A NUTRITIONAL AND ANTHROPOMETRIC ASSESSMENT OF MARSHALLESE SCHOOL CHILDREN Todd L Foster Submitted to the faculty of the University Graduate School in partial fulfillment of the requirements for the degree Doctor of Philosophy in the Department of Anthropology Indiana University April 2015 Accepted by the Graduate Faculty, Indiana University, in partial fulfillment of the requirements for the degree of Doctor of Philosophy. Doctoral Committee Paul L Jamison, Ph.D. Frederika Kaestle, Ph.D. Valerie O’Loughlin, Ph.D. Richard E. Ward, Ph.D. March 23rd, 2015 ii Copyright © 2015 Todd L Foster iii Acknowledgements Sitting down to write my acknowledgements gave me pause. I say this because it has been ten years since I began graduate school. In the autumn of 2004, I started a journey that I am not entirely sure how it would turn out. The entire process has been transformative and changed me as a person. The graduate school experience has been full of achievement, loss, and humility. I am a working class kid from Mars Hill, Indianapolis, Indiana. I was never supposed to be here. In the last ten years, I earned a master’s degree and a PhD, forged lifelong friendships, saw love come and go, became a father, overcame struggles, and found that I could make learning my profession. I have recently been asked if I am proud of my accomplishment here. I was hesitant to answer that question. It was not because I felt a lack of pride in the moment. The pause present in my reply was because I know that I would have never gotten here without the multitude of people who have been there to teach and guide me. I can never forget the people who fed me or gave me a couch to sleep on when I couldn’t afford much on a graduate student income. I will never forget the teachers and mentors who let me ask one more question because I just did not understand. I have a lot of people to thank here, but this will never repay them for the kindness, patience, and help they offered. I came into the Department of Anthropology at Indiana University in 2004 to be trained as a biological anthropologist with three awesome ladies. Susan Spencer, Maria Roditis, and Ellen Salter-Pedersen have all finished their PhDs before me. (And they say chivalry is dead!) Each of these ladies helped me through academic trials, for which I am sincerely thankful. Each of them has moved on to successful endeavors and I am proud to call them academic siblings. These ladies, along with Rob Taylor, Allison Foley, and Cameron Griffith, are people who I am iv very proud to call my friend. They pushed me when I needed pushed. They listened when I needed an ear. We walked this academic path together and I will forever be grateful for this experience because of them. I also want to thank Debra Wilkerson and Susie Bernhardt in the Department of Anthropology. You ladies do not get the respect you deserve. I have learned so much from the many professors that taught me over the years. Mark Braun, Michael Muehlenbein, Della Cook, Laura Scheiber, and Robert Meier are professors who deserve acknowledgement here. I might have only had one class with these professors (I never took a class with Laura Scheiber or Robert Meier), but these people took the time to listen and helped guide me as a student. I also want to thank Jeanette Dickerson-Putnam for introducing the peoples of the Pacific Ocean, specifically the Marshall Islands, to me in my undergraduate training. You planted the seed and watched my intrigue grow. This project would have never happened if it was not for some very key people in the Republic of the Marshall Islands. Alson Kelen, Ben Graham, Ben Chutaro, Justina Langridrik, Sheldon Riklon, and Neal Palafox were all instrumental in assisting me with methodology and design. They opened the doors to research in the Republic of the Marshall Islands. A huge thank you is extended to Majuro Cooperative School and Kathy Stratte. They gave me a job teaching middle school children while I was in the field. My project was not funded and without this income, I would not have been able to survive on Majuro Atoll. One of the more enriching experiences on Majuro Atoll was getting the opportunity to teach these young minds. The following people are included in my “Majuro”crew: Ryan and Angela Fronek, Kristin Olson, Lauren Pallotta, Darren Nakata, Clint Jeavons, Provan Crump, Jim Bruer, Anna Zelinsky, v Malcolm Freberg, Kiersten Hallquist, Natalie Nimmer, Ingrid Alhgren, Rachel Miller, Tamara Greenstone Alefaio, and Randy Sylvester. All of these people share a love of the Marshall Islands and its people. They also opened doors for this research and each one of them