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The TOTS Community Intervention to Prevent Overweight in American Indian Toddlers Beginning at Birth: A Feasibility and Efficacy Study

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Abstract

Excess weight gain in American Indian/Alaskan native (AI/AN) children is a public health concern. This study tested (1) the feasibility of delivering community-wide interventions, alone or in combination with family-based interventions, to promote breastfeeding and reduce the consumption of sugar-sweetened beverages; and (2) whether these interventions decrease Body Mass Index (BMI)-Z scores in children 18–24 months of age. Three AI/AN tribes were randomly assigned to two active interventions; a community-wide intervention alone (tribe A; n = 63 families) or community-wide intervention containing a family component (tribes B and C; n = 142 families). Tribal staff and the research team designed community-tailored interventions and trained community health workers to deliver the family intervention through home visits. Feasibility and acceptability of the intervention and BMI-Z scores at 18–24 months were compared between tribe A and tribes B & C combined using a separate sample pretest, posttest design. Eighty-six percent of enrolled families completed the study. Breastfeeding initiation and 6-month duration increased 14 and 15%, respectively, in all tribes compared to national rates for American Indians. Breastfeeding at 12 months was comparable to national data. Parents expressed confidence in their ability to curtail family consumption of sugar-sweetened beverages. Compared to a pretest sample of children of a similar age 2 years before the study begun, BMI-Z scores increased in all tribes. However, the increase was less in tribes B & C compared to tribe A (−0.75, P = 0.016). Family, plus community-wide interventions to increase breastfeeding and curtail sugar-sweetened beverages attenuate BMI rise in AI/AN toddlers more than community-wide interventions alone.

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Abbreviations

BMI:

Body Mass Index

PedNSS:

Pediatric Nutrition Surveillance System

WHO:

World Health Organization

IHS:

Indian Health Service

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Author information

Authors and Affiliations

  1. Center for Health Research, Kaiser, Permanente-Northwest 3800 N. Interstate Avenue, Portland, OR, 97227, USA

    Njeri Karanja

  2. Northwest Portland Area Indian Health Board, Portland, OR, USA

    Tam Lutz

  3. Department of Family and Community Medicine, University of Arizona, Tuscon, AZ, USA

    Cheryl Ritenbaugh & Mikel Aickin

  4. Department of Preventive and Community Dentistry, The Regenstrief Institute, Indiana University School of Dentistry, Indianapolis, IN, USA

    Gerardo Maupome

  5. City of Chicago, Department of Public Health, Chicago, IL, USA

    Joshua Jones

  6. Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR, USA

    Thomas Becker

Authors
  1. Njeri Karanja
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  2. Tam Lutz
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  3. Cheryl Ritenbaugh
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  4. Gerardo Maupome
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  5. Joshua Jones
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  6. Thomas Becker
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  7. Mikel Aickin
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Corresponding author

Correspondence to Njeri Karanja.

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Karanja, N., Lutz, T., Ritenbaugh, C. et al. The TOTS Community Intervention to Prevent Overweight in American Indian Toddlers Beginning at Birth: A Feasibility and Efficacy Study. J Community Health 35, 667–675 (2010). https://doi.org/10.1007/s10900-010-9270-5

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  • DOI: https://doi.org/10.1007/s10900-010-9270-5

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