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Article ; Online: Early maturity, shortened stature, and hardship: Can life-history trade-offs indicate social stratification and income inequality in the United States?

Rivara, Anna C / Madrigal, Lorena

American journal of human biology : the official journal of the Human Biology Council

2019 Volume 31, Issue 5, Page(s) e23283

Abstract: Objective: Life-history strategies promote reproductive fitness and survival. Limited energy availability and competing energetic demands between life-history decisions may result in organismal trade-offs leading to selection for "optimal" traits that ... ...

Abstract	Objective: Life-history strategies promote reproductive fitness and survival. Limited energy availability and competing energetic demands between life-history decisions may result in organismal trade-offs leading to selection for "optimal" traits that facilitate fitness and survival in present environmental conditions. Few life-history analyses have been conducted in food abundant/high resource human populations. Here, we use a life-history theory framework integrated with a biocultural approach to assess whether trade-offs between growth (height) and the onset of reproductive maturation (ages at menarche) were observed in a sample of adult women living in the United States. Methods: Adult women (18 years and older) from the National Health and Nutrition Examination Survey (NHANES) 2005 to 2006 were analyzed using complex survey regression to evaluate associations between ages at menarche, height, and biological, socio-economic, demographic, and anthropometric variables. Associations between stature, ages at menarche, and socio-economic status (household income and education level) suggest life-history trade-offs in this populations may be mitigated by access to resources and marginalization. Conclusions: These study results have applied public health implications. We demonstrate that females who experience early menarche in the US population achieve short stature. Our study also demonstrates the need for implementing life-history analyses in Western affluent populations, where marginalization may result in life-history trade-offs.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Anthropometry ; Body Height ; Female ; Humans ; Life History Traits ; Menarche ; Middle Aged ; Nutrition Surveys ; Reproduction ; Socioeconomic Factors ; United States ; Young Adult
Language	English
Publishing date	2019-07-03
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	1025339-7
ISSN	1520-6300 ; 1042-0533
ISSN (online)	1520-6300
ISSN	1042-0533
DOI	10.1002/ajhb.23283
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Article ; Online: Identifying patient preferences for diabetes care: A protocol for implementing a discrete choice experiment in Samoa.

Rivara, Anna C / Galárraga, Omar / Selu, Melania / Arorae, Maria / Wang, Ruiyan / Faasalele-Savusa, Kima / Rosen, Rochelle / Hawley, Nicola L / Viali, Satupaitea

PloS one

2023 Volume 18, Issue 12, Page(s) e0295845

Abstract: In Samoa, adult Type 2 diabetes prevalence has increased within the past 30 years. Patient preferences for care are factors known to influence treatment adherence and are associated with reduced disease progression and severity. However, patient ... ...

Abstract	In Samoa, adult Type 2 diabetes prevalence has increased within the past 30 years. Patient preferences for care are factors known to influence treatment adherence and are associated with reduced disease progression and severity. However, patient preferences for diabetes care, generally, are understudied, and other patient-centered factors such as willingness-to-pay (WTP) for diabetes treatment have never been explored in this setting. Discrete Choice Experiments (DCE) are useful tools to elicit preferences and WTP for healthcare. DCEs present patients with hypothetical scenarios composed of a series of multi-alternative choice profiles made up of attributes and levels. Patients choose a profile based on which attributes and levels may be preferable for them, thereby quantifying and identifying locally relevant patient-centered preferences. This paper presents the protocol for the design, piloting, and implementation of a DCE identifying patient preferences for diabetes care, in Samoa. Using an exploratory sequential mixed methods design, formative data from a literature review and semi-structured interviews with n = 20 Samoan adults living with Type 2 diabetes was used to design a Best-Best DCE instrument. Experimental design procedures were used to reduce the number of choice-sets and balance the instrument. Following pilot testing, the DCE is being administered to n = 450 Samoan adults living with diabetes, along with associated questionnaires, and anthropometrics. Subsequently, we will also be assessing longitudinally how preferences for care change over time. Data will be analyzed using progressive mixed Rank Order Logit models. The results will identify which diabetes care attributes are important to patients (p < 0.05), examine associations between participant characteristics and preference, illuminate the trade-offs participants are willing to make, and the probability of uptake, and WTP for specific attributes and levels. The results from this study will provide integral data useful for designing and adapting efficacious diabetes intervention and treatment approaches in this setting.
MeSH term(s)	Adult ; Humans ; Patient Preference ; Diabetes Mellitus, Type 2/therapy ; Surveys and Questionnaires ; Logistic Models ; Samoa ; Choice Behavior ; Review Literature as Topic
Language	English
Publishing date	2023-12-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0295845
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Article ; Online: Pregnancy and immune stimulation: re-imagining the fetus as parasite to understand age-related immune system changes in US women.