will forever be considered as a friend. Some of these people are also budding anthropologists and I look forward to collaborating with them in the future. I really think of my graduate experience as consisting of three trimesters. The first trimester included my coursework, the second involved my time in the Marshall Islands, and the third involved my time at St. Vincent Hospital. I ended up taking a position as a clinical research scientist at the beginning of 2011 for positive and negative reasons. My time at St. Vincent has taught me what it means to be a professional and rounded out my training as a scientist. Elizabeth Moore, Vicki Wasy, Anne Coleman, Curtis Ramsey, Adrian Katschke, and Tina Noonan all have been influential in getting me to this point. The Center for Prenatal Diagnosis also deserves mention here, particularly James Sumners. He has been another mentor to me and I owe him a debt of gratitude. I was told in the last year of my undergraduate training that graduate school would be one of the most selfish things I ever did. I do not think I understood that statement until the last few years. To my father, mother, step father, all of my friends, family, and Jedi council, I am so sorry that I have been absent from your lives over the last decade. I hope that you are proud of what I have accomplished here. I can never say enough to thank my dissertation committee: Valerie Dean-O’Loughlin, Frederika Kaestle, Rick Ward, and Paul Jamison. Each of you is special to me. In the end, I hope I made you proud, and yet, I hope to continue to make you proud for years to come. Each of you vi gave me your time when you did not have it. Each of you listened when you were tired of hearing my ramblings. You pushed me beyond my perceived limits and made me a better person. You saw me grow up over the past ten to fifteen years. (Rick Ward was my undergraduate mentor). My life would have been drastically different if you were not a part of it and I have been lucky to have you guide me. To the people living on Majuro Atoll and in the Marshall Islands at large, thank you. Ultimately, this dissertation is for you. It truly is my goal to continue to work and advocate for you for the rest of my academic career. My heart longs for the Marshall Islands and I will always consider the Marshall Islands as my second home. The Marshallese Islanders changed me and my heart is full of love for all of you. And last, but not least, I want to thank my daughter, Mary Rose. She is only two at the time of this writing, but I hope she is interested to read this dissertation twenty years from now. Young lady, I never wanted kids. I never wanted to be a parent. But, you have been the single most extraordinary thing in my life. I never knew I could love someone this much. Whether you know it or not, you helped me finish this dissertation. In the end, I did take this journey for myself, but you helped me across the finish line. Yokwe yuk. vii Todd L Foster A NUTRITIONAL AND ANTHROPOMETRIC ASSESSMENT OF MARSHALLESE SCHOOL CHILDREN The study is a cross-sectional examination of growth and nutritional status among Marshallese school children living on Majuro Atoll. Colonialism and globalization have altered the foods available, economic structure, and historical social constructs of Marshall Islanders, especially those living on Majuro Atoll and these transitions have affected the growth and nutrition of the islanders. Anthropometric measurements were used to calculate nutritional status and body composition indices. The WHO 2007 child growth reference and Frisancho’s Anthropometric Standards for the Assessment of Growth and Nutritional Status were used to explore the growth of Marshallese children. The sample consisted of 588 Marshallese children, aged 5 to 14 years of age, attending primary schools on Majuro Atoll. The overall rate of stunting among sampled Marshallese children was 34.6%. The rate of underweight children was less (8.2%) but this rate only reflects children aged 5-9 years due to the design of the WHO 2007 reference. This proportion of weight to height among the sample revealed body mass indices as “normal” when compared to the reference and the utility of body mass index among the Marshallese sample is brought into question. After exploring the rates of malnutrition among the entire sample, the anthropometric and body composition z-scores, as calculated in comparison to the references, of children attending public and private schools on Majuro were compared. The average z-scores for every nutrition and body composition measurement were statistically significantly higher in private school children.