Rachel Novotny - Academia.edu (original) (raw)

Papers by Rachel Novotny

JAMA Network Open

IMPORTANCE Few obesity prevention trials among children have demonstrated sustainable outcomes in... more IMPORTANCE Few obesity prevention trials among children have demonstrated sustainable outcomes in the long term. OBJECTIVES To sustain a community-wide decrease in the prevalence of overweight and obesity among young children in the US-affiliated Pacific region. DESIGN, SETTING, AND PARTICIPANTS In the Children's Healthy Living community-randomized clinical trial, hierarchical modeling comparing the change in intervention and control communities accounted for community randomization (community clustering with jurisdictions), and adjusted for the age and sex distribution of the assessed children in a cross-sectional design. The outcome measures were repeated in communities rather than among individual children. A total of 27

The FASEB Journal, 2013

ObjectiveGiven the importance of anti-oxidant dietary compounds for chronic disease prevention, w... more ObjectiveGiven the importance of anti-oxidant dietary compounds for chronic disease prevention, we examined the differences in serum levels of Coenzyme Q10 (CoQ10), α-tocopherol (α-Toc), γ-tocopher...

Hawai'i journal of health & social welfare, Jul 1, 2021

The FASEB Journal, 2014

Community food environment (CFE) is an important determinant of health, especially obesity. Facto... more Community food environment (CFE) is an important determinant of health, especially obesity. Factors of the CFE (including availability and quality of fruits/vegetables [F/V], store advertisement, c...

Mean obesity level of the 2–8-year-old children in the region was 14.4%, 14.1% were overweight, 2... more Mean obesity level of the 2–8-year-old children in the region was 14.4%, 14.1% were overweight, 2.7% were underweight, 1.4% were stunted, and 6.8% were stunted at birth. Acanthosis nigricans prevalence was 5%, an indicator of pre-diabetes. Sixty-one percent of the children were Native Hawaiian or Pacific Islander and 20% were of more than one race. Food insecurity was common. It was especially high in the Federated States of Micronesia and the Republic of the Marshall Islands at over 70%. Twenty-five percent of households in the region earned less than $10,000 per year. World Bank-defined upper middle-income jurisdictions had relatively high levels of both undernutrition and obesity. Jurisdiction income level was the most important factor influencing growth status in multivariate models. Policies and strategies for jurisdiction economic development and improvement of child growth status should protect local food systems and active living during economic transition. The terms of the ...

JAMA Network Open, 2018

IMPORTANCE Pacific Islanders have among the highest rates of obesity and type 2 diabetes in the w... more IMPORTANCE Pacific Islanders have among the highest rates of obesity and type 2 diabetes in the world. Targeting children is critical for primary prevention. OBJECTIVES To prevent young child overweight and obesity and to improve health in the US-Affiliated Pacific region via the Children's Healthy Living Program. DESIGN, SETTING, AND PARTICIPANTS 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-indifference 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. INTERVENTIONS Nineteen activities addressed policy, environment, messaging, training, and 6 target behaviors (sleep time, screen time, physical activity, fruits and vegetables, water, and sugarsweetened beverages). MAIN OUTCOMES AND MEASURES Primary outcomes were body size measurements. Secondary outcomes were acanthosis nigricans, sleep quality and duration, dietary intake, physical activity, and other questionnaire reponses. RESULTS 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 (continued) Key Points Question Does a multijurisdictional, multilevel, multicomponent community intervention decrease young child overweight and obesity in the US-Affiliated Pacific region? Findings Among 27 communities and 8371 children in this randomized clinical trial, the Children's Healthy Living Program decreased overweight and obesity prevalence by 3.95% among children aged 2 to 8 years in the US-Affiliated Pacific region. Meaning A multilevel, multicomponent approach reduced young child overweight and obesity.

Asia Pacific journal of clinical nutrition, 2018

In investigating diet-disease relationships, examination of dietary patterns allows for conclusio... more In investigating diet-disease relationships, examination of dietary patterns allows for conclusions to be drawn based on overall intake. This study characterized dietary patterns of early adolescent girls over a two-year period and examined the relationship between dietary patterns and body mass index (BMI). Cross-sectional analyses were performed using longitudinal data from food records of early adolescent girls (n=148) 9 to 14 years in Hawai'i from the Female Adolescent Maturation (FAM) study. Dietary patterns were identified using principal component analysis (PCA). Pearson's correlations between BMI percentile and z-score and dietary pattern factor scores at Times 1 (2001-2002) and 2 (2002-2003) were calculated. For each dietary pattern, participants were divided into low, intermediate, and high scorers. Mean BMI percentiles and z-scores were compared between groups using analysis of covariance. At Time 1, three patterns were identified, characterized by: (1) whole grai...

