New Interventions, Collaborations for Healthy Children, Strong Families | UW Family Medicine

Healthy Children, Strong Families (HCSF), a community-based research project that aims to promote healthy lifestyles and long-term wellness in American Indian (AI) preschool children and their families, is now entering its next phase.

The HCSF academic team (led by principal investigator Alexandra Adams, MD, PhD) is collaborating with six AI communities nationwide to enhance its promising lifestyle intervention model, and conduct a new randomized trial to measure its success.

A Foundation of Success HCSF-1 was based on the AI model of elders teaching life skills to the next generation. It aimed to reinforce cultural values of family interaction, healthy foods, and activity—and promote skill-based behavior change.

During HCSF-1,150 families from four Wisconsin AI communities participated in a randomized trial of a healthy lifestyle intervention that included mailed toolkits, newsletters, targeted home visits, and monthly group meetings.

The approach was well accepted—and successful. Body mass index (BMI) for adults and overweight/obese children improved, adult and child screen time decreased, fruit and vegetable intake increased, and participants gained new knowledge and confidence to lead healthier lifestyles.

The team also established community advisory boards to address environmental barriers and supports for healthier lifestyles. In one community, this resulted in the planting of over 50 community and home gardens; in another, it resulted in the creation of a natural playground with traditional features.

New Intervention Incorporates Social Networking, Stress, and Sleep Although similar to its predecessor, the HCSF-2 intervention will expand to include text messaging and social networking components.

Studies have shown that text reminders can help support behavior change and ultimately improve health outcomes, especially in low-resource communities. Social networking sites offer great potential for magnifying individual behavior change and group influence.

In keeping with community-based participatory research methods, the academic team is working closely with wellness staff in six AI communities nationwide to develop that part of the intervention. It could include weekly text tips and affirmations, study and community-specific Facebook pages, event updates, and participant feedback.

The academic team will also work with community collaborators to expand another part of the intervention, the mailed toolkits, to include lessons on two less-studied predictors of obesity: coping with stress and improving sleep.

“Our hope is that the positive effects and family receptiveness associated with HCSF-1 will be enhanced by the lesson modification and social networking components of HCSF-2,” Dr. Adams said.

A New Trial with National Reach The academic team and participating communities will then conduct a two-year randomized trial that compares the enhanced intervention with a control condition consisting of child and home safety education. (After the first year, the groups switch, so ultimately all participants receive both the intervention and the safety education.)

The six communities participating in HCSF-2 are located in diverse rural and urban settings across the US. (HCSF-1 participants were all located in Wisconsin). They are:

Study outcomes will include adult and child BMI, waist circumference, fruit/vegetable and added sugar intake, TV/screen time, activity, sleep, home environment changes, adult stress/depression, and use of social networking.

If the new intervention—and the community-based approach used to develop and implement it—proves effective, the HCSF model could be disseminated to AI health programs nationwide.

“Our short-term goal is to develop a successful obesity prevention intervention for AI families that is efficient and uses easily available technology,” Dr. Adams explained.

“But over the long term, we would like to embed this intervention into community structures,” she continued. “That will ensure sustainability, and will ultimately help reduce the rates of chronic disease in urban and tribal AI communities across the nation.”

The HCSF academic team thanks Judith Sheche for her work on the new HCSF-2 intervention, and to Ryan Berns for his work on the HSCF-2 newsletters.

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