Modernization has changed the Samoans' lifestyle, and their cardiovascular health as well. A study by Stephen McGarvey, director of Brown University's International Health Institute, and colleagues found that youngsters between the ages of 10 and 18 in American Samoa and independent Samoa had higher blood pressures in 1991–1993 than did the same age group in 1979; they attribute the increase to changes in body mass index, a body fat indicator.[1] McGarvey says these young people with elevated blood pressure are more likely to have obesity-related health problems such as hypertension and diabetes as adults.