OBJECTIVETo evaluate the effectiveness of a culturally adapted, primary care–based nurse–community health worker (CHW) team intervention to support diabetes self-management on diabetes control and other biologic measures.RESEARCH DESIGN AND METHODSTwo hundred sixty-eight Samoan participants with type 2 diabetes were recruited from a community health center in American Samoa and were randomly assigned by village clusters to the nurse-CHW team intervention or to a wait-list control group that received usual care.RESULTSParticipants had a mean age of 55 years, 62% were female, mean years of education were 12.5 years, 41% were employed, and mean HbA1c was 9.8% at baseline. At 12 months, mean HbA1c was significantly lower among CHW participants, compared with usual care, after adjusting for confounders (b = −0.53; SE = 0.21; P = 0.03). The odds of making a clinically significant improvement in HbA1c of at least 0.5% in the CHW group was twice the odds in the usual care group after controlling for confounders (P = 0.05). There were no significant differences in blood pressure, weight, or waist circumference at 12 months between groups.CONCLUSIONSA culturally adapted nurse-CHW team intervention was able to significantly improve diabetes control in the U.S. Territory of American Samoa. This represents an important translation of an evidence-based model to a high-risk population and a resource-poor setting.

Weight loss maintenance is a significant challenge in obesity treatment. During maintenance the “costs” of adhering to weight management behaviors may outweigh the “benefits.” This study examined the efficacy of a novel approach to weight loss maintenance based on modifying the cost-benefit ratio. Individuals who achieved a 5% weight loss (N=75) were randomized to one of three, 10-month maintenance interventions. All interventions were delivered primarily via the Internet. The Standard arm received traditional weight maintenance strategies. To increase benefits, or rewards, for maintenance behaviors, the two cost-benefit intervention conditions received weekly monetary rewards for self-monitoring and social reinforcement via e-coaching. To decrease behavioral costs (boredom) and increase novelty, participants in the cost-benefit conditions also monitored different evidence-based behaviors every two weeks (e.g., Weeks 1 & 2: steps; Week 3 & 4: red foods). The primary difference between the cost-benefit interventions was type of e-coach providing social reinforcement: Professional (CB Pro) or Peer (CB Peer). Study procedures took place in Providence, RI from 2013–2014. Retention was 99%. There were significant group differences in weight regain (p=.01). The Standard arm gained 3.5±5.7kg. In contrast, participants in CB Pro and CB Peer lost an additional 1.8±7.0kg and 0.5±6.4kg, respectively. These results suggest that an Internet delivered cost-benefit approach to weight loss maintenance may be effective for long-term weight control. In addition, using peer coaches to provide reinforcement may be a particularly economic alternative to professionals. These data are promising and provide support for a larger, longer trial. Clinicaltrials.gov Identifier NCT01760486

Objectives To describe long term food availability and prices from 1961 to 2007 and BMI trends from 1980–2010 in Samoa, and to contextualize these trends within political, economic, cultural, behavioral, and climatic influences. Methods National level data on food availability and pricing were obtained from the open access database FAO (http://faostat.fao.org). Data for Samoa were collected from annual food balance sheets available for the period 1961 to 2007. Mean BMI for Samoan men and women ages 35–44 years of age is reported from four different time periods, 1979–82, 1991, 2003, and 2010. Results Total energy availability increased substantially, by 47%, with more than 900 extra calories available per capita per day in 2007 than in 1961. Many of these extra calories are supplied by dietary fat, the availability of which rose by a proportionally greater amount, 73%. Availability of both meat and vegetable oils rose substantially. Poultry meat increased the most proportionally, from 10 to 117 kcal per capita per day. Coconut products, fruit and starchy root crops – all locally grown – showed little to no increase over this time. As import prices for poultry and mutton increased their availability decreased, but the availability of vegetable oils rose despite a rise in their price. Mean BMI for men and women ages 35–44 years rose 18% rise from 1980–2010. Conclusions These long-term trends in food availability and prices, and the temporal pattern of BMI provide national level data for understanding the process of the nutrition transition in Samoa. Further work on consumer food prices, diet, food security and health is needed to further contextualize the transformation of the local food system in Samoa.