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A Community-Based Intervention to Prevent Obesity Beginning at Birth Among American Indian Children: Study Design and Rationale for the PTOTS Study

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Abstract

Eating and physical activity behaviors associated with adult obesity have early antecedents, yet few studies have focused on obesity prevention interventions targeting very young children. Efforts to prevent obesity beginning at birth seem particularly important in populations at risk for early-onset obesity. National estimates indicate that American Indian (AI) children have higher rates of overweight and obesity than children of other races/ethnicities. The Prevention of Toddler Obesity and Teeth Health Study (PTOTS) is a community-partnered randomized controlled trial designed to prevent obesity beginning at birth in AI children. PTOTS was developed to test the effectiveness of a multi-component intervention designed to: promote breastfeeding, reduce sugar-sweetened beverage consumption, appropriately time the introduction of healthy solid foods, and counsel parents to reduce sedentary lifestyles in their children. A birth cohort of 577 children from five AI tribes is randomized by tribe to either the intervention (three tribes) or the comparison condition (two tribes). The strengths and weaknesses of PTOTS include a focus on a critical growth phase, placement in the community, and intervention at many levels, using a variety of approaches.

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Acknowledgments

This work was supported by NIH Grant# HL081624 through the National Heart Lung and Blood Institute. We are grateful to the tribal governments of the following communities for supporting this work: the Coeur d’Alene Tribe, the Confederated Tribes of the Colville Reservation, the Confederated Salish and Kootenai Tribes, Confederated Tribes of the Umatilla Indian Reservation, and the Yakima Indian Nation. The following key staff assisted the study team and provided advice on ways to implement the study in their communities:Coeur d’Alene Tribe:Benewah Medical Center Community Health Program: Cathy Armstrong, Kacy Ross, Andy Rae Zachary, Veronica Torpey, and Robin Hodgson. Confederated Tribes of the Colville Reservation: Tribal Health Program: Zekkethal Vargas, Dee GunShows, Mary Fry, Rena Whiteman, Sharon Peterson, Quail Orr, and Diane Mills. Confederated Salish and Kootenai Tribes: Department of Human Resources Development: Arlene Templer, Betty Weaselhead, Marcia Billedeaux, Weemus Wilder, and Camilla Kenmille. Salish Kootenai College: Anita Dupuis, Margaret Wheeler, and Carol Tenney. Confederated Tribes of the Umatilla Indian Reservation: Yellowhawk Tribal Health Center Community Health Program: Charlie Picard, Debra Shippentower, Wenona Laso, Carrie Sampson, and Sydelle Harris. Yakama Indian Nation: Yakama Tribal Health Maternal Child Health Program: Rosalie George, Evelyn Broncheau, and Gail Ganuelas. Tribal Dental Expert: Maxine Brings Him Back Janis, MPH, RDH (Oglala Sioux), Assistant Professor, Northern Arizona University Department of Dental Hygiene.

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  1. Jared B. Jobe

    Present address: Division of Cancer Control and Population Science, National Cancer Institute, Rockville, MD, USA

Authors and Affiliations

  1. Center for Health Research, Kaiser Permanente–Northwest/Hawaii/Southeast, 3800 N. Interstate Avenue, Portland, OR, 97227, USA

    Njeri Karanja

  2. Department of Family and Community Medicine, University of Arizona, Tucson, AZ, USA

    Mikel Aickin & Cheryl Ritenbaugh

  3. Division of Cardiovascular Sciences, National Heart, Lung and Blood Institute, Bethesda, MD, USA

    Jared B. Jobe

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

    Tam Lutz & Scott Mist

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

    Gerardo Maupomé

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Karanja, N., Aickin, M., Lutz, T. et al. A Community-Based Intervention to Prevent Obesity Beginning at Birth Among American Indian Children: Study Design and Rationale for the PTOTS Study. J Primary Prevent 33, 161–174 (2012). https://doi.org/10.1007/s10935-012-0278-8

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