Rivara, Anna C / Miller, Elizabeth M

American journal of human biology : the official journal of the Human Biology Council

2017 Volume 29, Issue 6

Abstract: Objectives: Pregnancy can increase production of Immunoglobulin E (IgE), an immune response more often directed towards parasite infections. An absence of parasitism makes the US population ideal to test the hypothesis that the maternal immune system ... ...

Abstract	Objectives: Pregnancy can increase production of Immunoglobulin E (IgE), an immune response more often directed towards parasite infections. An absence of parasitism makes the US population ideal to test the hypothesis that the maternal immune system recognizes a fetus as a parasite. We predict that total IgE levels are positively associated with a history of pregnancy across all ages of adult women, mirroring patterns of IgE in parasitized populations. Methods: Reproductive-aged women (n = 2201) from the National Health and Nutrition Examination Survey 2005-2006 were analyzed in a cross-sectional design using complex survey regression and multiple imputation to evaluate associations between total IgE levels, pregnancy history, and interactions between age and pregnancy. Results: Women with a history of pregnancy have significantly higher IgE levels and a significantly shallower slope of IgE levels across ages (P = .031). Conclusions: This research supports the hypothesis that maternal immune systems respond to prior pregnancies as they do to macro-parasitic exposures, and may modify the expected linear declines of IgE levels in women that accompanies aging. These finding have implications for understanding the evolution of internal gestation in mammals.
Language	English
Publishing date	2017-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	1025339-7
ISSN	1520-6300 ; 1042-0533
ISSN (online)	1520-6300
ISSN	1042-0533
DOI	10.1002/ajhb.23041
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Article ; Online: Indication of mixed glucose and fatty acid use by inferred brown adipose tissue activity in Samoans.

Niclou, Alexandra / Vesi, Lupesina / Arorae, Maria / Naseri, New Caledonia / Savusa, Kima Faasalele / Naseri, Take / Young, Jessica / Rivara, Anna C / Ocobock, Cara

American journal of human biology : the official journal of the Human Biology Council

2023 Volume 36, Issue 3, Page(s) e23998

Abstract: Objectives: Despite the growing rates of global obesity and the known positive associations between brown adipose tissue (BAT) and cardiovascular health, little is known about the metabolic effects of BAT activity in Samoans, a population at high risk ... ...

Abstract	Objectives: Despite the growing rates of global obesity and the known positive associations between brown adipose tissue (BAT) and cardiovascular health, little is known about the metabolic effects of BAT activity in Samoans, a population at high risk of obesity and type II diabetes. Here we assessed the potential effects of inferred BAT activity on metabolic health markers in Samoan adults exposed to mild cold. Methods: Using point-of-care finger prick technology we measured fasting glucose, total cholesterol, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) levels before and after 30 min of cold exposure among 61 individuals (38 females, 23 males, ages 31-54) from 'Upolu Island, Samoa. Respiratory quotient was measured by indirect calorimetry to determine substrate metabolism at room temperature and cold exposure. Results: Fasting glucose levels decreased significantly (p < .001) after cold exposure while neither total cholesterol (p = .88), HDL (p = .312), nor LDL (p = .089) changed. Respiratory quotient decreased significantly (p = .009) between exposures, suggesting an increased preference for lipid metabolism as a response to cold. Conclusions: The observed effects of inferred BAT activity on biomarkers suggest BAT activity utilizes both glucose and lipid-derived fatty acids as fuel for thermogenesis. Our work provides evidence for the beneficial metabolic effects of BAT and emphasizes the need for the population-specific development of metabolic treatments involving BAT to ensure the successful and equitable minimization of extreme consequences of obesity and metabolic health.
MeSH term(s)	Adult ; Female ; Humans ; Male ; Adipose Tissue, Brown/physiology ; Cholesterol ; Cold Temperature ; Diabetes Mellitus, Type 2 ; Energy Metabolism ; Fatty Acids/metabolism ; Fatty Acids/pharmacology ; Glucose/metabolism ; Glucose/pharmacology ; Obesity ; Pacific Island People ; Thermogenesis ; Middle Aged
Chemical Substances	Cholesterol (97C5T2UQ7J) ; Fatty Acids ; Glucose (IY9XDZ35W2)
Language	English
Publishing date	2023-10-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	1025339-7
ISSN	1520-6300 ; 1042-0533
ISSN (online)	1520-6300
ISSN	1042-0533
DOI	10.1002/ajhb.23998
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Article ; Online: Accelerometer-Based Estimates of Physical Activity and Sedentary Time Among Samoan Adults.

