The Healthy Children, Strong Families intervention promotes improvements in nutrition, activity and body weight in American Indian families with young children

Abstract

Objective: American Indian children of pre-school age have disproportionally high obesity rates and consequent risk for related diseases. Healthy Children, Strong Families was a family-based randomized trial assessing the efficacy of an obesity prevention toolkit delivered by a mentor v. mailed delivery that was designed and administered using community-based participatory research approaches.

Design: During Year 1, twelve healthy behaviour toolkit lessons were delivered by either a community-based home mentor or monthly mailings. Primary outcomes were child BMI percentile, child BMI Z-score and adult BMI. Secondary outcomes included fruit/vegetable consumption, sugar consumption, television watching, physical activity, adult health-related self-efficacy and perceived health status. During a maintenance year, home-mentored families had access to monthly support groups and all families received monthly newsletters.

Setting: Family homes in four tribal communities, Wisconsin, USA.

Subjects: Adult and child (2-5-year-olds) dyads (n 150).

Results: No significant effect of the mentored v. mailed intervention delivery was found; however, significant improvements were noted in both groups exposed to the toolkit. Obese child participants showed a reduction in BMI percentile at Year 1 that continued through Year 2 (P<0·05); no change in adult BMI was observed. Child fruit/vegetable consumption increased (P=0·006) and mean television watching decreased for children (P=0·05) and adults (P=0·002). Reported adult self-efficacy for health-related behaviour changes (P=0·006) and quality of life increased (P=0·02).

Conclusions: Although no effect of delivery method was demonstrated, toolkit exposure positively affected adult and child health. The intervention was well received by community partners; a more comprehensive intervention is currently underway based on these findings.

Keywords: American Indian; Community-based participatory research; Early childhood; Family; Home-based intervention; Nutrition; Paediatric obesity; Physical activity.

Fig. 1

Healthy Children, Strong Families study flow diagram. ‘Family’ indicates the adult–child dyad

Fig. 2

Adult BMI (a) and child BMI percentile (b) by weight status (, normal weight; , overweight; , obese class I (adults)/obese (children); , obese class II (adults only)) at baseline, post-intervention (Year 1) and follow-up (Year 2) for combined study arms (mailed group plus mentored group); Healthy Children, Strong Families intervention among American Indian families with young children (2–5-year-olds), Wisconsin, USA. Data are presented as means with their standard errors represented by vertical bars