Scholarly Work - CAIRHE (Center for American Indian and Rural Health Equity)

Permanent URI for this collectionhttps://scholarworks.montana.edu/handle/1/15449

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Development of a culturally informed child safety curriculum for American Indian families
(2017-04) Berns, Ryan M.; Tomayko, Emily J.; Cronin, Kate A.; Prince, Ronald J.; Parker, Tassy; Adams, Alexandra K.
American Indian (AI) children are disproportionately affected by unintentional injuries, with injury mortality rates approximately 2.3 times higher than the combined rates for all children in the United States. Although multiple risk factors are known to contribute to these increased rates, a comprehensive, culturally informed curriculum that emphasizes child safety is lacking for this population. In response to this need, academic and tribal researchers, tribal community members, tribal wellness staff, and national child safety experts collaborated to develop a novel child safety curriculum. This paper describes its development and community delivery. We developed the safety curriculum as part of a larger randomized controlled trial known as Healthy Children, Strong Families 2 (HCSF2), a family-based intervention targeting obesity prevention in early childhood (2–5 years). During the development of the HCSF2 intervention, participating tribal communities expressed concern about randomizing enrolled families to a control group who would not receive an intervention. To address this concern and the significant disparities in injuries and unintentional death rates among AI children, we added an active control group (Safety Journey) that would utilize our safety curriculum. Satisfaction surveys administered at the 12-month time point of the intervention indicate 94% of participants (N = 196) were either satisfied or very satisfied with the child safety curriculum. The majority of participants (69%) reported spending more than 15 min with the curriculum materials each month, and 83% thought the child safety newsletters were either helpful or very helpful in making changes to improve their family’s safety. These findings indicate these child safety materials have been well received by HCSF2 participants. The use of community-engaged approaches to develop this curriculum represents a model that could be adapted for other at-risk populations and serves as an initial step toward the creation of a multi-level child safety intervention strategy.
The Healthy Children, Strong Families 2 randomized controlled trial improved healthy behaviors in American Indian families with young children
(2018-11) Tomayko, Emily J.; Prince, Ronald J.; Cronin, Kate A.; Kim, KyungMann; Parker, Tassy; Adams, Alexandra K.
Background American Indian (AI) families experience disproportionate risk for obesity due to complex reasons, including poverty, historic trauma, rural isolation or urban loss of community connections, lack of access to healthy foods and physical activity opportunities, and high stress. Home-based obesity prevention interventions are lacking for these families. Objective Healthy Children, Strong Families 2 (HCSF2) was a randomized controlled trial of a healthy lifestyle promotion/obesity prevention intervention for American Indian families. Methods Four hundred and fifty dyads consisting of an adult primary caregiver and a two- to five-year-old child from five AI communities were randomly assigned to a monthly mailed healthy lifestyle intervention toolkit (Wellness Journey) with social support or to a child safety control toolkit (Safety Journey) for one year. The Wellness Journey toolkit targeted increased fruit/vegetable intake, increased physical activity, improved sleep, decreased added sugar intake, decreased screen time, and improved stress management (adults only). Anthropometrics were collected, and health behaviors were assessed via survey at baseline and at the end of Year 1. Adults completed surveys for themselves and the participating child. Repeated measures analysis of variance was used to assess change over the intervention period. Results Significant improvements in adult and child healthy diet patterns, adult fruit/vegetable intake, adult moderate-to-vigorous physical activity, home nutrition environment, and adult self-efficacy for health behavior change were observed in Wellness Journey compared to Safety Journey families. No changes were observed in adult body mass index (BMI), child BMI z-score, adult stress measures, adult/child sleep, adult/child screen time, or child physical activity. Qualitative feedback suggests the intervention was extremely well-received by the families and our community partners across five participating sites. Conclusions This multi-site community-engaged intervention addressed key gaps regarding family home-based approaches for early obesity prevention in AI communities and showed several significant improvements in health behaviors. Multiple communities are working to sustain intervention efforts.
The Healthy Children, Strong Families 2: a randomized controlled trial of a healthy lifestyle intervention for American Indian families designed using community-based approaches
(2017-04) Tomayko, Emily J.; Prince, Ronald J.; Cronin, Kate A.; Parker, Tassy; Kim, KyungMann; Grant, Vernon M.; Sheche, Judith N.; Adams, Alexandra K.