Manuscript 1: Comparison of breast density measured by dual energy x-ray Absorptiometry (DXA) wit... more Manuscript 1: Comparison of breast density measured by dual energy x-ray Absorptiometry (DXA) with mammographic density among adult women in Hawaii (Cancer Epidemiology, in press). Manuscript 2: Body fat and menarche are associated with breast density in multiethnic adolescent girls (American Journal of Human Biology, under review). Manuscript 3: Comparison of breast measures between mothers and adolescent daughters (Breast Cancer Research, under review).

Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health, Aug 1, 2017

This cross-sectional study examined the: (1) association between food store environment (FSE), fr... more This cross-sectional study examined the: (1) association between food store environment (FSE), fruit and vegetable (FV) availability and access, and prevalence of early childhood overweight/obesity (COWOB); and (2) influence of young child actual FV intake on the relationship between the FSE and early COWOB prevalence. Anthropometric and socio-demographic data of children (2 to 8 years; N=466) in baseline communities on Guam participating in the Children's Healthy Living (CHL) Program community trial were included. CDC year 2000 growth charts were used to calculate BMI z-scores and categories. FSE factors (fresh FV scores, store type) were assessed using the CX3 Food Availability and Marketing Survey amended for CHL. ArcGIS maps were constructed with geographic coordinates of participant residences and food stores to calculate food store scores within 1 mile of participant's residences. A sub-sample of participants (n = 355) had Food and Activity Log data to calculate FV and...

Medicine, 2016

Estimate prevalence of obesity and acanthosis nigricans (AN) among children in United States Affi... more Estimate prevalence of obesity and acanthosis nigricans (AN) among children in United States Affiliated Pacific (USAP) jurisdictions.

BMC Research Notes, 2016

Background: Quality assurance plays an important role in research by assuring data integrity, and... more Background: Quality assurance plays an important role in research by assuring data integrity, and thus, valid study results. We aim to describe and share the results of the quality assurance process used to guide the data collection process in a multi-site childhood obesity prevalence study and intervention trial across the US Affiliated Pacific Region. Methods: Quality assurance assessments following a standardized protocol were conducted by one assessor in every participating site. Results were summarized to examine and align the implementation of protocol procedures across diverse settings. Results: Data collection protocols focused on food and physical activity were adhered to closely; however, protocols for handling completed forms and ensuring data security showed more variability. Conclusions: Quality assurance protocols are common in the clinical literature but are limited in multi-site community-based studies, especially in underserved populations. The reduction in the number of QA problems found in the second as compared to the first data collection periods for the intervention study attest to the value of this assessment. This paper can serve as a reference for similar studies wishing to implement quality assurance protocols of the data collection process to preserve data integrity and enhance the validity of study findings.

Journal of nutrition education and behavior, 2016

To quantify the Head Start (HS) teacher mediating and moderating influence on the effect of a wel... more To quantify the Head Start (HS) teacher mediating and moderating influence on the effect of a wellness policy intervention. Intervention trial within a larger randomized community trial. HS preschools in Hawaii. Twenty-three HS classrooms located within 2 previously randomized communities. Seven-month multi-component intervention with policy changes to food served and service style, initiatives for employee wellness, classroom activities for preschoolers promoting physical activity (PA) and healthy eating, and training and technical assistance. The Environment and Policy Assessment and Observation (EPAO) classroom scores and teacher questionnaires assessing on knowledge, beliefs, priorities, and misconceptions around child nutrition and changes in personal health behaviors and status were the main outcome measures. Paired t tests and linear regression analysis tested the intervention effects on the classroom and mediating and moderating effects of the teacher variables on the classr...

Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health, 2016

The relationship between acculturation and physical activity stages of change is unexplored. Stag... more The relationship between acculturation and physical activity stages of change is unexplored. Stages of change conceptualize behavior change as a progression through a series of five stages indicating the readiness to change behavior. The level of acculturation can be assessed using the Ethnocultural Identity Behavioral Index (EIBI) which is based on three factors: Cultural Activities, Social Interaction and Language Opportunities. The purpose of this project was to explore the relationship between parental acculturation and physical activity stages of change in Hawai'i children. Participants (N = 85; 62% female; aged 5-8 years; 22% Native Hawaiian or Other Pacific Islanders, 42% Asian, 25% White, and 11% Other) completed the EIBI and a physical activity stages of change measure. Acculturation factor means were: Cultural Activities = 4 (SD = 1.26), Social Interaction = 3 (SD = 1.04), and Language Opportunities = 4 (SD = 1.29). The physical activity stages of change distribution w...