Hawley, Nicola L / Zarei, Parmida / Crouter, Scott E / Desai, Mayur M / Pomer, Alysa / Rivara, Anna C / Naseri, Take / Reupena, Muagututia Sefuiva / Viali, Satupaitea / Duckham, Rachel L / McGarvey, Stephen T

Journal of physical activity & health

2024 , Page(s) 1–9

Abstract: Background: The prevalence of obesity-related cardiometabolic disease in Samoa is among the highest globally. While physical activity is a modifiable risk factor for obesity-related disease, little is known about physical activity levels among adult ... ...

Abstract	Background: The prevalence of obesity-related cardiometabolic disease in Samoa is among the highest globally. While physical activity is a modifiable risk factor for obesity-related disease, little is known about physical activity levels among adult Samoans. Using wrist-worn accelerometer-based devices, this study aimed to characterize physical activity among Samoan adults. Methods: Samoan adults (n = 385; 55% female, mean [SD] age 52 [10] y) wore Actigraph GT3X+ devices for 7 to 10 days. General linear models were used to examine mean daily minutes of sedentary time, light physical activity, and moderate to vigorous physical activity by various participant characteristics. Results: Time spent in moderate to vigorous physical activity did not differ statistically between men (88 [5] min; 95% confidence interval [CI], 80-97) and women (78 [4] min; 95% CI, 70-86; P = .08). Women, however, spent more time than men in light physical activity: 380 (7) minutes (95% CI, 367-393) versus 344 (7) minutes (95% CI, 329-358; P < .001). While there were no differences in physical activity by census region, education, or occupation among women, men in urban areas spent significantly less time in moderate to vigorous physical activity than those in peri-urban and rural areas (P = .015). Women with class II/III obesity spent more time in sedentary activities than those with healthy weight or overweight/class I obesity (P = .048). Conclusions: This study characterizes physical activity among Samoan adults and highlights variation by sex, urbanicity, and weight status. In providing initial device-measured estimates of physical activity in Samoa, this analysis establishes a baseline from which the success of future attempts to intervene on physical activity may be assessed.
Language	English
Publishing date	2024-04-15
Publishing country	United States
Document type	Journal Article
ISSN	1543-5474
ISSN (online)	1543-5474
DOI	10.1123/jpah.2023-0590
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Article ; Online: When the cold gets under your skin: Evidence for brown adipose tissue activity in Samoan adults.

Niclou, Alexandra / Vesi, Lupesina / Arorae, Maria / Naseri, New Caledonia / Faasalele Savusa, Kima / Naseri, Take / DeLany, James P / McGarvey, Stephen T / Rivara, Anna C / Ocobock, Cara

American journal of biological anthropology

2023 Volume 183, Issue 2, Page(s) e24848

Abstract: Objectives: Brown adipose tissue (BAT) is a heat-producing organ aiding nonshivering thermogenesis (NST) during cold stress. Due to its potential cold-adaptive role BAT has been predominantly studied in cold and temperate climate populations, but not ... ...

