Duration: 10/01/2026 to 09/30/2031

Administrative Advisor(s):

NIFA Reps:

Non-Technical Summary

The Children’s Healthy Living Network (CHLN) Multistate addresses the urgent issue of high childhood obesity and related non-communicable diseases across the Pacific region, where rates of obesity, diabetes, and food insecurity are among the highest globally. These conditions threaten both community well-being and national security. Early prevention is critical, as childhood obesity strongly predicts adult obesity and chronic disease.

The goal of the renewed CHLN project is to strengthen and expand collaborative partnerships among Pacific states and territories to promote child health and wellness through integrated research, training, and extension. The objectives are to (1) assess the long-term effectiveness of previous CHL training and intervention efforts; (2) co-develop a culturally responsive model for intervention design, workforce development, and food system capacity building; and (3) broaden CHLN’s research infrastructure to include additional childhood stages and expand the Pacific food composition database with local and traditional foods.

Target audiences include researchers, community leaders, health and education professionals, and families across participating jurisdictions. They will benefit from improved tools, data, and culturally grounded models that inform local action and sustainable policy changes supporting child and community health.

Activities such as coordinated multistate research studies, workforce training, and community engagement directly lead to outcomes by generating evidence-based strategies, strengthening local capacity, and advancing policies and systems that promote healthy eating and active living. Together, these efforts will support resilient food systems and sustainable health improvements for Pacific children and their communities.

Statement of Issues and Justification

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. 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. 

Related, Current and Previous Work

The CHLN team represents US affiliated Pacific jurisdictions, states, and partners across the contiguous U.S., with a base in the land grant colleges and has evolved from past collaborations among its participants. The largest collaboration was from a USDA NIFA CAP grant (Grant number 2011-68001-30335), the Child Healthy Living Center grant (Grant number 69001-27551) and the CHL Food Systems grant (Grant number 2021-68012-35899). CHL evolved from 20 years developing land grant partnership through the Agricultural Development of the American Pacific Program, and its outgrowth, Healthy Living in Pacific Islands (Novotny et al 2013).  Developments as a result of CHL, include a functioning management structure that spans the region, PSE-oriented multi-level intervention research, built capacity and credit and non-credit curriculum in PSE-oriented work to prevent obesity in childhood, collection, analysis, and dissemination of data that filled the gap of missing nutrition surveillance systems in the region, and continued leveraging of these systems to contribute new knowledge through peer reviewed research and publication that informs programs and policies relevant to the underserved population of the Pacific. CHLN publications can be located at: https://www.chl-pacific.org/chln/chln-publications/. In addition, two training programs, the Child Health Assessment in the Pacific and Children’s Healthy Living Program Dietetic Scholars, have built capacity in the region around child assessment, child health, and dietetics professionals. Since NHANES does not sample the Pacific region, nor present data on Native Hawaiian, Native Alaskan or Pacific Islander race/ethnic groups, measured data on obesity, dietary intake and physical activity are not available without CHL, and are critical to guide programs and policies. Further, since Pacific foods are not identified in these surveys, they will not be analyzed by national labs for nutritional composition, to guide nutrition guidance and programs in the region.

