title: Using the ANGELO model to develop the children's healthy living program multilevel intervention to promote obesity preventing behaviors for young children in the U.S.-affiliated Pacific Region.
abstract: BACKGROUND
  Almost 40% of children are overweight or obese by age 8 years in the US-Affiliated Pacific, inclusive of the five jurisdictions of Alaska, Hawaii, American Samoa, Guam, and the Commonwealth of the Northern Mariana Islands. This article describes how the Children's Healthy Living (CHL) Program used the ANGELO (Analysis Grid for Environments/Elements Linked to Obesity) model to design a regional intervention to increase fruit and vegetable intake, water consumption, physical activity, and sleep duration and decrease recreational screen time and sugar-sweetened beverage consumption in young children ages 2-8 years.
  
  
  METHODS
  Using the ANGELO model, CHL (1) engaged community to identify preferred intervention strategies, (2) reviewed scientific literature, (3) merged findings from community and literature, and (4) formulated the regional intervention.
  
  
  RESULTS
  More than 900 community members across the Pacific helped identify intervention strategies on importance and feasibility. Nine common intervention strategies emerged. Participants supported the idea of a regional intervention while noting that cultural and resource differences would require flexibility in its implementation in the five jurisdictions. Community findings were merged with the effective obesity-reducing strategies identified in the literature, resulting in a regional intervention with four cross-cutting functions: (1) initiate or strengthen school wellness policies; (2) partner and advocate for environmental change; (3) promote CHL messages; and (4) train trainers to promote CHL behavioral objectives for children ages 2-8 years. These broad functions guided intervention activities and allowed communities to tailor activities to maximize intervention fit.
  
  
  CONCLUSIONS
  Using the ANGELO model assured that the regional intervention was evidence based while recognizing jurisdiction context, which should increase effectiveness and sustainability.
authors.affiliation: 1 Office of Public Health Studies, University of Hawaii at Mānoa , Honolulu, HI.
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Braun
authors.forename: Claudio R
authors.initials: CR
authors.lastname: Nigg
authors.forename: Marie K
authors.initials: MK
authors.lastname: Fialkowski
authors.forename: Jean
authors.initials: J
authors.lastname: Butel
authors.forename: James R
authors.initials: JR
authors.lastname: Hollyer
authors.forename: L Robert
authors.initials: LR
authors.lastname: Barber
authors.forename: Andrea
authors.initials: A
authors.lastname: Bersamin
authors.forename: Patricia
authors.initials: P
authors.lastname: Coleman
authors.forename: Ursula
authors.initials: U
authors.lastname: Teo-Martin
authors.forename: Agnes M
authors.initials: AM
authors.lastname: Vargo
authors.forename: Rachel
authors.initials: R
authors.lastname: Novotny
mesh_terms: D002648:Child; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D004032:Diet; D005247:Feeding Behavior; D005638:Fruit; D015438:Health Behavior; D006266:Health Education / Q000458:organization & administration*; D006293:Health Promotion; D006801:Humans; D019601:Pacific States / Q000453:epidemiology; D063766:Pediatric Obesity / Q000453:epidemiology / Q000517:prevention & control*; D012572:School Health Services / Q000458:organization & administration*; D014675:Vegetables