Multilevel program and policies to reduce chronic disease for American Indians

 描述(由申请人提供)：美国印第安人(AI)人口肥胖率和相关慢性病(CD)的比例高得不成比例。旨在改善人工智能社区食物环境的干预试验显示了积极的结果，例如增加了健康食品的购买和消费。目前的挑战是促进基于证据的政策的制定，以提高环境干预措施的可持续性。拟议研究的主要目标是通过与部落首领合作制定旨在减少CD的政策和计划，在多个层面(工作场所、学校、食品店)改善人工智能社区的食物和身体活动(PA)环境。我们将通过开发、实施和评估由部落首领通过政策支持或实施的基于社区的随机对照试验来实现这一目标。这项研究将在威斯康星州和新墨西哥州的六个人工智能社区进行。这个项目直接建立在我们之前在五个人工智能社区成功工作的基础上，我们在那里进行了一项针对食品店、工作场所和学校的多级别肥胖预防试验(OPREVENT)。这项拟议的试验(OPREVENT2)是对前一次试验的补充和扩大，其目的是促进部落首领制定相关政策，这是可持续性的关键。OPREVENT2的具体目标是：1)开展形成性研究，描述参与人工智能社区的部落政策制定和颁布，以支持部落卫生决策者通过能力建设和合作伙伴关系，确定维持肥胖和慢性病预防/减少方案的有效政策；2)根据我们早期的试验、目标1的形成性研究和科学文献中的最佳做法，为人工智能社区开发基于社区的CD预防方案；3)评估CD相关政策和方案对肥胖、心理社会因素和肥胖危险行为的影响，包括饮食质量(例如，水果和蔬菜供应)， 营养摄入量和PA在社区随机对照试验中。这项拟议的研究直接解决了NIH PAR-11-346的优先事项，通过在人工智能社区开发和测试创新的多级肥胖预防策略，将支持性政策与适合文化的多级干预相结合。拟议的研究也是在当地进行的，因此更有可能是自给自足的。我们预计将影响到PAR的以下感兴趣的领域：部落首领参与制定和实施CD政策，开发基于社区的适合文化的CD预防计划，增加健康食品的可获得性，改善饮食和PA，以及减少肥胖。

 DESCRIPTION (provided by applicant): American Indian (AI) populations experience disproportionately high rates of obesity and related chronic diseases (CD). Intervention trials aimed at modifying the food environment in AI communities have shown positive results, such as increasing the purchase and consumption of healthy foods. The current challenge is to facilitate the development of evidence-based policies in order to improve the sustainability of environmental interventions. The primary goal of the proposed research is to improve the food and physical activity (PA) environments in AI communities at multiple levels (worksites, schools, food stores) by working in partnership with tribal leaders to enact policies and programs that aim to reduce CDs. We will achieve this goal by developing, implementing, and evaluating a randomized controlled community-based trial which is supported or implemented by tribal leaders through policy. The study will take place in six AI communities located in Wisconsin and New Mexico. This project builds directly on our previous successful work in five AI communities where we conducted a multilevel obesity prevention trial (OPREVENT) targeting food stores, worksites and schools. This proposed trial (OPREVENT2) complements and expands upon the previous one, by fostering the development of relevant policies among tribal leaders which is key for sustainability. The specific aims of OPREVENT2 are: 1) To conduct formative research to describe tribal policy development and enactment in participating AI communities, in order to support tribal health policy makers to identify effective policies to sustain obesity and chronic disease prevention/reduction programs, by building capacity and collaborative partnerships; 2) To develop a community-based CD prevention program for AI communities informed by our earlier trials, formative research from Aim 1 and best-practices from the scientific literature; an 3) To evaluate the impact of the CD related policies and programs on adiposity, psychosocial factors and obesity risk behaviors, including dietary quality (e.g., fruit and vegetable servings), nutrient intake, and PA in a community- randomized controlled trial. The proposed study directly addresses NIH PAR-11-346 priorities by developing and testing an innovative multilevel obesity prevention strategy in AI communities that combines supportive policy with a culturally appropriate multilevel intervention. The proposed study is also locally generated and, therefore, more likely to be self-sustaining. We expect to impact the following areas of interest to the PAR: engagement of tribal leaders in developing and implementing CD policy, development of culturally appropriate community-based CD prevention programs, and increased availability of healthy foods, improvements in diet and PA, and reductions in adiposity.