The Journal of Primary Prevention

, Volume 33, Issue 4, pp 161–174 | Cite as

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

  • Njeri Karanja
  • Mikel Aickin
  • Tam Lutz
  • Scott Mist
  • Jared B. Jobe
  • Gerardo Maupomé
  • Cheryl Ritenbaugh
Research Methods and Practice


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.


Primary obesity prevention Infants Toddlers American Indians 


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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Njeri Karanja
    • 1
  • Mikel Aickin
    • 2
  • Tam Lutz
    • 4
  • Scott Mist
    • 4
  • Jared B. Jobe
    • 3
    • 6
  • Gerardo Maupomé
    • 5
  • Cheryl Ritenbaugh
    • 2
  1. 1.Center for Health ResearchKaiser Permanente–Northwest/Hawaii/SoutheastPortlandUSA
  2. 2.Department of Family and Community MedicineUniversity of ArizonaTucsonUSA
  3. 3.Division of Cardiovascular SciencesNational Heart, Lung and Blood InstituteBethesdaUSA
  4. 4.Northwest Portland Area Indian Health BoardPortlandUSA
  5. 5.Department of Preventive and Community DentistryIndiana University School of Dentistry, The Regenstrief Institute, IncIndianapolisUSA
  6. 6.Division of Cancer Control and Population ScienceNational Cancer InstituteRockvilleUSA

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