The TOTS community intervention to prevent overweight in American Indian toddlers beginning at birth: a feasibility and efficacy study.
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.
Center for Health Research, Kaiser, Permanente-Northwest 3800 N. Interstate Avenue, Portland, OR 97227, USA. Njeri.Karanja@kpchr.org
Njeri
N
Karanja
Tam
T
Lutz
Cheryl
C
Ritenbaugh
Gerardo
G
Maupome
Joshua
J
Jones
Thomas
T
Becker
Mikel
M
Aickin
D001628:Beverages / Q000009:adverse effects; D015992:Body Mass Index; D001942:Breast Feeding / Q000208:ethnology; D002662:Child Health Services / Q000458:organization & administration*; D002664:Child Nutritional Physiological Phenomena / Q000208:ethnology; D002675:Child, Preschool; D019422:Dietary Sucrose / Q000008:administration & dosage; D005240:Feasibility Studies; D006801:Humans; D007198:Indians, North American / Q000523:psychology* / Q000706:statistics & numerical data; D007223:Infant; D009765:Obesity / Q000208:ethnology / Q000517:prevention & control; D050177:Overweight / Q000208:ethnology* / Q000517:prevention & control*; D010287:Parent-Child Relations / Q000208:ethnology; D010865:Pilot Projects; D011368:Professional-Family Relations
D019422:Dietary Sucrose