Bright Start: Obesity Prevention in American Indian Children

描述(申请人提供)：肥胖是当今美国印第安人儿童面临的最严峻的健康挑战之一，并对包括2型糖尿病在内的严重慢性病的发展具有严重影响。早期预防儿童时期不适当的体重增加是至关重要的。这项拟议的研究针对松岭和罗斯巴德保留地的幼儿园和一年级的美国印第安人儿童，将开发和测试学校环境干预的有效性，并辅之以家庭家庭环境干预，通过增加体育活动和健康饮食习惯来减少过度体重增加。这项名为Ohiyu Lyojanjan-Bright Start计划的干预措施的重点是改变学校和家庭的饮食和体育活动环境。干预措施有三个主要目标：将学校体育活动增加到每天60分钟；修改学校膳食和零食以及课堂食物做法；让家庭参与改变家里的行为和环境。干预的效果将在一项分组随机对照试验中进行测试，14所学校被随机分为两种情况(干预或对照)。两组幼儿园儿童将被跟踪到一年级结束。主要假设是，在为期16个月的干预结束时，与对照学校的儿童相比，干预学校的儿童在调整基准值后，身体质量指数(BMI)和体脂百分比将显著降低。儿童的主要结果指标是BMI和体脂百分比。次要措施包括儿童每天的总体力活动，对学校膳食和零食的营养和食物类别分析，以及对课堂食物和体力活动实践的评估。儿童测量将在幼儿园开始(基线)、幼儿园结束(仅限体重指数)和一年级结束时进行。父母将接受基线调查，当他们的孩子在一年级结束时。父母评估将包括衡量家庭食物供应情况，父母报告自己和孩子的饮食和身体活动行为。这项研究将增进我们对如何最好地预防美洲印第安人肥胖的了解，美洲印第安人是一个极端危险的群体，这样做将有助于解决健康差距。拟议的干预措施有可能改变学校政策，这将在全国范围内的学校推广和可持续。

DESCRIPTION (provided by applicant): Obesity is one of the most daunting health challenges facing American Indian children today and has serious implications for the development of serious chronic diseases, including type-2 diabetes. Early prevention of inappropriate weight gain in childhood is critical. The proposed study, targeting kindergarten and 1st grade American Indian children on the Pine Ridge and Rosebud reservations, will develop and test the efficacy of a school environmental intervention, augmented with a family household environmental intervention, to reduce excessive weight gain by increasing physical activity and healthy dietary practices. The focus of the intervention, Ohiyu lyojanjan - Bright Start Program, is to create dietary and physical activity environmental change at school and home. The intervention has three primary goals: increase physical activity at school to 60 min/day; modify school meals and snacks, and classroom food practices; and involve families in making behavioral and environmental changes at home. The efficacy of the intervention will be tested in a group-randomized controlled trial with 14 schools randomized to two conditions (intervention or control). Two cohorts of kindergarten children will be followed through the end of 1st grade. The major hypothesis is that by the end of the 16-month intervention, children in the intervention schools, relative to children in the control schools, will have significantly lower body mass index (BMI) and percent body fat after adjustment for baseline values. The primary outcome measures in children are BMI and percent body fat. Secondary measures include child's total daily physical activity, nutrient and food-group analysis of school meals and snacks, and assessment of classroom food and physical activity practices. Child measures will occur at the beginning of kindergarten (baseline), at the end of kindergarten (BMI only), and at the end of the 1st grade. Parents will be surveyed at baseline, and when their child is at the end of the 1st grade. Parent assessments will include measures of household food availability, parent reports of their own and child eating and physical activity behaviors. The study will advance our knowledge of how best to prevent obesity in American Indians, a population at extreme risk, and in doing so will help address health disparities. The proposed intervention has potential for school policy change that would be generalizable and sustainable in schools nationwide.