OBESITY PREVENTION IN AMERICAN INDIANS & ALASKA NATIVES

本提案描述了一个两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 居住在印第安人保留地的美国印第安儿童的肥胖率 在阿伯丁地区的印第安人健康服务中心 的干预措施 包括学校课程，旨在教授技能， 通过健康的饮食和定期的体育活动来增加体重， 修改学校的膳食，以降低脂肪和增加复杂的 碳水化合物，也是一个以家庭为基础的家庭组件， 加强和支持学校的计划。 此外还将有 预订杂货店的参与，以增加可用性， 低脂肪食物的选择，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规程， 与其他受资助的外地中心一起进行试点测试和修订 在这个RFA下。 第二阶段拟议为期六年， 评估阶段，其中干预计划将受到 在每个实地中心的小学进行全面实地评估。 每个 菲尔德中心将招募6-8所小学进行随机试验 两种研究条件，干预条件和对照 条件 对于第二阶段，两组三年级学生（2 连续的班级）将被跟踪和调查，每年四次 直到六年级结束。 在他们的第三，第四， 和五年级学年，干预条件下的两个队列 将接受学校和家庭为基础的干预活动计划 来改变他们的饮食和身体活动行为。 校本 干预措施包括课堂课程、体育课程， 以及学校食品服务的变化。 家庭干预 包括家庭活动计划和家庭之夜。 干预 美国印第安人将直接参与开发组件 在需求评估阶段通过焦点小组和访谈， 以及美国印第安人咨询理事会的持续投入。 主要结果指标将是体重指数的变化， 肱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多余的热量 以及增加中度到剧烈的身体活动。 第一阶段的规划和可行性研究建议将 制定和试点测试两个方面的干预措施和评价， 在南达科他州、玫瑰花蕾保护区和松岭的保留地 保留地，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.