). The combination of trade winds and relatively wall-less domestic architecture has been by no means the sole contributor to the lower rates of TB in the Samoas compared with Pacific Island groups elsewhere in Polynesia and in Micronesia and Melanesia, which have differing environmental conditions, demographics, and traditional architecture that more customarily had a greater presence of walls.