Maternal and Child Health Journal

, Volume 18, Issue 10, pp 2261-2274

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

A Community Engagement Process Identifies Environmental Priorities to Prevent Early Childhood Obesity: The Children’s Healthy Living (CHL) Program for Remote Underserved Populations in the US Affiliated Pacific Islands, Hawaii and Alaska

  • Marie Kainoa FialkowskiAffiliated withUniversity of Hawai‘i at Manoa Email author 
  • , Barbara DeBarysheAffiliated withUniversity of Hawai‘i at Manoa
  • , Andrea BersaminAffiliated withUniversity of Alaska at Fairbanks
  • , Claudio NiggAffiliated withUniversity of Hawai‘i at Manoa
  • , Rachael Leon GuerreroAffiliated withUniversity of Guam
  • , Gena RojasAffiliated withUniversity of Guam
  • , Aufa’i Apulu Ropeti AretaAffiliated withAmerican Samoa Community College
  • , Agnes VargoAffiliated withAmerican Samoa Community College
  • , Tayna Belyeu-CamachoAffiliated withNorthern Marianas College
    • , Rose CastroAffiliated withNorthern Marianas College
    • , Bret LuickAffiliated withUniversity of Alaska at Fairbanks
    • , Rachel NovotnyAffiliated withUniversity of Hawai‘i at Manoa
    • , the CHL Team


Underserved minority populations in the US Affiliated Pacific Islands (USAPI), Hawaii, and Alaska display disproportionate rates of childhood obesity. The region’s unique circumstance should be taken into account when designing obesity prevention interventions. The purpose of this paper is to (a), describe the community engagement process (CEP) used by the Children’s Healthy Living (CHL) Program for remote underserved minority populations in the USAPI, Hawaii, and Alaska (b) report community-identified priorities for an environmental intervention addressing early childhood (ages 2–8 years) obesity, and (c) share lessons learned in the CEP. Four communities in each of five CHL jurisdictions (Alaska, American Samoa, Commonwealth of the Northern Mariana Islands, Guam, Hawai‘i) were selected to participate in the community-randomized matched-pair trial. Over 900 community members including parents, teachers, and community leaders participated in the CEP over a 14 month period. The CEP was used to identify environmental intervention priorities to address six behavioral outcomes: increasing fruit/vegetable consumption, water intake, physical activity and sleep; and decreasing screen time and intake of sugar sweetened beverages. Community members were engaged through Local Advisory Committees, key informant interviews and participatory community meetings. Community-identified priorities centered on policy development; role modeling; enhancing access to healthy food, clean water, and physical activity venues; and healthy living education. Through the CEP, CHL identified culturally appropriate priorities for intervention that were also consistent with the literature on effective obesity prevention practices. Results of the CEP will guide the CHL intervention design and implementation. The CHL CEP may serve as a model for other underserved minority island populations.


Early childhood Obesity prevention Community-based Pacific Environment