Tomayko Emily J, Prince Ronald J, Cronin Kate A, Kim KyungMann, Parker Tassy, Adams Alexandra K
Nutrition, School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR.
Departments of Population Health, University of Wisconsin, Madison, WI.
Curr Dev Nutr. 2018 Nov 16;3(Suppl 2):53-62. doi: 10.1093/cdn/nzy087. eCollection 2019 Aug.
American Indian (AI) families experience a disproportionate risk of obesity due to a number of complex reasons, including poverty, historic trauma, rural isolation or urban loss of community connections, lack of access to healthy foods and physical activity opportunities, and high stress. Home-based obesity prevention interventions are lacking for these families.
Healthy Children, Strong Families 2 (HCSF2) was a randomized controlled trial of a healthy lifestyle promotion/obesity prevention intervention for AI families.
Four hundred and fifty dyads consisting of an adult primary caregiver and a child ages 2 to 5 y from 5 AI communities were randomly assigned to a monthly mailed healthy lifestyle intervention toolkit () with social support or to a child safety control toolkit () for 1 y. The toolkit targeted increased fruit/vegetable (F/V) intake and physical activity, improved sleep, decreased added sugar intake and screen time, and improved stress management (adults only). Anthropometrics were collected, and health behaviors were assessed via survey at baseline and at the end of Year 1. Adults completed surveys for themselves and the participating child. Repeated measures analysis of variance was used to assess change over the intervention period.
Significant improvements to adult and child healthy diet patterns, adult F/V intake, adult moderate-to-vigorous physical activity, home nutrition environment, and adult self-efficacy for health behavior change were observed in compared with families. No changes were observed in adult body mass index (BMI), child BMI z-score, adult stress measures, adult/child sleep and screen time, or child physical activity. Qualitative feedback suggests the intervention was extremely well-received by both the families and our community partners across the 5 participating sites.
This multi-site community-engaged intervention addressed key gaps regarding family home-based approaches for early obesity prevention in AI communities and showed several significant improvements in health behaviors. Multiple communities are working to sustain intervention efforts. This trial was registered at clinicaltrials.gov as NCT01776255.
由于多种复杂原因，美国印第安（AI）家庭面临着不成比例的肥胖风险，这些原因包括贫困、历史创伤、农村地区的孤立或城市社区联系的丧失、缺乏获得健康食品和体育活动机会以及高压力。针对这些家庭的家庭肥胖预防干预措施尚缺。
“健康儿童，强壮家庭2（HCSF2）”是一项针对AI家庭的健康生活方式促进/肥胖预防干预措施的随机对照试验。
来自5个AI社区的450对由一名成年主要照料者和一名2至5岁儿童组成的二元组被随机分配到每月邮寄一次的、有社会支持的健康生活方式干预工具包（）或儿童安全对照工具包（）中，为期1年。干预工具包的目标是增加水果/蔬菜（F/V）摄入量和体育活动，改善睡眠，减少添加糖摄入量和屏幕时间，并改善压力管理（仅限成年人）。在基线和第1年末收集人体测量数据，并通过调查评估健康行为。成年人完成针对自己和参与研究的儿童的调查。采用重复测量方差分析来评估干预期间的变化。
与对照家庭相比，干预家庭在成人和儿童健康饮食模式、成人F/V摄入量、成人中度至剧烈体育活动、家庭营养环境以及成人健康行为改变自我效能方面有显著改善。在成人体重指数（BMI）、儿童BMI z评分、成人压力测量、成人/儿童睡眠和屏幕时间或儿童体育活动方面未观察到变化。定性反馈表明，该干预措施在5个参与地点均受到家庭和社区合作伙伴的高度好评。
这项多地点社区参与的干预措施解决了AI社区家庭早期肥胖预防的家庭干预方法方面的关键差距，并在健康行为方面显示出多项显著改善。多个社区正在努力维持干预措施。该试验已在clinicaltrials.gov上注册，注册号为NCT01776255。