Abstract	Objectives: Brown adipose tissue (BAT) is a heat-producing organ aiding nonshivering thermogenesis (NST) during cold stress. Due to its potential cold-adaptive role BAT has been predominantly studied in cold and temperate climate populations, but not among warm-climate adults. This work explores if BAT activity can be inferred in Samoans. Materials and methods: We inferred BAT activity by comparing metabolic rate and surface heat dissipation using indirect calorimetry and thermal imaging between room temperature and cold exposure among Samoans (N = 61, females: n = 38) from 'Upolu Island, Samoa. BAT activity was inferred using ANOVA linear regression models with the variables measured at cold exposure as outcomes. T-tests were used to compare changes in surface temperature between room temperature and cold exposure. Results: Metabolic rate significantly increased after cooling. In both the supraclavicular area, a known BAT location, and the sternum, a non-BAT location, temperatures decreased significantly upon cold exposure. Differences in supraclavicular temperatures between room temperature and cold were significantly smaller than differences in sternum temperatures between exposures. These results suggest that BAT thermogenesis occurred in known BAT-locations and thus contributed to NST during cooling. Conclusions: This study adds to our understanding of BAT activity across different populations and climates. Further study may illuminate whether the cold-adaptive properties of BAT may have played a role in the successful expansion of populations across the globe, including warm-climate groups.
MeSH term(s)	Adult ; Female ; Humans ; Adipose Tissue, Brown/metabolism ; Body Temperature Regulation ; Cold Temperature ; Pacific Island People ; Thermogenesis ; Male
Language	English
Publishing date	2023-09-23
Publishing country	United States
Document type	Journal Article
ISSN	2692-7691
ISSN (online)	2692-7691
DOI	10.1002/ajpa.24848
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Article ; Online: Association between age at menarche and cardiometabolic risk among Samoan adults.

Oyama, Sakurako / Duckham, Rachel L / Pomer, Alysa / Rivara, Anna C / Kershaw, Erin E / Wood, Ashlee / Fidow, Ulai T / Naseri, Take / Reupena, Muagututia S / Viali, Satupaitea / McGarvey, Stephen T / Hawley, Nicola L

American journal of human biology : the official journal of the Human Biology Council

2023 Volume 36, Issue 1, Page(s) e23982

Abstract: Objectives: Recent studies suggest that early menarche may increase cardiometabolic morbidity and mortality. Yet few studies have examined this association in the Pacific Islands, where obesity prevalence is among the highest globally. We sought to ... ...

Abstract	Objectives: Recent studies suggest that early menarche may increase cardiometabolic morbidity and mortality. Yet few studies have examined this association in the Pacific Islands, where obesity prevalence is among the highest globally. We sought to examine associations between age at menarche and cardiometabolic risk in Samoa. Methods: Participants were from the Soifua Manuia study (n = 285, age 32-72 years) conducted in Samoa from 2017 to 2019. Logistic regressions were conducted to estimate odds of obesity, hypertension, diabetes, dyslipidemia, and metabolic syndrome per one-year increase in age at menarche. Linear regressions were conducted to examine associations between age at menarche and continuous measures of adiposity, blood pressure, insulin resistance, and serum lipids. Results: Median age at menarche was 14 years (IQR = 2). After controlling for relevant covariates, each one-year increase in age at menarche was associated with a 15% decrease (OR = 0.85, 95% CI: 0.72-1.01, p = .067) in odds of hypertension, but a 21% increase (OR = 1.21, 95% CI: 1.01-1.45, p = .044) in odds of diabetes and 18% increase (OR = 1.18, 95% CI: 0.98-1.42, p = .081) in odds of high total cholesterol. Each additional year in age at menarche was associated with a 1.60 ± 0.52 kg (p = .002) decrease in lean mass and 1.56 ± 0.51 kg (p = .003) decrease in fat-free mass. Conclusions: Associations between age at menarche and cardiometabolic risk may be population-specific and are likely influenced by both current and historical nutritional and epidemiological contexts. Prospective studies are needed to clarify the role of childhood adiposity and other early life exposures on age at menarche and subsequent cardiometabolic risk.
MeSH term(s)	Adult ; Female ; Humans ; Child, Preschool ; Middle Aged ; Aged ; Menarche/physiology ; Risk Factors ; Body Mass Index ; Age Factors ; Pediatric Obesity ; Hypertension/epidemiology ; Hypertension/etiology ; Diabetes Mellitus ; Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/etiology
Language	English
Publishing date	2023-09-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	1025339-7
ISSN	1520-6300 ; 1042-0533
ISSN (online)	1520-6300
ISSN	1042-0533
DOI	10.1002/ajhb.23982
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Article ; Online: Persistence of anaemia among Samoan preschool age children: a longitudinal study.