Background/Aims Few obesity prevention trials have focused on young children and their families in the home environment, particularly in underserved communities. Healthy Children, Strong Families 2 is a randomized controlled trial of a healthy lifestyle intervention for American Indian children and their families, a group at very high risk of obesity. The study design resulted from our long-standing engagement with American Indian communities, and few collaborations of this type resulting in the development and implementation of a randomized clinical trial have been described. Methods Healthy Children, Strong Families 2 is a lifestyle intervention targeting increased fruit and vegetable intake, decreased sugar intake, increased physical activity, decreased TV/screen time, and two less-studied risk factors: stress and sleep. Families with young children from five American Indian communities nationwide were randomly assigned to a healthy lifestyle intervention (Wellness Journey) augmented with social support (Facebook and text messaging) or a child safety control group (Safety Journey) for 1 year. After Year 1, families in the Safety Journey receive the Wellness Journey, and families in the Wellness Journey start the Safety Journey with continued wellness-focused social support based on communities’ request that all families receive the intervention. Primary (adult body mass index and child body mass index z-score) and secondary (health behaviors) outcomes are assessed after Year 1 with additional analyses planned after Year 2. Results To date, 450 adult/child dyads have been enrolled (100% target enrollment). Statistical analyses await trial completion in 2017. Lessons learned Conducting a community-partnered randomized controlled trial requires significant formative work, relationship building, and ongoing flexibility. At the communities’ request, the study involved minimal exclusion criteria, focused on wellness rather than obesity, and included an active control group and a design allowing all families to receive the intervention. This collective effort took additional time but was critical to secure community engagement. Hiring and retaining qualified local site coordinators was a challenge but was strongly related to successful recruitment and retention of study families. Local infrastructure has also been critical to project success. Other challenges included geographic dispersion of study communities and providing appropriate incentives to retain families in a 2-year study. Conclusion This multisite intervention addresses key gaps regarding family/home-based approaches for obesity prevention in American Indian communities. Healthy Children, Strong Families 2’s innovative aspects include substantial community input, inclusion of both traditional (diet/activity) and less-studied obesity risk factors (stress/sleep), measurement of both adult and child outcomes, social networking support for geographically dispersed households, and a community selected active control group. Our data will address a literature gap regarding multiple risk factors and their relationship to health outcomes in American Indian families.
Predictors of Overweight and Obesity in American Indian Families With Young Children
(2019-02) Adams, Alexandra K.; Tomayko, Emily J.; Cronin, Kate A.; Prince, Ronald J.; Kim, Kyungmann; Carmichael, Lakeesha; Parker, Tassy
Objective: To describe sociodemographic factors and health behaviors among American Indian (AI) families with young children and determine predictors of adult and child weight status among these factors. Design: Descriptive, cross-sectional baseline data. Setting: One urban area and 4 rural AI reservations nationwide. Participants: A total of 450 AI families with children aged 2-5 years participating in the Healthy Children, Strong Families 2 intervention. Intervention: Baseline data from a healthy lifestyles intervention. Main Outcome Measures: Child body mass index (BMI) z-score and adult BMI, and multiple healthy lifestyle outcomes. Analysis: Descriptive statistics and stepwise regression. Results: Adult and child combined overweight and obesity rates were high: 82% and 40%, respectively. Food insecurity was high (61%). Multiple lifestyle behaviors, including fruit and vegetable and sugar-sweetened beverage consumption, adult physical activity, and child screen time, did not meet national recommendations. Adult sleep was adequate but children had low overnight sleep duration of 10 h/d. Significant predictors of child obesity included more adults in the household (P = .003; beta = 0.153), an adult AI caregiver (P = .02; beta= 0.116), high adult BMI (P = .001; beta= 0.176), gestational diabetes, high child birth weight (P < .001; beta= 0.247), and the family activity and nutrition score (P = .04; beta= 0.130). Conclusions and Implications: We found multiple child-, adult-, and household-level factors influence early childhood obesity in AI children, highlighting the need for interventions to mitigate the modifiable factors identified in this study, including early life influences, home environments, and health behaviors.