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Published in: Journal of Community Health 6/2010

01-12-2010 | Original paper

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

Authors: Njeri Karanja, Tam Lutz, Cheryl Ritenbaugh, Gerardo Maupome, Joshua Jones, Thomas Becker, Mikel Aickin

Published in: Journal of Community Health | Issue 6/2010

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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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Literature
1.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
2.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
3.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
4.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
5.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
6.
go back to reference 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. 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.
7.
go back to reference 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.PubMed 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.PubMed
8.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
9.
go back to reference Campbell, D., & Stanley, J. C. (1963). Experimental and quasi-experimental designs for research. Chicago: Rand McNally College Publishing Company. Campbell, D., & Stanley, J. C. (1963). Experimental and quasi-experimental designs for research. Chicago: Rand McNally College Publishing Company.
10.
go back to reference Wasik, B. H., & Bryant, D. M. (2001). Home visiting: Procedures for helping families. Thousand Oaks, CA: Sage publications. Wasik, B. H., & Bryant, D. M. (2001). Home visiting: Procedures for helping families. Thousand Oaks, CA: Sage publications.
11.
go back to reference 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. 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.
12.
go back to reference Miltenberger, R. G. (2008). Behavior modification: Principles and procedures (4th ed.). Pacific Grove, CA: Thomson/Wadsworth publishing. Miltenberger, R. G. (2008). Behavior modification: Principles and procedures (4th ed.). Pacific Grove, CA: Thomson/Wadsworth publishing.
13.
go back to reference Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change (2nd ed.). New York, NY: Guilford Press. Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change (2nd ed.). New York, NY: Guilford Press.
14.
go back to reference 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. 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.
15.
go back to reference 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. 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.
16.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
17.
go back to reference Ludwig, D. S. (2007). Childhood obesity—The shape of things to come. New England Journal of Medicine, 357, 2325–2327.CrossRefPubMed Ludwig, D. S. (2007). Childhood obesity—The shape of things to come. New England Journal of Medicine, 357, 2325–2327.CrossRefPubMed
18.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
19.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
20.
go back to reference 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.CrossRef 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.CrossRef
Metadata
Title
The TOTS Community Intervention to Prevent Overweight in American Indian Toddlers Beginning at Birth: A Feasibility and Efficacy Study
Authors
Njeri Karanja
Tam Lutz
Cheryl Ritenbaugh
Gerardo Maupome
Joshua Jones
Thomas Becker
Mikel Aickin
Publication date
01-12-2010
Publisher
Springer US
Published in
Journal of Community Health / Issue 6/2010
Print ISSN: 0094-5145
Electronic ISSN: 1573-3610
DOI
https://doi.org/10.1007/s10900-010-9270-5

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