The TOTS Community Intervention to Prevent Overweight in American Indian Toddlers Beginning at Birth: A Feasibility and Efficacy Study
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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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- The TOTS Community Intervention to Prevent Overweight in American Indian Toddlers Beginning at Birth: A Feasibility and Efficacy Study
Journal of Community Health
Volume 35, Issue 6 , pp 667-675
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Obesity prevention
- Sugar-sweetened beverages
- Author Affiliations
- 1. Center for Health Research, Kaiser, Permanente-Northwest 3800 N. Interstate Avenue, Portland, OR, 97227, USA
- 2. Northwest Portland Area Indian Health Board, Portland, OR, USA
- 3. Department of Family and Community Medicine, University of Arizona, Tuscon, AZ, USA
- 4. Department of Preventive and Community Dentistry, The Regenstrief Institute, Indiana University School of Dentistry, Indianapolis, IN, USA
- 5. City of Chicago, Department of Public Health, Chicago, IL, USA
- 6. Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR, USA