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NSG6101 FINAL PROJECT TEMPLATE REQUIRED WITH example NSG6101 FINAL PROJECT TEMPLATE REQUIRED WITH example NSG6101 FINAL PROJECT TEMPLATE REQUIRED WITH example

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OBESITY AMONG HAWAIIANS 2

Obesity among Native Hawaiians and Pacific Islanders

Obesity of various populations has become an increasing concern both nationally and in

the State of Hawaii. Statistics about obesity among Native Hawaiians and Pacific Islanders

(NHPI) reveals alarming health disparities for this underserved population. The U.S.

Department of Health and Human Services (USDHHS) Office of Minority Health (2013) found

that in 2011 NHPI were “almost four times more likely to be obese than the overall Asian

American population [and] 30 percent more likely to be obese than non-Hispanic Whites” (para

1). Despite these statistics, NHPI are underrepresented in health care research. The Office of

Hawaiian Affairs (OAH) in 2010 indicated it is important to develop programs addressing the

multiple risk factors and consequences of obesity in the NHPI population, but it is challenging

since determinants of obesity cover environmental, social, psychological and biological factors.

Family Nurse Practitioners (FNP) are in an excellent position to be leaders in efforts to

reduce obesity among the NHPI population in several important ways such as encouraging

participation of patients in obesity prevention and treatment programs, cooperating with or

conducting research, and supporting legislation and health policy that promotes and supports

healthy lifestyles. Effective health promotion and obesity treatment programs that are shown to

be effective through research are needed to reduce the level of obesity among NHPI living in

Hawaii and elsewhere. Decreasing obesity in this population would improve health disparities,

reduce the healthcare burden of obesity and improve the overall health of all Hawaiians. To be

effective, obesity reduction programs must be both culturally based and participatory.

Background and Significance of the Problem
Obesity is a rising epidemic in the United States and in the State of Hawaii. The issue of

obesity is important to address since obesity is a risk factor for other health problems such as

diabetes and heart and kidney diseases. Obesity continues to be a problem in the U.S. despite

,OBESITY AMONG HAWAIIANS 3

government and private spending of large portions of the gross domestic product (GDP) on

healthcare. The US Federal Budget indicated that 24% of GDP was spent on healthcare in 2013

and plans are to spend 26% of GDP on healthcare in 2014 (US Federal Budget, 2013). The

Center for Disease Control and Prevention (CDC) in 2012, through their National Center for

Health Statistics (NCHS), indicated that in 2012 35.7% of adults and 16.9% of children were

obese. In an article by Look, Trask-Batti, Agres, Mau, and Kaholokula (2013), a community

needs assessment of NHPI found obesity rates higher for this population than those posted by

CDC. They found that 38% of NHPI adults were overweight or obese. In the same community

assessment, 32.6% of NHPI children were considered either overweight or obese.

Obesity is a risk factor for several chronic health problems and diseases such as high

cholesterol, hypertension and diabetes. According to the CDC (2014a), NHPI consistently have

higher rates than national and state averages of most of the chronic diseases associated with

obesity. CDC also reported in 2014 that 9.3% of native Hawaiians were diagnosed with

diabetes, compared to 9.7% of combined races nationally and 7.8% of all combined races in

Hawaii. The CDC also reported that over 32% of NHPI have been diagnosed with hypertension,

compared to 30.9% of combined races nationally and 28.7% of all races in Hawaii. Fully 41.5%

of NHPI have been diagnosed with high levels of cholesterol, compared to 38.4% of all races

nationally and 37% of all races in Hawaii (CDC, 2014b). A sedentary lifestyle and poor diets

that are high in fat and low in fruit and vegetables contributes to obesity. Unfortunately, NHPI

have high rates of these behavioral risk factors for obesity (Moy, Sallis, & David, 2010).

Community-based participatory programs offer several promising approaches to

promoting lifestyle behavior changes (Allensworth & Fertman, 2010). Community-based

participatory programs could be adopted by FNPs to tackle health problems such as obesity if the

, OBESITY AMONG HAWAIIANS 4

programs are also culturally sensitive (Carney et al., 2012). Various community-based

participatory gardening programs, with and without diet and exercise education classes, have

been attempted. Gardening projects have been shown to have some impact on the obesity

epidemic among NHPI, but these types of approaches need to be further researched (Kaholokula,

et al., 2013).

Statement of the Problem and Purpose of the Study
The problem this research will address is the lack of culturally based health promotion

programs to encourage healthy weight for NHPI designed to encourage healthy behaviors such

as eating a balanced diet and increasing physical activity levels. Participatory community

gardening programs have been tried but not proven effective in reducing obesity among NHPI

despite evidence that the programs work for other cultural groups. The purpose of this research

is to determine if a community-based, culturally appropriate gardening program, implemented by

an FNP and aimed at encouraging positive lifestyle behaviors and improving health outcomes, is

effective to treat or prevent obesity among NHPI adults residing in Hawaii. If the participatory

gardening program is found to be effective then it may be possible for these or similar methods

to be implemented by individual FNPs to prevent or treat obesity in NHPI or other cultural

groups.

Literature Review

The first step in planning this research was a literature review to determine previous

research knowledge about obesity among NHPIs. This review helped to identify remaining

relevant problems that need to be researched. In order to achieve this goal, a search of the

research literature was generated using the South University Online library. A search using

CINAHL, ProQuest, and PubMed was initiated based on the search terms “obese” or “obesity

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