American Journal of Human Biology, 2015

Objectives: Anthropometric standardization is essential to obtain reliable and comparable data fr... more Objectives: Anthropometric standardization is essential to obtain reliable and comparable data from different geographical regions. The purpose of this study is to describe anthropometric standardization procedures and findings from the Children's Healthy Living (CHL) Program, a study on childhood obesity in 11 jurisdictions in the US-Affiliated Pacific Region, including Alaska and Hawai'i. Methods: Zerfas criteria were used to compare the measurement components (height, waist, and weight) between each trainee and a single expert anthropometrist. In addition, intra-and inter-rater technical error of measurement (TEM), coefficient of reliability, and average bias relative to the expert were computed. Results: From September 2012 to December 2014, 79 trainees participated in at least 1 of 29 standardization sessions. A total of 49 trainees passed either standard or alternate Zerfas criteria and were qualified to assess all three measurements in the field. Standard Zerfas criteria were difficult to achieve: only 2 of 79 trainees passed at their first training session. Intra-rater TEM estimates for the 49 trainees compared well with the expert anthropometrist. Average biases were within acceptable limits of deviation from the expert. Coefficient of reliability was above 99% for all three anthropometric components. Conclusions: Standardization based on comparison with a single expert ensured the comparability of measurements from the 49 trainees who passed the criteria. The anthropometric standardization process and protocols followed by CHL resulted in 49 standardized field anthropometrists and have helped build capacity in the health workforce in the Pacific Region. Am.

Journal of Nutrition Education and Behavior, 2015

Evaluation: Community Service Attitudes Scale (CSAS) was used to collect data. This CSAS scale qu... more Evaluation: Community Service Attitudes Scale (CSAS) was used to collect data. This CSAS scale quantified four phases: perception, moral obligation, reassessment and helping measures with sub-scales for each phase. In addition, the intervention group answered four open-ended questions including barriers and benefits of service learning. Students filled-out the survey at the beginning and end of semester. Data were analyzed using chi-square test and ANOVA. Over 85% of the students from the control and intervention classes reported participating in unpaid community service at least once a year. Both groups reported very positive attitudes except the attitude toward costs and no significance differences were found between intervention and control groups. Most common benefits service-learning students' mentioned were ''feeling of accomplishment'' and ''seeing community issues up close'' and barrier was ''limited time.'' Conclusions and Implications: Exposure to community service improved the attitudes. Service-learning faculty members must help students see that costs are outweighed by the benefits derived. Funding: None.

Translational Behavioral Medicine, 2015

Your article is protected by copyright and all rights are held exclusively by Society of Behavior... more Your article is protected by copyright and all rights are held exclusively by Society of Behavioral Medicine. This e-offprint is for personal use only and shall not be selfarchived in electronic repositories. If you wish to self-archive your article, please use the accepted manuscript version for posting on your own website. You may further deposit the accepted manuscript version in any repository, provided it is only made publicly available 12 months after official publication or later and provided acknowledgement is given to the original source of publication and a link is inserted to the published article on Springer's website. The link must be accompanied by the following text: "The final publication is available at link.springer.com".

Childhood obesity (Print), 2015

Pacific Kids DASH for Health (PacDASH) aimed to improve child diet and physical activity (PA) lev... more Pacific Kids DASH for Health (PacDASH) aimed to improve child diet and physical activity (PA) level and prevent excess weight gain and elevation in blood pressure (BP) at 9 months. PacDASH was a two-arm, randomized, controlled trial (ClinicalTrials.gov: NCT00905411). Eighty-five 5- to 8-year-olds in the 50th-99th percentile for BMI were randomly assigned to treatment (n=41) or control (n=44) groups; 62 completed the 9-month trial. Sixty-two percent were female. Mean age was 7.1±0.95 years. Race/ethnicity was Asian (44%), Native Hawaiian or Other Pacific Islander (28%), white (21%), or other race/ethnicity (7%). Intervention was provided at baseline and 3, 6 and 9 months, with monthly supportive mailings between intervention visits, and a follow-up visit at 15 months to observe maintenance. Diet and PA were assessed by 2-day log. Body size, composition, and BP were measured. The intervention effect on diet and PA, body size and composition, and BP by the end of the intervention was t...

Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health, 2013

Birth size has important implications for health and disease in adulthood. This study examined th... more Birth size has important implications for health and disease in adulthood. This study examined the association of birth size with central body fat distribution in late adolescence. Data were from a cross-sectional survey of adolescent girls (N = 143, 13-18y) of Asian, White and Mixed Asian-white ethnicity collected in 2005-2007 in Hawai'i, USA. Central body fat distribution was assessed with dual-energy x-ray absorptiometry and birth size from birth certificates and parent recall. Food diaries (3-day) were used to determine energy intake and metabolic equivalents of energy expenditure. The proportion of Asian ancestry was determined by questions and anthropometry was performed. T-tests compared groups, and multiple regression examined predictors of central body fat distribution, adjusting for potential confounders. Asian girls had a lower mean weight and gestational age at birth than White girls, and a lower mean dietary fat intake in adolescence. Girls of Asian and Mixed Asian-...