Since the establishment of the CHLN Multistate (W1194),  an additional $14,325,903 in USDA funds has been awarded in the Pacific, over 1,100 individuals have received formal education on Pacific child nutrition and health through the online Children’s Healthy Living Program Summer Institute courses, four Native Hawaiian students pursuing degrees in Dietetics have been provided partial scholarships, five graduate students pursuing degrees in nutrition have been awarded graduate assistance scholarships, standardized protocols for collecting anthropometric measures (weight, height, waist circumference) have been developed and adopted across the Network partners with over 300 people being standardized, data on the nutritional status of individuals and communities in the region has been collected by measuring 1,753 individuals and assessing 548 community environments and CHL data has yielded 74 peer-reviewed publications and been utilized by 30 students in pursuit of higher education. The foundational groundwork for this was accomplished through the CHL CAP grant where CHL gathered data on 51 communities in 11 jurisdictions on over 11,000 children, their households, and their communities. 27 of these communities in 5 jurisdictions were involved in a multilevel community randomized controlled trial (Wilkens et al 2014) and the other 25 communities collected the same data in a one-time prevalence survey.  Data include acanthosis nigricans screening, weight, height and waist circumference assessment, 2 randomly selected days of 6,453 food and activity logs (food records and physical activity logs) from 2-8yo children throughout the region, 3,550 community environment assessments (store, park, church, walkability and food and utility cost assessments), and through a Freedom of Information Act (FOIA) request multiple years of Expanded Food and Nutrition Education (EFNEP) data was obtained providing data on 14,739 EFNEP participants in the Pacific region and 85,996 EFNEP data from the contiguous US. These data will continue to be evaluated to help fill the void in data for policy and program planning, and will provide a foundation from which ongoing monitoring systems will be developed and sustained. 

Further, CHL has developed a community-based intervention program (Braun et al. 2014, Fialkowski et al. 2013, Wilken et al 2013) and CHLN works to disseminate it and continues to serve as a data hub and a facilitator of coalition building and training in the community (Fialkowski et al 2015, Novotny et al, 2024). 

CHL work was conducted through a community engaged process (Fialkowski et al 2013, Hovmand et al, 2025) that involved development of Local Advisory Committees (LAC’s) in each jurisdiction, that included all sectors and provide groups identified that might influence child health.  These LAC’s meet at least annually and evolved into community and jurisdiction level coalitions that organized and sustained key efforts.  CHL was recognized as a backbone organization that facilitates the work and provides a key evaluation and training role that we aim to sustain with this multistate project; this role suited to the land grant mission of facilitation of community work (extension), evaluation (research) and training (instruction).

The renewal of the CHLN multistate project will enhance and expand collaborative partnerships to advance efforts in childhood obesity prevention through integrated research, training, and extension programs that promote child health and wellness. This renewed initiative will also extend the CHL network’s activities to encompass additional developmental stages, while broadening its scope to strengthen food system resiliency and its role in supporting child health throughout the region. 

Objectives

1. By the end of Year 5, assess the long-term effectiveness of CHL-initiated training and intervention activities through two coordinated multistate research studies.
   
2. By the end of Year 5, co-develop an integrated culturally responsive model for intervention design, workforce development, and capacity building that draw upon influential drivers identified through CHL and CHLN.
   
3. By the end of Year 5, broaden and strengthen the CHL Network’s applied research infrastructure by (a) expanding activities to include additional critical developmental stages in childhood, and (b) increasing the Pacific regional food composition database to include at least 5 additional local and traditional foods.
   

Methods

1. To assess the long-term effectiveness of CHL-initiated training and intervention activities the CHLN team will utilize CHL training program evaluation data, CHL intervention process data and conduct surveys. The two research studies will examine: 1) Training program concepts and elements; and 2) Implemented intervention activities and processes to identify key sustained impacts and influential factors. The findings will provide evidence-based strategies for sustaining desired health outcomes. Two grant proposals aimed at scaling the most effective elements of the CHL model will be co-developed.

 

2. To co-develop an integrated culturally responsive model for intervention design, workforce development, and capacity building, the CHLN team will synthesize influential drivers from existing CHL data. The integrated model will focus on designing an integrated intervention and training approach that incorporates local customs, protocols and values that can be used to adapt evidence-based interventions making them more acceptable and applicable to the population, along with a comprehensive "Trainer-of-Trainers" package that blends technical skills with cultural competence and traditional practices to empower communities and build local leadership across the network.

 

 

3. To broaden and strengthen CHLN’s applied research, the CHLN team will identify a critical developmental stage (i.e., 5 to 8 year olds), health outcomes, and a culturally appropriate research protocol specific to this stage, and formally integrating this expansion into the CHL Network’s research agenda and data systems. To strengthen the database, focus on collaborating to prioritize at least five local and traditional foods, conducting comprehensive laboratory nutrient analysis, and integrating this new data into the Pacific regional food composition database.

