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Anna Rivara, PhD, MPH

GHES U.S. Fellow 2018-2019

FELLOWSHIP SITE: Samoa Ministry of Health Collaborative Research Center, Samoa

Project Title: Biocultural construction of obesity risk: an investigation of inflammation, activity patterns, and socio-ecological pressures, among Samoans

Obesity is occurring at epidemic rates globally, and is associated with co-morbidities including: diabetes, cardiometabolic diseases, and iron-deficiency anemia. Low and Middle-Income Countries (LMIC), including the Pacific Islands, are disproportionately impacted; over half of the adult population of Samoa is obese (Hawley and McGarvey, 2015). While a genetic variant increases obesity risk in Samoans (Minster et al., 2016), more work is needed to understand causes and consequences of obesity in the population. Cardiometabolic co-morbidities and metabolic dysregulation in obese people are linked to chronic low-grade inflammation (Ouchi et al., 2011). Samoan women may be at heightened risk for co-morbidities due to their increased rates of obesity (Hawley et al., 2014) and inflammation (Soriano-Maldonado et al., 2016), and low rates of physical activity compared to men (STEPS, 2002; Nicklas et al., 2004). 

From August 2018-July 2019, I will be conducting research in Apia Samoa with Yale University, and the Samoa Ministry of Health Collaborative Research Center with Dr. Nicola L. Hawley, Ph.D., and Dr. Satupaitea Viali, MBchB, MPH. I will analyze biomarkers of inflammation (i.e. C-Reactive Protein and leptin) and anemia in adult Samoan men and women (n=180) to identify obesity co-morbidity risks. Over 40 weeks, I will conduct semi-structured interviews with adult women (n= 70) recording and measuring: patterns of and attitudes towards physical activity and health, diet, cultural pressures, and daily sanitary conditions. I will conduct home visits and record local ecology, sanitation, and visible obstacles to physical activity. Focus groups with a sub-set of the women, and interviews with community leaders and health workers will further identify obstacles to female health improvement. 

Results from this study will demonstrate how socio-ecological, physical, inflammatory, and cultural, factors influence physical activity and health, and identify unique risks of obesity co-morbidities in Samoan women. This study integrates localized constructions of health with socio-ecological pressures, to provide a holistic analysis of obesity. These types of analyses are essential in LMICs experiencing rapid socio-ecological transitions, high obesity rates, and marked gender disparities.