OBESITY PREVENTION IN AMERICAN INDIANS & ALASKA NATIVES

该提案描述了一项分两个阶段的干预和评估计划 以学校和家庭为基础的干预措施，旨在降低患病率 居住在印第安人保留地的美国印第安人儿童的肥胖率 在印度卫生服务机构的阿伯丁地区。干预措施 包括旨在教授技能的学校课程，以限制过度 通过健康的饮食和规律的体力活动增加体重， 修改学校膳食以降低脂肪和增加复合体 碳水化合物和以家庭为基础的家庭组件 加强和支持学校项目。此外，还将有 预订杂货店参与以增加可获得性 低脂肪食物选择，水果和蔬菜。 第一阶段是一个为期三年的发展阶段， 将制定干预和评估材料和方案， 试点-测试和修订，与其他外地中心共同资助 在这份RFA下。第二阶段拟议为六年实施，并 评估阶段，其中干预计划将受到 在每个田径中心的小学进行全面的田野评估。每个人 菲尔德中心将招募6-8所小学进行随机试验 有两种研究条件，一种干预条件和对照 条件。对于第二阶段，两组三年级学生(2 连续课程)将每年跟踪调查四次 几年到六年级结束。在他们的第三，第四， 和五年级，两个队列在干预条件下 将接受以学校和家庭为基础的干预活动 来改变他们的饮食和体育活动行为。以学校为本 干预措施包括课堂课程、体育课程和 以及学校餐饮服务的变化。以家庭为基础的干预 包括家庭活动计划和家庭之夜。干预措施 组件的开发将由美国印第安人直接投入 在需求评估阶段通过重点小组和面谈， 以及来自美国印第安人咨询委员会的持续投入。 主要的结果衡量标准将是体重指数和 三头肌和肩胛下部位皮褶厚度的总和。 次要结果包括减少膳食脂肪和过量卡路里 以及增加中等到剧烈的体力活动。 这是第一阶段的规划和可行性研究提案，将 制定和试行以下两项干预措施和评估 南达科他州的保留区、玫瑰花蕾保留区和松岭 保留，在每个保留地的一所学校。

This proposal describes a two-phase intervention and evaluation plan for a school and family-based intervention designed to reduce the prevalence of obesity among American Indian children residing on Indian reservations in the Aberdeen Area of the Indian Health Service. The interventions include school curricula designed to teach skills to limit excessive weight gain through a healthy diet and regular physical activity, modification of the school meals to lower fat and increase complex carbohydrates and also a family-based home component designed to reinforce and support the school program. In addition, there will be reservation grocery store involvement to increase the availability of lower fat food choices, fruits and vegetables. Phase I is proposed as a three-year development phase wherein intervention and evaluation materials and protocols will be developed, pilot-tested and revised, in concert with other Field Centers funded under this RFA. Phase II is proposed as a six-year implementation and evaluation phase wherein the intervention program will be subject to a full field evaluation in elementary schools at each Field Center. Each Field Center will recruit 6-8 elementary schools for a randomized trial with two study conditions, an Intervention Condition and Control Condition. For Phase II, two cohorts of 3rd grade students (2 consecutive classes) will be followed and surveyed annually for four years through the end of their 6th grade year. During their 3rd, 4th, and 5th grade school years, the two cohorts in the Intervention Condition will receive a program of school and family-based intervention activities to modify their eating and physical activity behaviors. The school-based interventions include classroom curricula, physical education program as well as changes in school food service. The family-based intervention includes a home activity program and family nights. The intervention components will be developed with direct input from American Indians through focus groups and interviews during the Needs Assessment phase, as well as continuing input from an American Indian Advisory Council. The primary outcome measures will be changes in the Body Mass Index and the sum of skinfold thicknesses at the triceps and subscapular sites. Secondary outcomes include reduction of dietary fat and excess calories and an increase in moderate to vigorous physical activity. This proposal for Phase I, the planning and feasibility study, will develop and pilot-test the interventions and evaluations on two reservations in South Dakota, the Rosebud Reservation and Pine Ridge Reservation, in one school on each reservation.