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Overweight/obesity has been declared an epidemic and is among the most significant challenges facing the world today. Overweight/obesity in childhood is a major risk factor for severe negative health, psychological, and social outcomes. Native American populations have the highest prevalence of obesity among North American youth. Obesity in children is the result of physical inactivity and (or) consuming excess calories. While some schools in the U.S. have implemented various components of school-based exercise or nutrition programs, childhood obesity continues to increase and remains high. Wide-spread adoption of school-based interventions is limited due to severe constraints in school resources and limited in-class time. Some evidence suggests that after-school programs are a promising setting to improve children’s physical activity (PA) and other health related behaviors. As many as 6.6 million youth in the U.S. participate in some form of after-school programming. While after-school programs offer a safe environment and programming does not compete with school academic content, the effectiveness of such programs on reducing children’s risk factors for obesity is not established. Parents also play an important role in supporting healthy PA and nutrition. Parents, however, often lack skills, resources, or motivation to do so and have rarely been integrated into school or after-school programs. Recent studies as well as our own work (Journey to Native Youth Health, R34DK7446) suggest that after-school interventions may have greater impact if they engaged parents more and had longer and more intense PA and nutrition sessions. Strengthening family support systems and spending longer time in activities that promote healthy eating and exercise could ultimately decrease risk of childhood obesity.

More than 23 million U.S. children and adolescents are now overweight or obese. Although Native American populations have the highest prevalence of obesity among North American youth, very few obesity prevention trials have targeted, and none have been successful at, preventing obesity in this population. After-school programs offer safe places for children to develop lifelong physical activity (PA) and nutrition habits that can prevent obesity. Caregivers play an important role in supporting healthy PA and nutrition although they often lack the skills or resources to do so. Recent studies as well as our own work with Native youth (Journey to Native Youth Health, R34DK7446) suggest that after-school interventions may have greater impact if they engaged caregivers more and had longer PA and nutrition sessions. However increases in program intensity and caregiver involvement raises issues of feasibility.

We recently completed an 11-week randomized, two-group pilot test of physical activity and healthy eating modules for Native and non-Native children, age 6-9, and their caregiver(s) in an after-school and home-based program on the Flathead Indian reservation. The intervention included sending a toolkit home to caregivers 3 times a week that contain activities and resources to support healthy lifestyles. Caregivers participated in three nutrition and physical activity educational family nights during the study that included activities and information about the after-school program. Prizes and drawings for kids, and cell phone voice and text messaging for caregivers were used to prompt and enhance the intervention activities.At the end of the Year 2 grant, we will have accomplished the major project goal – which was to further establish feasibility and our ability to engage caregivers in the intervention that more closely resembles what we plan to propose in the R01. We included Native American children and their caregivers in this longer pilot study because very few obesity interventions include this high-risk, minority population.

Project Goals

  1. Prepare and submit an R01 application for the full-scale trial of the intervention if the pilot study results are promising OR prepare and submit an R21 application if we need to further develop certain aspects of the intervention activities; we plan to submit the R01 or R21 application to NICHD, NHLBI or NCI in June of 2016
  2. Prepare and submit a manuscript to Journal of Obesity reporting key outcomes of the after-school and home-based obesity prevention program pilot study; and
  3. Prepare and submit a manuscript to Health Promotion Practice describing the innovative approaches to engaging family members in addressing their children’s diet and activity.
  4. Prepare and submit one additional manuscript. We expect the focus will be on children’s sleep quality, parent and child activity monitoring data, or parent support for children’s healthy behavior.

In collaboration with the project statistical team and project consultants we will explore different randomization strategies, such as options for the unit of randomization (i.e., family versus after-school program site) and stratifying based on age or obesity risk. We will select the design that best assesses the promise of the intervention for those with or without existing risk factors for obesity, estimates effect sizes, and assesses the feasibility of retaining children and their caregivers to the intervention over a longer period of time. While some design details may change as a result of on-going input from our expert consultants (Alexandra Adams and Rebecca Lee) that became engaged in our work in Year 1, the significant results from our current Year 2 pilot study will be added in the overall aims are described below.

Specific Aim

To conduct a 12-month trial of a 3-day/week, 180 minutes per week, nutrition and physical activity after-school and home-based childhood obesity prevention program for children ages 6 to 9 and their caregiver/guardian.

  • The primary aim of the 12-month study is to determine the magnitude of pre- to posttest changes in the treatment versus the assessment only condition in PA (i.e., increase in the number of minutes of moderate to vigorous PA per day), and dietary intake [i.e., decrease in total energy (kilocalories), and increase in Healthy Eating Index scores].
  • The secondary aims of the study is to determine the pre-to posttest changes in the treatment versus the assessment only condition on screen time (i.e. decrease in number of minutes of screen time per day), sleep quality and PA (i.e., the number of minutes of child’s sleep per week will be associated with the number of minutes of child’s moderate to vigorous PA per week), and child BMI and waist circumference.
  • Exploratory aims include exploring psychosocial mediators that are associated with children’s risk factors for obesity, such as learning about sugar, food labels and salt. Caregiver/guardian outcomes assessed will be BMI and support for their child’s nutrition and PA behaviors.

Anticipated Impact: If effective, the wide reach of after-school programs and engaging caregivers in their child’s exercise and nutrition choices, suggest strong potential for broad impact on children’s health. The methods could save lives by reducing risk factors associated with obesity at an early age, which would hopefully carry over into adulthood. These long-term health effects save dollars by reducing diabetes, cardiovascular and obesity-related health care costs.

Primary Contact: Blakely Brown blakely.brown@umontana.edu