Wu, Bohao / Choy, Courtney C / Rivara, Anna C / Soti-Ulberg, Christina / Naseri, Take / Reupena, Muagututia S / Duckham, Rachel L / Hawley, Nicola L

Public health nutrition

2021 Volume 24, Issue 18, Page(s) 5995–6006

Abstract: Objective: To characterise the prevalence and persistence of anaemia among Samoan children over a 2-3-year period.: Design: Data were from two consecutive waves (2015 and 2017-2018) of the Ola Tuputupua'e 'Growing up' study. Anaemia (Hb < 11·0 or 11· ... ...

Abstract	Objective: To characterise the prevalence and persistence of anaemia among Samoan children over a 2-3-year period. Design: Data were from two consecutive waves (2015 and 2017-2018) of the Ola Tuputupua'e 'Growing up' study. Anaemia (Hb < 11·0 or 11·5 g/dl for 2-4 and ≥ 5 years old, respectively) was considered 'transient' when it occurred at only one wave or 'persistent' if it was present at two consecutive waves. Child, maternal and household correlates of anaemia were examined using log-binomial and modified Poisson regressions. Setting: Eleven Samoan villages. Participants: Mother-child pairs (n 257) recruited in 2015 and reassessed in 2017-2018. Results: Anaemia prevalence was 33·9 % in 2015 and 28·0 % in 2017-2018; 35·6 % of cases identified in 2015 were persistent. Risk of anaemia at only one wave was lower among children who were older in 2015 (age 4 v. 2 years, adjusted relative risk (aRR) = 0·54, (95 % CI 0·35, 0·84), P = 0·007), had older mothers (≥ 40 v. 18-29 years, aRR = 0·61, (95 % CI 0·39, 0·95), P = 0·029) and had higher daily sodium intake (for every 100 mg/d, aRR = 0·97, (95 % CI 0·95, 0·99), P = 0·003) than children with no anaemia. Children whose anaemia persisted were more likely to have had a mother with anaemia (aRR = 2·13, (95 % CI 1·17, 3·89), P = 0·013) and had higher daily dietary iron intake (for every 10 mg/d, aRR = 4·69, (95 % CI 1·33, 16·49), P = 0·016) than those with no anaemia. Conclusions: Alongside broadly targeted prevention efforts, which are warranted given the moderate-high anaemia prevalence observed, specific attention should be paid to children with risk factors for persistent anaemia. Routine screening of children whose mothers have anaemia should be encouraged.
MeSH term(s)	Anemia/epidemiology ; Attention ; Child, Preschool ; Cross-Sectional Studies ; Female ; Humans ; Longitudinal Studies ; Nutritional Status ; Prevalence ; Risk Factors
Language	English
Publishing date	2021-09-15
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	1436024-x
ISSN	1475-2727 ; 1368-9800
ISSN (online)	1475-2727
ISSN	1368-9800
DOI	10.1017/S1368980021003980
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Article: Persistence of anaemia among Samoan preschool age children: a longitudinal study

Wu, Bohao / Choy, Courtney C / Rivara, Anna C / Soti-Ulberg, Christina / Naseri, Take / Reupena, Muagututia S / Duckham, Rachel L / Hawley, Nicola L

Public health nutrition. 2021 Dec., v. 24, no. 18

2021

Abstract: To characterise the prevalence and persistence of anaemia among Samoan children over a 2–3-year period. Data were from two consecutive waves (2015 and 2017–2018) of the Ola Tuputupua’e ‘Growing up’ study. Anaemia (Hb < 11·0 or 11·5 g/dl for 2–4 and ≥ 5 ... ...

