Journal of Community Health

, Volume 35, Issue 6, pp 667–675

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

  • Njeri Karanja
  • Tam Lutz
  • Cheryl Ritenbaugh
  • Gerardo Maupome
  • Joshua Jones
  • Thomas Becker
  • Mikel Aickin
Original paper

DOI: 10.1007/s10900-010-9270-5

Cite this article as:
Karanja, N., Lutz, T., Ritenbaugh, C. et al. J Community Health (2010) 35: 667. doi:10.1007/s10900-010-9270-5


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.


Obesity prevention Infants Toddlers Breastfeeding Sugar-sweetened beverages 



Body Mass Index


Pediatric Nutrition Surveillance System


World Health Organization


Indian Health Service

Supplementary material

10900_2010_9270_MOESM1_ESM.doc (82 kb)
Supplementary material 1 (DOC 83 kb)

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Njeri Karanja
    • 1
  • Tam Lutz
    • 2
  • Cheryl Ritenbaugh
    • 3
  • Gerardo Maupome
    • 4
  • Joshua Jones
    • 5
  • Thomas Becker
    • 6
  • Mikel Aickin
    • 3
  1. 1.Center for Health ResearchPortlandUSA
  2. 2.Northwest Portland Area Indian Health BoardPortlandUSA
  3. 3.Department of Family and Community MedicineUniversity of ArizonaTusconUSA
  4. 4.Department of Preventive and Community Dentistry, The Regenstrief InstituteIndiana University School of DentistryIndianapolisUSA
  5. 5.City of Chicago, Department of Public HealthChicagoUSA
  6. 6.Department of Public Health and Preventive MedicineOregon Health and Science UniversityPortlandUSA

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