The Children’s Healthy Living Program for Remote Underserved Minority Populations in the Pacific Region Network (CHLN) Multistate is a partnership among remote Pacific states and other jurisdictions of the US: Alaska, Arizona, American Samoa, the Commonwealth of the Northern Mariana Islands (CNMI), Guam, Federated States of Micronesia (FSM), Hawai‘i, Republic of Palau, the Republic of the Marshall Islands (RMI), Tennessee, Texas and West Virginia. All CHLN partners are connected via the US Land Grant College system and an interest in addressing the health status of indigenous populations and those living in rural communities. CHLN partners, inclusive of land grant colleges and public health partners, share a purpose to build capacity to address relevant health issues through research, training and extension. These partnerships aim to affect policies, systems and environments that affect health and are explicitly called for in the Make Our Children Healthy Again Report (2025). The goal of the CHLN is to develop social/cultural, physical/built, and political/economic environments that will promote active play and intake of healthy food to prevent young child obesity in the Pacific Region. To do this, CHL engages the community, and focuses on capacity building and sustainable environmental change.

The Pacific region has some of the highest rates of non-communicable disease in the world. The Marshall Islands and American Samoa are in the top ten for diabetes prevalence in the world (23.0% and 20.3%, respectively, Magliano 2021). Diabetes, heart diseases, stroke, cancers and other non-communicable diseases are affecting Pacific peoples at a disproportionate rate compared to other populations, placing a significant burden on their daily functionality, and threatening the national security of these island countries and territories (PIHOA 2010). All of these conditions have a primary common factor: obesity. The number of adults with obesity is among the highest in the world in these countries, ranging from 72.5%(RMI) to 93.5% (American Samoa) in adults (PIHOA 2018). Pacific lifestyles continue to transition from native crops to imported foods, and from active forms of work and play to sedentary ones, as in most of the world (World Health Organization, 2015). These populations face a dual burden of food insecurity and obesity, where estimates of nearly half of children sampled by the CHL research program on Guam were living in households who lacked sufficient food or resources to feed the household (Li et al, 2016). 

Data are limited on children of the region. Obesity in children is an important determinant of obesity in adulthood. CHL has been successful in collecting data on child growth in the region, where 30% of children in the CHL sample suffered from overweight or obesity (Li et al, 2016). Children with obesity have a higher chance of developing obesity, premature death and disability in adulthood. Children with obesity have breathing difficulties, increased risk of fractures, hypertension, early markers of cardiovascular disease, insulin resistance and psychological effects. Contributors to obesity occur across the life course and include both early undernutrition and nutrition excess. Obesity is associated with social and health problems. Prevention is the best long-term solution.

This multistate project continues to support and extend the CHL network's training, intervention activities and research programs initiated through CHL, which has demonstrated feasibility of the approach. The land grant institutions held community meetings that resulted in the CHL application.  The community engagement process included over 900 community members that included parents, teachers, and community leaders; who identified the need for environmental interventions that address six key behavioral outcomes that became the six CHL target behaviors (Fialkwoski, 2013). The priorities and intervention strategies remain relevant as evidenced by sustained CHL interventions and partner programs (Novotny et al, 2022). This multistate project continues to serve as a vital mechanism for maintaining stable partnerships and coordinated activities, while also facilitating expansion to include partners from Arizona, Tennessee, Texas, and West Virginia. These new collaborators contribute valuable resources and interventions that can be adapted for use in our region, just as CHL interventions can be tailored to promote child health in their respective communities. Non-Pacific participants include researchers with expertise in child health, nutrition, obesity prevention, and youth development. These collaborators have contributed to a range of research and extension projects focused on improving health outcomes among children and families in diverse communities. Their participation strengthens CHLN by contributing complementary methodological expertise, comparative perspectives, and opportunities for cross-site collaboration. In turn, CHLN findings and culturally grounded intervention approaches can inform efforts to improve child health among Pacific populations living outside the region and support adaptation of successful strategies for other rural populations. This reciprocal exchange enhances the generalizability, dissemination, and broader public health relevance of CHLN research while maintaining the Pacific region as the central focus of the project.

The project also supports the acquisition and sharing of EFNEP datasets, which strengthen regional research capacity and provide a foundation for developing data-informed resources and strategies across participating states and territories. Without this multistate framework, partners would need to rely on smaller, less coordinated grant opportunities, likely resulting in fragmented efforts. Overall, this project has the potential to serve as a model for how multistate initiatives can function as platforms for coordinated health extension coalitions that foster broad, cross-sector partnerships for improving community health.