OBESITY PREVENTION IN AMERICAN INDIANS--FIELD CENTER

这项建议是一项为期三年的规划和可行性研究 并测试一个为期六年的全面干预计划，与 其他选定的外地中心响应NHLBI RFA，标题为： “美洲印第安人/阿拉斯加原住民肥胖的初级预防。” 美洲原住民社区几种慢性病的发病率很高， 最明显的是糖尿病和肥胖症。美国肥胖症的增加。 人口，特别是在美洲原住民中， 论证全面干预研究的必要性，旨在 扭转这一全国趋势。为Pima和Tohono O‘odham印第安人 在这个田野中心的参与者中，肥胖的早期发病 青春期前儿童的平均水平已经上升到令人震惊的水平 8-10岁儿童的身体质量指数已达到或超过95 美国总人口的百分位数。我们已经对身体进行了估计 这些孩子的脂肪含量，发现大约50%是肥胖的 相比之下，这个年龄段的美国人口只有5%-10%。在这 我们已经开发了一个多学科干预计划， 是以学校、家庭和社区为基础的，这源于社会 学习理论和采用扩散模型。该计划一直是 根据之前的计划适应美洲原住民社区 在吉拉河和Tohono O‘odham印第安人社区开发。这个 干预计划旨在增加体力活动水平和 自尊和改变饮食摄入量，包括校外 以及在校课程，全面的暑期计划，以及 面向学校教职员工、家长和社区的计划。在第一次 年，我们提出了一种文化分析，以进一步选择和调整课程 对这群人来说。在第二年和第三年，我们建议 对体能课程进行广泛的试点测试， 心理社会发展与营养教育。此外，我们还将 评估主要的(身体成分)和次要的可靠性 终点(体力活动和健康、饮食摄入量的测量 和选定的心理社会测量)。对于全面的，六年制 干预研究，我们提出了一项随机临床试验，为期四年 针对二年级、三年级、四年级和五年级学生的干预计划 每两个队列中各有300名儿童。规模相仿的学校和其他 特征将被配对并随机分配给肥胖者 干预性武装或控制(酒精和药物滥用)方案，因此 使所有儿童都能接受预防教育。我们的建议 干预计划包括在吉拉河工作的专业人员， Tohono O‘odham和Salt River印第安人社区， 亚利桑那大学和美国国立卫生研究院的顾问 克利夫兰诊所的糖尿病、消化和肾脏疾病 基金会、地中海研究所和国家研究所 酒精中毒和酗酒。这些个人集体提供 在健康促进、校本干预方面的专门知识 计划、营养教育和评估、身体成分 评估、体力活动评估和健身教育，实质 虐待、临床心理学、儿科学、流行病学和生物统计学。

This proposal is a three-year planning and feasibility study to develop and test a six-year, full-scale intervention program in coordination with other selected field centers in response to the NHLBI RFA titled: "Primary Prevention of Obesity in American Indians/Alaska Natives." Native American communities have high rates of several chronic diseases, most notably diabetes and obesity. The increase in obesity in the U.S. population, and particularly in the Native American population, demonstrates the need for comprehensive intervention studies designed to reverse this national trend. For Pima and Tohono O'odham Native American participants in this field center, the early onset of obesity in preadolescent children has increased to alarming levels with the mean body mass index in 8 to 10 year-old children already at or above the 95th percentile for the general U.S. population. We have estimated the body fat content of these children and found that about 50% are obese as compared to only 5-10% of the U.S. population in this age group. In this proposal we have developed a multidisciplinary intervention program that is school, family, and community-based and that draws from social learning theory and adoption-diffusion models. The program has been adapted to the Native American community based on programs previously developed at the Gila River and Tohono O'odham Indian communities. The intervention program is designed to increase physical activity levels and self-esteem and to modify dietary intake and includes an out-of-school as well as in-school curriculum, a comprehensive summer program, and programs for the school staff, parents and community. During the first year we propose a cultural analysis to further select and adapt curricula for this population. During the second and third years we propose extensive pilot testing of the curricula in physical fitness, psychosocial development and nutrition education. In addition, we will assess the reliability of both primary (body composition) and secondary endpoints (measurements of physical activity and fitness, dietary intake and selected psychosocial measurements). For the full-scale, six-year intervention study, we propose a randomized clinical trial and four-year intervention program for second, third, fourth and fifth graders using 300 children in each of two cohorts. Schools of similar size and other characteristics will be paired and randomly assigned to either an obesity intervention arm or control (alcohol and substance abuse) program, thus enabling all children to receive prevention education. Our proposed intervention program includes professionals working at the Gila River, Tohono O'odham and Salt River Indian communities, scholars at The University of Arizona and consultants from the National Institute of Diabetes and Digestive and Kidney diseases, the Cleveland Clinic Foundation, the Medlantic Research Institute and the National Institute of Alcoholism and Alcohol Abuse. These individuals collectively provide expertise in the areas of health promotion, school-based intervention programs, nutrition education and assessment, body composition assessment, physical activity assessment and fitness education, substance abuse, clinical psychology, pediatrics, epidemiology, and biostatistics.