Underserved minority populations in the US Affiliated Pacific Islands (USAPI), Hawaii, and Alaska display disproportionate rates of childhood obesity. The region’s unique circumstance should be taken into account when designing obesity prevention interventions. The purpose of this paper is to (a), describe the community engagement process (CEP) used by the Children’s Healthy Living (CHL) Program for remote underserved minority populations in the USAPI, Hawaii, and Alaska (b) report community-identified priorities for an environmental intervention addressing early childhood (ages 2–8 years) obesity, and (c) share lessons learned in the CEP. Four communities in each of five CHL jurisdictions (Alaska, American Samoa, Commonwealth of the Northern Mariana Islands, Guam, Hawai‘i) were selected to participate in the community-randomized matched-pair trial. Over 900 community members including parents, teachers, and community leaders participated in the CEP over a 14 month period. The CEP was used to identify environmental intervention priorities to address six behavioral outcomes: increasing fruit/vegetable consumption, water intake, physical activity and sleep; and decreasing screen time and intake of sugar sweetened beverages. Community members were engaged through Local Advisory Committees, key informant interviews and participatory community meetings. Community-identified priorities centered on policy development; role modeling; enhancing access to healthy food, clean water, and physical activity venues; and healthy living education. Through the CEP, CHL identified culturally appropriate priorities for intervention that were also consistent with the literature on effective obesity prevention practices. Results of the CEP will guide the CHL intervention design and implementation. The CHL CEP may serve as a model for other underserved minority island populations.

Poor oral health in early childhood can have long-term consequences, and parents often are unaware of the importance of preventive measures for infants and toddlers. Children in rural, low-income families suffer disproportionately from the effects of poor oral health. Participants were 91 parents of infants and toddlers enrolled in Early Head Start (EHS) living in rural Hawai'i, USA. In this quasi-experimental design, EHS home visitors were assigned to use either a didactic or family-centered video with parents they served. Home visitors reviewed short segments of the assigned videos with parents over an eight-week period. Both groups showed significant prepost gains on knowledge and attitudes/behaviors relating to early oral health as well as self-reported changes in family oral health routines at a six-week followup. Controlling for pretest levels, parents in the family-centered video group showed larger changes in attitudes/behaviors at posttest and a higher number of positive changes in family oral health routines at followup. Results suggest that family-centered educational videos are a promising method for providing anticipatory guidance to parents regarding early childhood oral health. Furthermore, establishing partnerships between dental care, early childhood education, and maternal health systems offers a model that broadens potential reach with minimal cost.

Accessible and affordable early childhood care and education (ECE) is crucial to child, family, and community well-being. High quality ECE programs set the stage for lifelong learning, health, and overall well-being and yield a high rate of return on public investment. Equitable access to ECE remains an intractable challenge in the U.S. and elsewhere. We used spatial analysis to create a single micro-level indicator of ECE affordability for an urban county. This indicator combined information on supply (number of nearby sets), demand (number of children competing for these seats), and cost burden (cost as a percentage of median family income). We measured and mapped the affordability of programs within a 3-mile driving distance of a prototypical family home using a two-step floating catchment area method. Overall, affordability was low, with only 14% of young children having access to ECE that met the federal affordability threshold. Although affordability was inversely related to neighborhood income, not all low-income areas were under-resourced. The ECE affordability indicator can arm community advocates and help policymakers identify inequities and direct resources to the highest-need communities. The computational procedures and mapping techniques applied are flexible and can be scaled up to visualize inequities across large areas (e.g., a province or state), or used at a micro level to identify where in a community a new childcare center would have the most impact.

Emergent writing is a key component of early literacy development and contributes to later school success, yet it receives little attention in most preschool classrooms. This paper presents results of a quasi-experimental study of a teacher professional development package that included writing as one of four focal areas. The study was conducted in 15 Head Start classrooms located in the U.S. state of Hawaiʻi. The participants were 39 lead and assistant teachers and 240 children. Intervention teachers had higher quality writing environments and overall classroom environments, while intervention children showed better outcomes on emergent reading and upper case letter knowledge. Emergent writing was assessed only in the intervention group, where children showed large gains along with changes in code-related skills needed for invented spelling. Results are discussed in terms of recommended practices for early writing instruction and teacher professional development.