Multilevel program and policies to reduce chronic disease for American Indians

 描述（由申请人提供）：美国印第安人（AI）人群的肥胖和相关慢性疾病（CD）发生率不成比例地高。旨在改变人工智能社区食品环境的干预试验已经显示出积极的结果，例如增加健康食品的购买和消费。目前的挑战是促进制定循证政策，以提高环境干预措施的可持续性。拟议研究的主要目标是通过与部落领袖合作制定旨在减少CD的政策和计划，在多个层面（工作场所，学校，食品店）改善人工智能社区的食物和身体活动（PA）环境。我们将通过开发、实施和评估一项基于社区的随机对照试验来实现这一目标，该试验由部落领导人通过政策支持或实施。这项研究将在位于威斯康星州和新墨西哥州的六个人工智能社区进行。该项目直接建立在我们之前在五个人工智能社区的成功工作基础上，我们在那里进行了针对食品商店，工作场所和学校的多层次肥胖预防试验（OPREVENT）。这项拟议的试验（OPREVENT 2）补充和扩大了前一项试验，促进部落领导人制定相关政策，这是可持续性的关键。OPREVENT 2的具体目标是：1）进行形成性研究，以描述参与AI社区的部落政策制定和颁布，以支持部落健康政策制定者通过建立能力和合作伙伴关系，确定有效的政策，以维持肥胖和慢性病预防/减少计划; 2）根据我们早期的试验、目标1的形成性研究和科学文献的最佳实践，为人工智能社区制定一个基于社区的CD预防计划; 3）评估CD相关政策和计划对肥胖、心理社会因素和肥胖风险行为的影响，包括饮食质量（例如，水果和蔬菜份）， 营养素摄入量和PA在社区随机对照试验。这项拟议的研究通过在人工智能社区开发和测试一种创新的多层次肥胖预防策略，将支持性政策与文化上适当的多层次干预相结合，直接解决了NIH PAR-11-346的优先事项。拟议的研究也是当地产生的，因此更有可能自我维持。我们期望影响PAR感兴趣的以下领域：部落领导人参与制定和实施CD政策，制定文化上适当的基于社区的CD预防计划，增加健康食品的供应，改善饮食和PA，减少肥胖。

 DESCRIPTION (provided by applicant): American Indian (AI) populations experience disproportionately high rates of obesity and related chronic diseases (CD). Intervention trials aimed at modifying the food environment in AI communities have shown positive results, such as increasing the purchase and consumption of healthy foods. The current challenge is to facilitate the development of evidence-based policies in order to improve the sustainability of environmental interventions. The primary goal of the proposed research is to improve the food and physical activity (PA) environments in AI communities at multiple levels (worksites, schools, food stores) by working in partnership with tribal leaders to enact policies and programs that aim to reduce CDs. We will achieve this goal by developing, implementing, and evaluating a randomized controlled community-based trial which is supported or implemented by tribal leaders through policy. The study will take place in six AI communities located in Wisconsin and New Mexico. This project builds directly on our previous successful work in five AI communities where we conducted a multilevel obesity prevention trial (OPREVENT) targeting food stores, worksites and schools. This proposed trial (OPREVENT2) complements and expands upon the previous one, by fostering the development of relevant policies among tribal leaders which is key for sustainability. The specific aims of OPREVENT2 are: 1) To conduct formative research to describe tribal policy development and enactment in participating AI communities, in order to support tribal health policy makers to identify effective policies to sustain obesity and chronic disease prevention/reduction programs, by building capacity and collaborative partnerships; 2) To develop a community-based CD prevention program for AI communities informed by our earlier trials, formative research from Aim 1 and best-practices from the scientific literature; an 3) To evaluate the impact of the CD related policies and programs on adiposity, psychosocial factors and obesity risk behaviors, including dietary quality (e.g., fruit and vegetable servings), nutrient intake, and PA in a community- randomized controlled trial. The proposed study directly addresses NIH PAR-11-346 priorities by developing and testing an innovative multilevel obesity prevention strategy in AI communities that combines supportive policy with a culturally appropriate multilevel intervention. The proposed study is also locally generated and, therefore, more likely to be self-sustaining. We expect to impact the following areas of interest to the PAR: engagement of tribal leaders in developing and implementing CD policy, development of culturally appropriate community-based CD prevention programs, and increased availability of healthy foods, improvements in diet and PA, and reductions in adiposity.