A SCHOOL-BASED INTERVENTION REDUCING RISK OF T2 DIAB IN OK INDIAN KIDS

该子项目是利用NIH/NCRR资助的中心赠款提供的资源的许多研究子项目之一。子项目和研究者（PI）可能从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。所列机构为中心机构，不一定为研究者机构。本项目的目的是评估以学校为基础的干预计划的有效性，以减少俄克拉荷马州五个文明部落的美国印第安人（AI）儿童患2型糖尿病（DM）的风险。我们建议通过以下措施来检查以学校和家庭为基础的干预措施的有效性：a）改善学校食品服务、体育课程和健康课程，B）诱导AI儿童潜在的可持续行为变化，从而导致更健康的生活方式，以及c）加强人工智能医疗专业人员进行研究的能力，以解决儿童和青少年中正在出现的第二型糖尿病流行病的健康差异。研究将分三个阶段进行。每个阶段的具体目标如下。第一阶段：形成性评估和基线数据收集（第一年）根据部落间咨询理事会的建议，设计和实施形成性评估，以便：a.确定学校、家庭和社区可获得的食物种类; B.确定学校、家庭和社区中可用于体育活动的设施和资源; c.获得学校和社区现有的卫生课程和教育方案的信息; d.确定可能阻碍或促进干预成功的潜在障碍和机会; e.收集干预和对照学校250名儿童的身高、体重、体重指数、腰围和臀围、体脂百分比、空腹血糖、胰岛素、瘦素、血脂、活动回忆、24小时饮食回忆、家族病史和糖尿病危险因素知识的基线数据。第二阶段：根据形成性评估的结果和部落间咨询理事会的建议，在五所随机分配的干预学校设计和实施一项适合年龄和文化的学校和家庭干预方案，教导儿童及其家庭如何增加体育活动和选择健康饮食。我们假设，与基线数据相比，学校和家庭为基础的干预将导致美国印第安儿童的比例显着下降，这些儿童的生理措施或行为增加了2型糖尿病的风险。此外，我们假设干预学校儿童的减少幅度将大于在五所随机分配的对照学校儿童中观察到的任何减少幅度。第三阶段：评估在250名儿童中对与基线相同的测量进行干预后评估，评估和比较干预组和对照组，并分析结果以确定是否：干预增加了做出健康食物选择的AI儿童的百分比; B.干预增加AI儿童定期有氧体育活动的数量和质量; c.干预增加了AI儿童对糖尿病危险因素和健康行为的认识; d.干预降低了具有2型糖尿病危险因素的AI儿童的比例。由于干预措施，部落共同调查人员和卫生专业人员组织和进行研究以解决其儿童中2型糖尿病流行的能力得到提高; f.由于干预，人工智能社区和人们之间的研究信任得到了改善

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The purpose of this project is to evaluate the effectiveness of a school-based intervention program to reduce the risk of Type 2 diabetes mellitus (DM) among American Indian (AI) children of the Five Civilized Tribes of Oklahoma. We propose to examine the effectiveness of a school and family-based intervention for reducing the disproportionate prevalence of obesity, inactivity, dyslipidemia and hyperinsulinemia in AI children by a) improving the school food service, physical education program, and health curriculum, b) inducing potentially sustainable behavioral changes in AI children that will lead to healthier lifestyles, and c) enhancing the capacity of AI health professionals to conduct research to address the health disparity of the emerging epidemic of Type 2 DM in their children and adolescents. The study will have three phases. The specific aims of each phase are listed below. Phase I: Formative Assessment and Collection of Baseline Data (Year 1) Based on recommendations of an Inter-Tribal Advisory Council, design and implement a formative assessment to: a. determine the kinds of foods available in the schools, homes and communities; b. determine the facilities and resources available for physical activity in the schools, homes and communities; c. obtain information on health curricula and educational programs available in the schools and communities; d. identify potential barriers and opportunities that might impede or facilitate success of the intervention; e. collect baseline data on height, weight, body mass index, waist and hip circumference, percent body fat, fasting blood glucose, insulin, leptin, plasma lipids, activity recall, 24-hour dietary recall, family medical history, and diabetes risk factor knowledge in 250 children in intervention and control schools. Phase II: Intervention Based on results of the formative assessment and advice from the Inter-Tribal Advisory Council, design and implement an age and culturally appropriate school and family-based intervention program, in five randomly allocated intervention schools, to teach children and their families how to increase physical activity and choose a healthy diet. We hypothesize that the school and family-based intervention will result in a significant decrease in the proportion of American Indian children with physiologic measures or behaviors that increase risk for Type 2 DM, compared with baseline data. In addition, we hypothesize that the magnitude of the decrease among children in intervention schools will be greater than the magnitude of any decrease observed in children in five randomly allocated control schools. Phase III: Evaluation Perform a post-intervention assessment of the same measures as a baseline in the 250 children, evaluate and compare the intervention and control groups, and analyze results to determine whether the: a. intervention increases the percentage of AI children who make healthy food choices; b. intervention increases the amount and quality of regular aerobic physical activity in AI children; c. intervention increases the knowledge of diabetes risk factors and healthy behaviors in AI children; d. intervention decreases the proportion of AI children with risk factors for Type 2 DM e. capacity of tribal co-investigators and health professionals to organize and conduct research to address the epidemic of Type 2 DM in their children is improved as a result of the intervention; f. trust of research among AI communities and people is improved as a result of the intervention