OBESITY PREVENTION IN AMERICAN INDIANS--FIELD CENTER

本提案是一项为期三年的规划和可行性研究， 并测试一个为期六年的全面干预计划， 其他选定的现场中心，以响应NHLBI RFA，标题为： "美国印第安人/阿拉斯加原住民肥胖的初级预防。" 美洲原住民社区的几种慢性病发病率很高， 尤其是糖尿病和肥胖症。 美国肥胖症的增加 人口，特别是美洲原住民， 表明需要进行全面的干预研究， 扭转这一全国性趋势。 Pima和Tohono O'odham印第安人 在这个研究中心的参与者中， 青春期前的儿童已经增加到惊人的水平， 8至10岁儿童的体重指数已经达到或超过95 百分之一的美国人口。 我们估计尸体 这些儿童的脂肪含量，发现约50%是肥胖， 相比之下，这个年龄段的美国人口只有5 - 10%。 在这 我们已经制定了一项多学科干预计划， 是以学校、家庭和社区为基础的， 学习理论和采用扩散模型。 该方案已 适应美国原住民社区的基础上，以前的计划， Gila River和Tohono O'odham印第安人社区开发的。 的 干预计划旨在提高身体活动水平， 自尊和修改饮食摄入量，包括校外 以及校内课程，全面的暑期课程， 为学校工作人员、家长和社区制定计划。 在第一 今年，我们建议进行文化分析，以进一步选择和调整课程 对于这个人口。 在第二年和第三年，我们建议 对体能课程进行广泛的试点测试， 社会心理发展和营养教育。 此外，我们将 评估主要（身体成分）和次要（身体成分）的可靠性 终点（身体活动和健康的测量，饮食摄入量 和选定的心理社会测量）。 对于全面的，六年 干预研究，我们建议进行一项随机临床试验， 二、三、四、五年级学生的干预方案， 两个队列各300名儿童。 规模相近的学校和其他 特征将被配对并随机分配给肥胖者或肥胖者。 干预武装或控制（酒精和药物滥用）方案，因此， 使所有儿童都能接受预防教育。 我们提出的 干预计划包括在吉拉河工作的专业人员， Tohono O'odham和Salt River印第安人社区， 亚利桑那大学和来自美国国立卫生研究院的顾问 糖尿病、消化和肾脏疾病，克利夫兰诊所 基金会、地中海研究所和国家研究所 酒精中毒和酒精滥用。 这些人共同提供 健康促进、学校干预等领域的专门知识 项目，营养教育与评价，身体成分 评估，身体活动评估与健康教育，实质 滥用，临床心理学，儿科学，流行病学和生物统计学。

This proposal is a three-year planning and feasibility study to develop and test a six-year, full-scale intervention program in coordination with other selected field centers in response to the NHLBI RFA titled: "Primary Prevention of Obesity in American Indians/Alaska Natives." Native American communities have high rates of several chronic diseases, most notably diabetes and obesity. The increase in obesity in the U.S. population, and particularly in the Native American population, demonstrates the need for comprehensive intervention studies designed to reverse this national trend. For Pima and Tohono O'odham Native American participants in this field center, the early onset of obesity in preadolescent children has increased to alarming levels with the mean body mass index in 8 to 10 year-old children already at or above the 95th percentile for the general U.S. population. We have estimated the body fat content of these children and found that about 50% are obese as compared to only 5-10% of the U.S. population in this age group. In this proposal we have developed a multidisciplinary intervention program that is school, family, and community-based and that draws from social learning theory and adoption-diffusion models. The program has been adapted to the Native American community based on programs previously developed at the Gila River and Tohono O'odham Indian communities. The intervention program is designed to increase physical activity levels and self-esteem and to modify dietary intake and includes an out-of-school as well as in-school curriculum, a comprehensive summer program, and programs for the school staff, parents and community. During the first year we propose a cultural analysis to further select and adapt curricula for this population. During the second and third years we propose extensive pilot testing of the curricula in physical fitness, psychosocial development and nutrition education. In addition, we will assess the reliability of both primary (body composition) and secondary endpoints (measurements of physical activity and fitness, dietary intake and selected psychosocial measurements). For the full-scale, six-year intervention study, we propose a randomized clinical trial and four-year intervention program for second, third, fourth and fifth graders using 300 children in each of two cohorts. Schools of similar size and other characteristics will be paired and randomly assigned to either an obesity intervention arm or control (alcohol and substance abuse) program, thus enabling all children to receive prevention education. Our proposed intervention program includes professionals working at the Gila River, Tohono O'odham and Salt River Indian communities, scholars at The University of Arizona and consultants from the National Institute of Diabetes and Digestive and Kidney diseases, the Cleveland Clinic Foundation, the Medlantic Research Institute and the National Institute of Alcoholism and Alcohol Abuse. These individuals collectively provide expertise in the areas of health promotion, school-based intervention programs, nutrition education and assessment, body composition assessment, physical activity assessment and fitness education, substance abuse, clinical psychology, pediatrics, epidemiology, and biostatistics.