title: Using the Social-Ecological Model as a research and intervention framework to understand and mitigate obesogenic factors in Samoan populations.
abstract: OBJECTIVE
  The purpose of this study is to identify the relevant contributions and interactions of political, socioeconomic, cultural, and biological factors toward the increasing rates of obesity in Samoans. The constructs of the Social-Ecological Model of Health, which posit that there are multiple levels of influence on individual health behaviors, are used as a conceptual framework to synthesize the current research investigating obesity and chronic diseases in Samoan populations.
  
  
  METHODS
  Twenty-five studies, representing over 20 years of empirical research with Samoans, were assessed and synthesized. These studies included quantitative and qualitative designs. The reviewed studies used participants from (Western) Samoa and American Samoa jurisdictions, as well as migrant Samoan populations living in the USA and New Zealand.
  
  
  RESULTS
  Analysis of the current research revealed a convergence of factors, including the effects of recent political and socioeconomic changes in Samoan jurisdictions, combined with specific Samoan cultural and biological dynamics, which have contributed to the current trends toward poor health in Samoans. Interventions designed to address obesity in Samoans must be able to modify multiple determinants of personal health, with particular emphasis on the appropriate use of Samoan cultural concepts.
  
  
  CONCLUSIONS
  The application of the Social-Ecological Model of Health, as used in this review, provides guidance for future investigations that may identify multiple factors that contribute to disparities in health. The use of intervention strategies, designed to improve the health status of Samoans, may also indicate methods to address obesity and the development of chronic diseases in other population groups who share similar social conditions and health trends.
authors.affiliation: Office of Public Health Studies, Cancer Research Center of Hawai'i, University of Hawai'i, Honolulu, HI 96813, USA. kevin@crch.hawaii.edu
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Cassel
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009520:New Zealand; D009765:Obesity / Q000453:epidemiology / Q000208:ethnology* / Q000235:genetics* / Q000517:prevention & control; D011057:Politics; D018947:Samoa / Q000453:epidemiology / Q000208:ethnology; D012959:Socioeconomic Factors; D014481:United States