The Healthy Children, Strong Families intervention promotes improvements in nutrition, activity and body weight in American Indian families with young children

Emily J Tomayko, Ronald J Prince, Kate A Cronin, Alexandra K Adams, Emily J Tomayko, Ronald J Prince, Kate A Cronin, Alexandra K Adams

Abstract

Objective: American Indian children of pre-school age have disproportionally high obesity rates and consequent risk for related diseases. Healthy Children, Strong Families was a family-based randomized trial assessing the efficacy of an obesity prevention toolkit delivered by a mentor v. mailed delivery that was designed and administered using community-based participatory research approaches.

Design: During Year 1, twelve healthy behaviour toolkit lessons were delivered by either a community-based home mentor or monthly mailings. Primary outcomes were child BMI percentile, child BMI Z-score and adult BMI. Secondary outcomes included fruit/vegetable consumption, sugar consumption, television watching, physical activity, adult health-related self-efficacy and perceived health status. During a maintenance year, home-mentored families had access to monthly support groups and all families received monthly newsletters.

Setting: Family homes in four tribal communities, Wisconsin, USA.

Subjects: Adult and child (2-5-year-olds) dyads (n 150).

Results: No significant effect of the mentored v. mailed intervention delivery was found; however, significant improvements were noted in both groups exposed to the toolkit. Obese child participants showed a reduction in BMI percentile at Year 1 that continued through Year 2 (P<0·05); no change in adult BMI was observed. Child fruit/vegetable consumption increased (P=0·006) and mean television watching decreased for children (P=0·05) and adults (P=0·002). Reported adult self-efficacy for health-related behaviour changes (P=0·006) and quality of life increased (P=0·02).

Conclusions: Although no effect of delivery method was demonstrated, toolkit exposure positively affected adult and child health. The intervention was well received by community partners; a more comprehensive intervention is currently underway based on these findings.

Keywords: American Indian; Community-based participatory research; Early childhood; Family; Home-based intervention; Nutrition; Paediatric obesity; Physical activity.

Figures

Fig. 1
Fig. 1
Healthy Children, Strong Families study flow diagram. ‘Family’ indicates the adult–child dyad
Fig. 2
Fig. 2
Adult BMI (a) and child BMI percentile (b) by weight status (, normal weight; , overweight; , obese class I (adults)/obese (children); , obese class II (adults only)) at baseline, post-intervention (Year 1) and follow-up (Year 2) for combined study arms (mailed group plus mentored group); Healthy Children, Strong Families intervention among American Indian families with young children (2–5-year-olds), Wisconsin, USA. Data are presented as means with their standard errors represented by vertical bars

