PREVENTING DIABETES--A MOHAWK COMMUNITY INITIATIVE

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Non-insulin dependent diabetes mellitus (NIDDM) and obesity (its major risk factor) are disorders of epidemic proportion in Native American communities and they are occurring at progressively earlier ages. The long-term goal of this proposal is to reduce the prevalence of NIDDM in the Mohawk people in Akwesasne by supporting the development of an enduring community commitment to healthy lifestyles and by enhancing the community's capacity to facilitate more physical activity and a lower caloric intake, especially from fats. The primary target of the intervention in this study will be the children aged 5-8 years living in Akwesasne and a secondary target will be their parents. The major outcomes sought during the study period are; 1. a reduction in the proportion of children eating diets containing 38% fat, from the median national level of 50% to 35%; 2. an increase in the proportion of children reporting playing running games or sports more than 3 times per week from 75% to 90% and a reduction in the proportion of children watching more than 2 hours of television per day from 65% to 50%; 3. a reduction int he proportion of children with a body mass index above the 85th percentile from the current level of 43% to 30%, an objective consistent with the Healthy People 2000 goal for Native Americans. The effectiveness of the broad-based community health education approach, which will address a wide range of community needs, will be tested in a quasi-experimental design, using pre- and post-measurements in a cohort of 5-8 year old children who will be compared longitudinally over 5 years, and cross-sectionally with a second cohort of 5-8 year old children 5 years later. In addition changes over time in the first cohort will be compared with those in the children of the same age living in Kahnawake (a similarly sized Mohawk community 300 miles away) to compare the effectiveness of the community-wide effort to prevent NIDDM with the focused approach of a school health education curriculum that will emphasize dietary behavior, exercise and weight control, that is being undertaken in Kahnawake.