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Colorado School of Public Health



Tribal Turning Point

Katherine Sauder, PhD, Dana Dabelea, MD, PhD, Multiple Principal Investigators

TTP is exploring a culturally appropriate behavioral intervention to prevent obesity, increase physical activity and eventually prevent type 2 diabetes in American Indian youth, the population with the highest rates in the US. A successful pilot study with Eastern Band Cherokee and Navajo youth is being followed up with a larger trial including both Navajo on reservation and American Indians in the Phoenix urban area.

Researchers involved: Katherine Sauder, Dana Dabelea, Jeffrey Powell, William Knowler (NIDDK)

Abstract: Sauder KA, Dabelea D, Bailey-Callahan R, Kanott Lambert S, Powell J, James R, Percy C, Jenks BF, Testaverde L, Thomas JM, Barber R, Smiley J, Hockett CW, Zhong VW, Letourneau L, Moore K, Delamater AM, Mayer-Davis E: Targeting risk factors for type 2 diabetes in American Indian youth: the Tribal Turning Point pilot study. Pediatr Obes 2017;DOI: 10.1111/ijpo.12223

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 analyzed 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 m2, p < 0.001) but not intervention participants (+0.3 kg m2, 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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