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The Feasibility of the Strengthening Family and an Adapted American Indian Nutrition and Physical Activity Program: A
Marylou Mylant1, Mary J Isaacson1, Jennifer Heil2
1College of Nursing, South Dakota State University.
Insights
This study evaluated a culturally adapted physical activity and nutrition program for American Indian (AI) children aged 3-5. The program showed promise in maintaining obesity rates, unlike the control group which saw an increase.
Area of Science:
- Public Health
- Pediatric Obesity Prevention
- Indigenous Health Interventions
Background:
- American Indian (AI) children face significant challenges with excessive weight and obesity, linked to sedentary lifestyles, poverty, and childhood trauma.
- Existing interventions like the Strengthening Family Program (SFP) have limitations in addressing AI cultural contexts for nutrition and physical activity.
- A significant percentage of AI children enter kindergarten already overweight or obese, highlighting the need for early-life interventions.
Purpose of the Study:
- To examine the feasibility and preliminary effects of a newly developed AI physical activity and nutrition adjunct program for preschool and kindergarten children.
- To adapt and evaluate an intervention targeting childhood obesity in AI young children (ages three to five) within their cultural context.
- To promote strong AI families and improve childhood health through culturally relevant nutrition and exercise.
Main Methods:
- A quasi-experimental wait-list control group design was employed over two 14-week sessions.
- The intervention included an AI activity and nutrition program, incorporating curricula from Eagle Books and Health is Life in Balance.
- Mixed methods were used, collecting quantitative child BMI data pre- and post-intervention, supplemented by a qualitative focus group.
Main Results:
- The intervention group maintained obesity rates at 14% (preschool) and 38% (kindergarten) pre- and post-intervention.
- The wait-list control group experienced an increase in obesity rates from 30% to 50%.
- Focus groups identified strengths in positive child behaviors and perceived meaning, but noted an 'adult disconnect' weakness.
Conclusions:
- The developed AI physical activity and nutrition program demonstrated feasibility and preliminary positive effects on weight management in young AI children.
- Limited caregiver participation and challenges in engagement were noted, suggesting a need for improved strategies.
- Further community-based dialogue is essential to ensure the long-term sustainability and cultural relevance of the intervention.
Problem:
Excessive weight and obesity have been identified as the most serious health problems facing American Indian (AI) children. Thirty-eight percent of the preschool and kindergarten children who participated in this study were either overweight or obese. Potential reasons for this prevalence include the physical activity transition of AI people to sedentary lifestyles, in utero exposure to diabetes, and social determinants of health, especially poverty. In 2013, 29.8 percent of single-race AI/Alaska Native people were living in poverty. Childhood trauma and stress have also been linked to obesity. The experience of numerous negative life events in childhood increases the risk for being overweight by age 15.
Purpose:
Early-life home and preschool interventions with children between the ages of five and 14 have a greater impact on preventing childhood obesity, primarily with children who enter kindergarten already overweight. The purpose of this study was to examine the feasibility and preliminary effects of the Strengthening Family Program (SFP) on the physical health (primarily weight) of AI young children. The goal of this study was to promote strong AI families and improve childhood health; however, the nutrition and exercise activities within the SFP were minimal and not adapted to the AI culture. Therefore, a nutrition and exercise program for AI children between the ages of three to five was developed. The primary objective for this study was then revised to evaluate the feasibility and preliminary effects of the newly developed AI physical activity and nutrition adjunct program for preschool and kindergarten children.
Method:
Two 14-week sessions of the SFP were implemented with an AI activity and nutrition program that incorporated curricula from the Eagle Books and Health is Life in Balance. A mixed methods approach was used with a quasi-experimental wait-list control group design. Quantitative data gathered included child BMI pre- and post-intervention. A focus group was then conducted to identify the strengths and weaknesses of the SFP and the AI activity and nutrition program.
Results:
Twenty-five children participated in either one of two intervention groups or one waitlist control group. The obesity rates of the preschool and kindergarten intervention groups stayed at 14 percent and at 38 percent pre- and post-intervention, respectively. The obesity rates for the waitlist control group, however, increased from 30 percent at pre-test to 50 percent at post-test. Focus group narratives resulted in two categories of strengths (positive child behaviors and meaning to child) and one weakness (adult disconnect).
Conclusion:
Caregiver participation was limited and challenging. Further community-based dialogue is needed to ensure sustainability.
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