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
References
Ogden, C. L., Flegal, K. M., Carroll, M. D., & Johnson, C. L. (2002). Prevalence and trends in overweight among US children and adolescents, 1999–2000. JAMA, 288, 1728–1732.
Hedley, A. A., Ogden, C. L., Johnson, C. L., Carroll, M. D., Curtin, L. R., Flegal, K. M., et al. (2004). Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. JAMA, 291, 2847–2850.
Zephier, E., Himes, J. H., & Story, M. (1999). Prevalence of overweight and obesity in American Indian school children and adolescents in the Aberdeen area: A population study. International Journal of Obesity and Related Metabolic Disorders, 23(Suppl 2), S28–S30.
Lindsay, R. S., Cook, V., Hanson, R. L., Salbe, A. D., Tataranni, A., Knowler, W. C., et al. (2002). Early excess weight gain of children in the Pima Indian population. Pediatrics, 109, E33.
Touger, L., Looker, H. C., Krakoff, J., Lindsay, R. S., Cook, V., & Knowler, W. C. (2005). Early growth in offspring of diabetic mothers. Diabetes Care, 28, 585–589.
Polhamus, B., Dalenius, K., Borland, E., Smith, B., & Grummer-Strawn, L. (2007). Pediatric nutrition surveillance 2006 report. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention.
Owen, C. G., Martin, R. M., Whincup, P. H., Davey-Smith, G., Gillman, M. W., & Cook, D. G. (2005). The effect of breastfeeding on mean body mass index throughout life: A quantitative review of published and unpublished observational evidence. American Journal of Clinical Nutrition, 82, 1298–1307.
Nelson, J. A., Carpenter, K., & Chiasson, M. A. (2006). Diet, activity, and overweight among preschool-age children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Preventing Chronic Disease, 3, A49.
Campbell, D., & Stanley, J. C. (1963). Experimental and quasi-experimental designs for research. Chicago: Rand McNally College Publishing Company.
Wasik, B. H., & Bryant, D. M. (2001). Home visiting: Procedures for helping families. Thousand Oaks, CA: Sage publications.
Crane, B., & Dean, C. (1999). Empowerment skills for family workers: The comprehensive curriculum of the New York State family development credential, trainer’s manual. Ithaca, NY: Cornell Empowering Families Project.
Miltenberger, R. G. (2008). Behavior modification: Principles and procedures (4th ed.). Pacific Grove, CA: Thomson/Wadsworth publishing.
Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change (2nd ed.). New York, NY: Guilford Press.
DiClemente, C. C., & Velasquez, M. W. (2002). Motivational interviewing and the stages of change. In W. R. Miller & S. Rollnick (Eds.), Motivational interviewing: Preparing people for change (2nd ed., pp. 217–250). New York, NY: Guilford Press.
World Health Organization. Indicators for assessing infant and young child feeding practices. Part 1, Definitions. Conclusions of a consensus meeting held 6–8 November 2007 in Washington, DC, USA.
Perez-Escamilla, R., Segura-Milla, S., Pollitt, E., & Dewey, K. G. (1992). Effect of the maternity ward system on the lactation success of low-income urban Mexican women. Early Human Development, 31, 25–40.
Ludwig, D. S. (2007). Childhood obesity—The shape of things to come. New England Journal of Medicine, 357, 2325–2327.
Stettler, N., Zemel, B. S., Kumanyika, S., & Stallings, V. A. (2002). Infant weight gain and childhood overweight status in a multicenter, cohort study. Pediatrics, 109, 194–199.
Suarez-Balcazar, Y., Redmond, L., Kouba, J., Hellwig, M., Davis, R., Martinez, L. I., et al. (2007). Introducing systems change in the schools: The case of school luncheons and vending machines. American Journal of Community Psychology, 39, 335–345.
Costom, B. H., & Shore, D. (1983). Effect of a comprehensive nutritional program on the growth and ponderosity of infants. Clinical Pediatrics (Phila), 22, 105–111.
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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