K A Sauder1, D Dabelea1,2, R Bailey-Callahan3, S Kanott Lambert3, J Powell4, R James3, C Percy5, B F Jenks6, L Testaverde2, J M Thomas6, R Barber5, J Smiley5, C W Hockett2, V W Zhong6, L Letourneau7, K Moore8, A M Delamater9, E Mayer-Davis6,10. 1. Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA. 2. Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA. 3. Eastern Band of Cherokee Indians, Cherokee, NC, USA. 4. Department of Community Health, Shiprock Service Unit, Navajo Area Indian Health Service, NM, USA. 5. Northern Navajo Medical Center Diabetes Research, NM, USA. 6. Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA. 7. Kovler Diabetes Center, University of Chicago, Chicago, IL, USA. 8. Centers for American Indian and Alaskan Native Health, Colorado School of Public Health, Aurora, CO, USA. 9. Department of Pediatrics, University of Miami, Miami, FL, USA. 10. Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.
Abstract
BACKGROUND:American Indian (AI) youth are at high risk for type 2 diabetes. OBJECTIVES: To partner with Eastern Band of Cherokee Indians and Navajo Nation to develop a culturally sensitive behavioural intervention for youth (Tribal Turning Point; TTP) and assess feasibility in an 8-month randomized pilot study. METHODS: We enrolled 62 overweight/obese AI children (7-10 years) who participated with ≥1 parent/primary caregiver. Intervention participants (n = 29) attended 12 group classes and five individual sessions. Control participants (n = 33) attended three health and safety group sessions. We analysed group differences for changes in anthropometrics (BMI, BMI z-score, waist circumference), cardiometabolic (insulin, glucose, blood pressure) and behavioural (physical activity and dietary self-efficacy) outcomes. RESULTS: Study retention was 97%, and intervention group attendance averaged 84%. We observed significant treatment effects (p = 0.02) for BMI and BMI z-score: BMI increased in control (+1.0 kg m-2 , p < 0.001) but not intervention participants (+0.3 kg m-2 , p = 0.13); BMI z-score decreased in intervention (-0.17, p = 0.004) but not control participants (0.01, p = 0.82). There were no treatment effects for cardiometabolic or behavioural outcomes. CONCLUSIONS: We demonstrated that a behavioural intervention is feasible to deliver and improved obesity measures in AI youth. Future work should evaluate TTP for effectiveness, sustainability and long-term impact in expanded tribal settings.
RCT Entities:
BACKGROUND: American Indian (AI) youth are at high risk for type 2 diabetes. OBJECTIVES: To partner with Eastern Band of Cherokee Indians and Navajo Nation to develop a culturally sensitive behavioural intervention for youth (Tribal Turning Point; TTP) and assess feasibility in an 8-month randomized pilot study. METHODS: We enrolled 62 overweight/obese AI children (7-10 years) who participated with ≥1 parent/primary caregiver. Intervention participants (n = 29) attended 12 group classes and five individual sessions. Control participants (n = 33) attended three health and safety group sessions. We analysed group differences for changes in anthropometrics (BMI, BMI z-score, waist circumference), cardiometabolic (insulin, glucose, blood pressure) and behavioural (physical activity and dietary self-efficacy) outcomes. RESULTS: Study retention was 97%, and intervention group attendance averaged 84%. We observed significant treatment effects (p = 0.02) for BMI and BMI z-score: BMI increased in control (+1.0 kg m-2 , p < 0.001) but not intervention participants (+0.3 kg m-2 , p = 0.13); BMI z-score decreased in intervention (-0.17, p = 0.004) but not control participants (0.01, p = 0.82). There were no treatment effects for cardiometabolic or behavioural outcomes. CONCLUSIONS: We demonstrated that a behavioural intervention is feasible to deliver and improved obesity measures in AI youth. Future work should evaluate TTP for effectiveness, sustainability and long-term impact in expanded tribal settings.
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