 

CHLN will have available data from the CHL prevalence, intervention studies, follow-up studies, CHL Food System systems dynamic interfaces, and EFNEP data along with tools and training used to collect those data (accelerometers, stadiometers, scales, measuring tapes, Pacific Tracker diet and activity software), and surveys. Additionally, developed training materials (Group Model Building Guide, Pacific Food Guide, CHL Summer Institute, Open Education Resource Textbooks:  Human Nutrition, Nutrition throughout the Lifespan, Pacific Food System) and CHL’s intervention materials (How to Intervention Guide, Role Model Training Guide, Master Gardening and Food Preservation Materials). Community social marketing materials (flyers, infographics, banners, etc.) will be available for CHLN use.

These resources, data, and collaborations will form the basis of new grant proposals, training programs, extension and outreach activities and capacity building within each jurisdiction.

Measurement of Progress and Results

Outputs

• Coordinated multistate research datasets, analytical reports, and peer-reviewed publications assessing the long-term effectiveness of prior CHL interventions on child and family health behaviors. Comments: Grant proposals developed through this collaboration will extend the research base to evaluate environmental, behavioral, and policy-level determinants of nutrition and physical activity.
• Co-developed, culturally responsive model will be produced to guide intervention design, workforce training, and capacity-building initiatives tailored to Pacific and Indigenous contexts. Comments: This model will incorporate best practices identified through CHL and CHLN research and will include training materials, evaluation tools, and implementation protocols.
• Infrastructure-focused outputs will expand the CHL Network’s research capacity and database systems. Comments: The Pacific regional food composition database will be updated with nutrient data for at least five additional local or traditional foods, improving the accuracy of dietary assessment and food system analyses. Additionally, CHL data-sharing protocols, templates, and governance agreements will be developed or refined to support multistate data harmonization. Collectively, these outputs will result in publicly accessible data, research publications, applied intervention model, enhanced regional datasets, and strengthened institutional partnerships supporting evidence-based nutrition, health, and food system strategies in Pacific communities.

Outcomes or Projected Impacts

• Long-term evaluation of CHL interventions will yield evidence on sustained changes in child and family health behaviors, guiding regional and federal health promotion strategies. Increased collaboration among multistate partners will strengthen capacity for longitudinal and culturally responsive evaluation research. These outcomes will enhance institutional readiness to secure external funding and embed CHL-informed approaches in local programs and policies.
• Adoption of a culturally responsive intervention and training model will improve the relevance and effectiveness of community health initiatives. Enhanced workforce competencies in culturally grounded approaches will increase program acceptability and sustainability. Regional partnerships fostered through co-development processes will promote equitable research collaboration and support Indigenous leadership in health promotion.
• Infrastructure outcomes will include expanded longitudinal research addressing developmental stages and improved availability of food composition data for Pacific foods. These improvements will facilitate more accurate dietary monitoring and strengthen the evidence base for nutrition guidelines and policy. Projected impacts include improved nutritional well-being and health among Pacific children and families; increased institutional and community capacity for culturally responsive research; and regional advancement in data-driven food system policy. In the long term, the integration of CHL findings into practice and policy will contribute to healthier, more resilient Pacific communities with stronger food and health systems.

Milestones

(1):• Establish multistate coordination team and finalize research protocols for longitudinal CHL follow-up studies. • Initiate literature synthesis and secondary data analysis on CHL intervention outcomes. • Engage community and institutional partners to co-define priorities for intervention and training model development.

(2):• Complete at least one coordinated multistate research study assessing CHL intervention outcomes. • Draft and submit at least one external grant proposal extending CHL evaluation or expanding to additional developmental stages. • Begin pilot development of culturally responsive intervention and training models. • Identify and prioritize traditional and local foods for analysis in the Pacific food composition database.