References

    1. Vamosi M, Heitmann BL & Kyvik KO (2010) The relation between an adverse psychological and social environment in childhood and the development of adult obesity: a systematic literature review. Obes Rev 11, 177–184.
    1. Dixon B, Pena MM & Taveras EM (2012) Lifecourse approach to racial/ethnic disparities in childhood obesity. Adv Nutr 3, 73–82.
    1. Nader PR, Huang TT, Gahagan S et al.. (2012) Next steps in obesity prevention: altering early life systems to support healthy parents, infants, and toddlers. Child Obes 8, 195–204.
    1. Dalenius K, Borland E, Smith B et al.. (2012) Pediatric Nutrition Surveillance 2010 Report. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention.
    1. Whitaker RC, Wright JA, Pepe MS et al.. (1997) Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med 337, 869–873.
    1. Pan L, May AL, Wethington H et al.. (2013) Incidence of obesity among young us children living in low-income families, 2008–2011. Pediatrics 132, 1006–1013.
    1. Hoelscher DM, Kirk S, Ritchie L et al.. (2013) Position of the Academy of Nutrition and Dietetics: interventions for the prevention and treatment of pediatric overweight and obesity. J Acad Nutr Diet 113, 1375–1394.
    1. Bruss MB, Morris J & Dannison L (2003) Prevention of childhood obesity: sociocultural and familial factors. J Am Diet Assoc 103, 1042–1045.
    1. Strauss RS & Knight J (1999) Influence of the home environment on the development of obesity in children. Pediatrics 103, e85.
    1. Lindsay AC, Sussner KM, Kim J et al.. (2006) The role of parents in preventing childhood obesity. Future Child 16, 169–186.
    1. Davison KK, Jurkowski JM, Li K et al.. (2013) A childhood obesity intervention developed by families for families: results from a pilot study. Int J Behav Nutr Phys Act 10, 3.
    1. Waters E, de Silva-Sanigorski A, Hall BJ et al.. (2011) Interventions for preventing obesity in children. Cochrane Database Syst Rev issue 12, CD001871.
    1. LaRowe TL, Wubben DP, Cronin KA et al.. (2007) Development of a culturally appropriate, home-based nutrition and physical activity curriculum for Wisconsin American Indian families. Prev Chronic Dis 4, A109.
    1. Adams AK, LaRowe TL, Cronin KA et al.. (2012) The Healthy Children, Strong Families intervention: design and community participation. J Prim Prev 33, 175–185.
    1. Kuczmarski RJ, Ogden CL, Grummer-Strawn LM et al.. (2000) CDC growth charts: United States. Adv Data issue 314, 1–27.
    1. Spear BA, Barlow SE, Ervin C et al.. (2007) Recommendations for treatment of child and adolescent overweight and obesity. Pediatrics 120, Suppl. 4, S254–S288.
    1. Centers for Disease Control and Prevention (2015) About Adult BMI. (accessed May 2015).
    1. LaRowe TL, Adams AK, Jobe JB et al.. (2010) Dietary intakes and physical activity among preschool-aged children living in rural American Indian communities before a family-based healthy lifestyle intervention. J Am Diet Assoc 110, 1049–1057.
    1. Ware J, Kosinski M & Keller SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34, 220–233.
    1. Little R & Yau L (1996) Intent-to-treat analysis for longitudinal studies with drop-outs. Biometrics 52, 1324–1333.
    1. Sterne JA, White IR, Carlin JB et al.. (2009) Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ 338, b2393.
    1. White IR, Royston P & Wood AM (2011) Multiple imputation using chained equations: issues and guidance for practice. Stat Med 30, 377–399.
    1. Margolius D, Bodenheimer T, Bennett H et al.. (2012) Health coaching to improve hypertension treatment in a low-income, minority population. Ann Fam Med 10, 199–205.
    1. Janicke DM, Lim CS, Mathews AE et al.. (2013) The community-based healthy-lifestyle intervention for rural preschools (CHIRP) study: design and methods. Contemp Clin Trials 34, 187–195.
    1. Williamson DF (1993) Descriptive epidemiology of body weight and weight change in US adults. Ann Intern Med 119, 646–649.
    1. Curioni CC & Lourenco PM (2005) Long-term weight loss after diet and exercise: a systematic review. Int J Obes (Lond) 29, 1168–1174.
    1. Sciamanna CN, Kiernan M, Rolls BJ et al.. (2011) Practices associated with weight loss versus weight-loss maintenance results of a national survey. Am J Prev Med 41, 159–166.
    1. Sarwer DB, von Sydow Green A, Vetter ML et al.. (2009) Behavior therapy for obesity: where are we now? Curr Opin Endocrinol Diabetes Obes 16, 347–352.
    1. Lora KR, Sisson SB, DeGrace BW et al.. (2014) Frequency of family meals and 6–11-year-old children’s social behaviors. J Fam Psychol 28, 577–582.
    1. Berge JM, Wall M, Hsueh TF et al.. (2014) The protective role of family meals for youth obesity: 10-year longitudinal associations. J Pediatr 166, 296–301.
    1. Birch L & Fisher J (1998) Development of eating behaviors among children and adolescents. Pediatrics 101, 539–549.
    1. Faith MS, Berman N, Heo M et al.. (2001) Effects of contingent television on physical activity and television viewing in obese children. Pediatrics 107, 1043–1048.
    1. Davis SM, Sanders SG, FitzGerald CA et al.. (2013) CHILE: an evidence-based preschool intervention for obesity prevention in Head Start. J Sch Health 83, 223–229.

Source: PubMed

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