Abstract	To characterise the prevalence and persistence of anaemia among Samoan children over a 2–3-year period. Data were from two consecutive waves (2015 and 2017–2018) of the Ola Tuputupua’e ‘Growing up’ study. Anaemia (Hb < 11·0 or 11·5 g/dl for 2–4 and ≥ 5 years old, respectively) was considered ‘transient’ when it occurred at only one wave or ‘persistent’ if it was present at two consecutive waves. Child, maternal and household correlates of anaemia were examined using log-binomial and modified Poisson regressions. Eleven Samoan villages. Mother–child pairs (n 257) recruited in 2015 and reassessed in 2017–2018. Anaemia prevalence was 33·9 % in 2015 and 28·0 % in 2017–2018; 35·6 % of cases identified in 2015 were persistent. Risk of anaemia at only one wave was lower among children who were older in 2015 (age 4 v. 2 years, adjusted relative risk (aRR) = 0·54, (95 % CI 0·35, 0·84), P = 0·007), had older mothers (≥ 40 v. 18–29 years, aRR = 0·61, (95 % CI 0·39, 0·95), P = 0·029) and had higher daily sodium intake (for every 100 mg/d, aRR = 0·97, (95 % CI 0·95, 0·99), P = 0·003) than children with no anaemia. Children whose anaemia persisted were more likely to have had a mother with anaemia (aRR = 2·13, (95 % CI 1·17, 3·89), P = 0·013) and had higher daily dietary iron intake (for every 10 mg/d, aRR = 4·69, (95 % CI 1·33, 16·49), P = 0·016) than those with no anaemia. Alongside broadly targeted prevention efforts, which are warranted given the moderate-high anaemia prevalence observed, specific attention should be paid to children with risk factors for persistent anaemia. Routine screening of children whose mothers have anaemia should be encouraged.
Keywords	anemia ; children ; longitudinal studies ; nutrition ; public health ; relative risk ; sodium
Language	English
Dates of publication	2021-12
Size	p. 5995-6006.
Publishing place	Cambridge University Press
Document type	Article
ZDB-ID	1436024-x
ISSN	1475-2727 ; 1368-9800
ISSN (online)	1475-2727
ISSN	1368-9800
DOI	10.1017/S1368980021003980
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: Protocol: Implementation and evaluation of an adolescent-mediated intervention to improve glycemic control and diabetes self-management among Samoan adults.

Hawley, Nicola L / Rivara, Anna C / Naseri, Joshua / Faumuina, Kitiona / Potoa'e-Solaita, Noelle / Iopu, Francine / Faiai, Mata'uitafa / Naveno, Eminoni / Tasele, Susie / Lefale, Temukisa / Lantini, Ryan / Carlson, Jenna C / Rabin, Tracy L / Semaia, Penny / Mugadza, Phyllis / Rosen, Rochelle K

PloS one

2023 Volume 18, Issue 2, Page(s) e0279084

Abstract: Background: Diagnoses of Type 2 Diabetes in the United States have more than doubled in the last two decades. One minority group at disproportionate risk are Pacific Islanders who face numerous barriers to prevention and self-care. To address the need ... ...

Abstract	Background: Diagnoses of Type 2 Diabetes in the United States have more than doubled in the last two decades. One minority group at disproportionate risk are Pacific Islanders who face numerous barriers to prevention and self-care. To address the need for prevention and treatment in this group, and building on the family-centered culture, we will pilot test an adolescent-mediated intervention designed to improve the glycemic control and self-care practices of a paired adult family member with diagnosed diabetes. Methods: We will conduct a randomized controlled trial in American Samoa among n = 160 dyads (adolescent without diabetes, adult with diabetes). Adolescents will receive either a six-month diabetes intervention or a leadership and life skills-focused control curriculum. Aside from research assessments we will have no contact with the adults in the dyad who will proceed with their usual care. To test our hypothesis that adolescents will be effective conduits of diabetes knowledge and will support their paired adult in the adoption of self-care strategies, our primary efficacy outcomes will be adult glycemic control and cardiovascular risk factors (BMI, blood pressure, waist circumference). Secondarily, since we believe exposure to the intervention may encourage positive behavior change in the adolescent themselves, we will measure the same outcomes in adolescents. Outcomes will be measured at baseline, after active intervention (six months post-randomization) and at 12-months post-randomization to examine maintenance effects. To determine potential for sustainability and scale up, we will examine intervention acceptability, feasibility, fidelity, reach, and cost. Discussion: This study will explore Samoan adolescents' ability to act as agents of familial health behavior change. Intervention success would produce a scalable program with potential for replication in other family-centered ethnic minority groups across the US who are the ideal beneficiaries of innovations to reduce chronic disease risk and eliminate health disparities.
MeSH term(s)	Adult ; Adolescent ; Humans ; Diabetes Mellitus, Type 2/therapy ; Diabetes Mellitus, Type 2/diagnosis ; Self-Management ; Glycemic Control ; Ethnicity ; Minority Groups ; Health Behavior ; Randomized Controlled Trials as Topic
Language	English
Publishing date	2023-02-16
Publishing country	United States
Document type	Clinical Trial Protocol ; Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0279084
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In stock of ZB MED Bonn / Germany

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In stock of ZB MED Bonn / Germany

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Inter-library loan at ZB MED

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Order via subito