(3):• Conduct fieldwork or community pilot testing for one culturally responsive intervention model. • Submit second multistate research proposal and refine data infrastructure based on lessons learned from Year 1–2 studies. • Analyze and publish preliminary findings from CHL longitudinal studies. • Complete nutrient analysis for at least three local foods and integrate data into the CHL database.

(4):• Finalize and evaluate culturally responsive model for feasibility, acceptability, and training outcomes. • Disseminate findings through ≥2 peer-reviewed publications and community briefs. • Expand CHL research framework to include at least one additional developmental stage. • Add two additional traditional foods to the regional food composition database.

(5):• Complete synthesis of longitudinal findings and integration into regional nutrition and health programs. • Submit ≥2 peer-reviewed manuscripts and present results at multistate and Pacific health conferences. • Evaluate network-wide data infrastructure and document sustainability plan for continued CHLN collaboration. • Compile final report summarizing project outputs, outcomes, and measurable regional impacts.

Projected Participation

View Appendix E: Participation

Outreach Plan

The CHLN webpage (https://www.chl-pacific.org/chln/) on the CHL (http://www.chl-pacific.org/) website will be maintained to provide access to publications, intervention material and community reports and scientific reports, and data dashboards.  Peer-reviewed publications will be accessible to the scientific community through national research databases and the CHL website.

Classes will be offered through an online platform (CHL Summer Institute) through Outreach College at the University of Hawai‘i in child obesity policy, systems and environmentally focused multi-level prevention, child health, nutrition assessment and monitoring. This method allows anyone to take these courses at the in-state tuition rate for credit. Non-credit classes for continuing education will also be offered. In addition, the content of these courses is readily available for all to view.

Training and partnership in child health assessment and monitoring will be available through the CHLN.

Organization/Governance

The proposed multi-state group (CHLN) has a history of using a collaborative approach in implementing their research projects.  This relationship started with the Agricultural Development of the American Pacific Program and Healthy Living in Pacific Islands, and was fortified further with our largest collaboration (CHL) and now the CHAP.  The research team has established common procedures, protocols, and organizational structure. The CHL Coordinating Center will be maintained with guidance provided by the CHL Program Steering Committee (PSC) composed of a representative from each jurisdiction that participated in CHL (Hawai‘i, Alaska, American Samoa, Guam, Commonwealth of the Northern Mariana Islands, Palau, RMI, FSM).  CHL data and publication guidelines will be followed and will provide opportunity for submission and review of manuscript proposals from any interested party.

An annual meeting will take place to evaluate progress and to plan for the upcoming year. The attendees at the supporting CHLN annual meeting will nominate and elect a chair, a vice chair and a secretary to oversee the annual plan of work. The chair will appoint subcommittees to complete specific objectives and tasks; subcommittees will meet on a monthly basis. The vice-chair will succeed the chair and support the chair in performing his/her duties and serve for a one-year term.  The secretary will distribute documents prior to meetings, provide minutes describing the discussion and actions suggested during the meetings maintain an updated members roster, and help the chair/vice-chair prepare the accomplishments report.  The secretary will succeed the vice-chair.

Conference calls for multistate representatives will be held, at minimum, quarterly. Sub-committees will share updates on progress towards meeting specific objectives.

Jurisdiction local advisory committee meetings will be held to ensure cross-sector partnership.

Literature Cited

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Fialkowski MK, DeBaryshe B, Bersamin A, Nigg C, LeonGuerrero RT, et al. A community engagement process identifies environmental priorities to prevent early childhood obesity: the Children’s Healthy Living Program for Remote Underserved Populations in the Pacific Region (CHL). Maternal Child Health J, 2013;18:2261-2274. DOI 10.1007/s10995-013-1353-3. (PMID: 24043557)

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Magliano DJ, Boyko EJ; IDF Diabetes Atlas 10th edition scientific committee . IDF DIABETES ATLAS [Internet]. 10th edition. Brussels: International Diabetes Federation; 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK581934/

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Attachments

Land Grant Participating States/Institutions

HI

Non Land Grant Participating States/Institutions