Multilevel program and policies to reduce chronic disease for American Indians

减少美洲印第安人慢性病的多层次计划和政策

• 批准号: 9297331
• 负责人: Joel Gittelsohn
• 金额: $ 66.66万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-05-14 至 2020-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9297331
• 关键词: Address; Adult; American; American Indians; Area; Behavior Therapy; Body Weight; Body fat; Body mass index; Child; Chronic Disease; Communities; Complement; Consumption; Coupled; Development; Diabetes Mellitus; Diet; Effectiveness of Interventions; Environment; Fatty acid glycerol esters; Food; Fostering; Goals; Health; Health Food; Household; Institution; Intake; Intervention; Intervention Trial; Lead; Literature; Malignant Neoplasms; Names; New Mexico; Nutrient; Obesity; Physical activity; Policies; Policy Developments; Policy Maker; Population; Prevention Research; Prevention program; Prevention strategy; Prevention trial; Program Sustainability; Psychosocial Factor; Randomized; Randomized Controlled Trials; Research; Risk Behaviors; Running; Schools; Testing; Time; United States National Institutes of Health; Waist-Hip Ratio; Wisconsin; Work; Workplace; base; disorder prevention; environmental intervention; evidence base; experience; food environment; fruits and vegetables; improved; innovation; instrument; interest; obesity prevention; obesity risk; prevention evaluation; programs; public health relevance; sedentary activity; successful intervention; theories; tribal health; tribal leader

 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.

 描述（由申请人提供）：美洲印第安人 (AI) 人群的肥胖率和相关慢性病 (CD) 比例异常高。旨在改变人工智能社区食物环境的干预试验已显示出积极成果，例如增加健康食品的购买和消费。当前的挑战是促进循证政策的制定，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领袖合作制定旨在减少 CD 的政策和计划，改善人工智能社区多个层面（工作场所、学校、食品店）的食物和身体活动 (PA) 环境。我们将通过开发、实施和评估基于社区的随机对照试验来实现这一目标，该试验由部落领袖通过政策支持或实施。该研究将在位于威斯康星州和新墨西哥州的六个人工智能社区进行。该项目直接建立在我们之前在五个人工智能社区的成功工作基础上，在这些社区中，我们针对食品店、工作场所和学校进行了多级肥胖预防试验 (OPREVENT)。这项拟议的试验（OPREVENT2）通过促进部落领导人制定相关政策来补充和扩展前一项试验，这对于可持续发展至关重要。 OPREVENT2 的具体目标是： 1) 进行形成性研究，描述参与人工智能社区的部落政策制定和制定，以支持部落卫生政策制定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/减少计划的有效政策； 2) 根据我们早期的试验、目标 1 的形成性研究以及科学文献中的最佳实践，为人工智能社区制定基于社区的 CD 预防计划； 3) 评估 CD 相关政策和计划对肥胖、心理社会因素和肥胖风险行为的影响，包括膳食质量（例如水果和蔬菜份量）， 社区随机对照试验中的营养摄入量和 PA。拟议的研究通过在 AI 社区中开发和测试创新的多级肥胖预防策略，将支持性政策与文化上适当的多级干预相结合，直接解决 NIH PAR-11-346 的优先事项。拟议的研究也是在当地产生的，因此更有可能是自我维持的。我们期望对 PAR 感兴趣的以下领域产生影响：部落领袖参与制定和实施 CD 政策、制定适合文化的基于社区的 CD 预防计划、增加健康食品的供应、改善饮食和 PA 以及减少肥胖。