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Research Team

Alexandra Adams, MD, PhD
Kate Cronin, MPH
Ron Prince, MS
Emily Tomayko, RD, PhD
Kyungmann Kim, PhD
Felix Elwert, PhD
Vernon Grant, PhD
Tassy Parker, PhD (University of New Mexico)

In collaboration with member Tribal Communities

Project Goal

Healthy lifestyle changes to promote long-term wellness.


Obesity rates among American Indian (AI) children are the highest of any race or ethnic group in the United States. Once established, early obesity persists into later life and greatly increases risk of future chronic diseases such as cardiovascular disease and type 2 diabetes. Healthy Children, Strong Families (HCSF) is a community-based, multimodal, early childhood intervention which addresses the growing problem of AI childhood obesity. HCSF directly involves parents/ primary caregivers of preschool age AI children in making family based healthy lifestyle changes. An initial small HCSF trial showed promise in reducing adult BMI and child BMI z-score in overweight/obese AI children, increasing adult/child fruit/vegetable intake, decreasing TV/screen time, and increasing adult self-efficacy for healthy behavior change. The proposed study will use community-based participatory research methods to enhance the intervention and then conduct a 2-arm staggered-enrollment randomized trial of HCSF vs. control (child safety intervention) in a 2-year design in 5 diverse rural and urban AI communities nationally. Intervention outcomes will be measured at 0, 6, 12, 18, and 24 months. Primary outcomes are adult BMI and child BMI Z-score. Secondary outcomes include adult/child waist circumference, fruit/vegetable and added sugar intake, TV/screen time, activity, sleep, home environment changes, and adult psychosocial factors (stress/depression) and use of social networking. Communities will work with investigators to enhance the previously tested HCSF intervention to include novel methods of delivery (mailed lesson kits with cell phone coaching/ social networking) and two less-studied obesity determinants (sleep and stress) to increase impact and sustainability. The research addresses four key gaps in obesity prevention studies: pre-school age families, social networking support, stress and sleep.

The short term goal for this research is to develop a successful obesity intervention for AI families that is practical and easily replicated. The long-term goal is to disseminate the intervention by incorporating HCSF into AI health programs to ensure local sustainability and utility nationally. In terms of public health impact, if the hypotheses are proven, HSCF will be the first evidence-based, culturally adapted, healthy lifestyles intervention for AI families with young children that addresses the obesity epidemic. If successful, it will assist communities in preventing and reducing obesity, and thereby, impact the high and increasing rates of chronic disease in both urban and rural AI communities.

Funding Sources

R01HL114912 from NIH/NHLBI, A.K. Adams

Related Publications

Tomayko EJ, Prince RJ, Cronin KA, Adams AK. The Healthy Children, Strong Families intervention promotes improvements in nutrition, activity and body weight in American Indian families with young children. Public Health Nutr. 2016 Oct;19(15):2850-9. doi: 10.1017/S1368980016001014. Epub 2016 May 23.

Adams AK, Scott JR, Prince R, Williamson A. Using Community Advisory Boards to Reduce Environmental Barriers to Health in American Indian Communities, Wisconsin, 2007–2012. Prev Chronic Dis 2014; 11:140014.

Lindberg, SM, Adams AK, Prince RJ.  Early predictors of obesity and cardiovascular risk among American Indian children. Maternal and Child Health Journal 2012; Epub 2012 April 21. PMID: 22527771

Jobe JB, Adams AK, Henderson JA, Karanja N, Lee ET, Walters KL.  Community-responsive interventions to reduce cardiovascular risk in American Indians. Journal of Primary Prevention 2012 Aug; 33(4):153-159. doi: 10.1007/s10935-012-0277-9. Review. PMID: 22983753.

Adams AK, Larowe TL, Cronin KA, Prince RJ, Wubben DP, Parker T, Jobe JB.  The healthy children, strong families intervention: Design and community participation Journal of Primary Prevention 2012.

Adams AK.  Understanding community and family barriers and supports to physical activity in American Indian children. Journal of Public Health Management Practice, 2010; 16(5):401-403. PMCID: PMC3477811

Adams AK, Harvey H, Brown D. Constructs of health and environment inform child obesity prevention in American Indian communities. Obesity (Silver Spring). 2008 Feb;16(2):311-7. doi: 10.1038/oby.2007.71.

LaRowe TL, Wubben DP, Cronin KA, Vannatter SM, Adams AK. Development of a culturally appropriate, home-based nutrition and physical activity curriculum for Wisconsin American Indian families. Prev Chronic Dis. 2007 Oct;4(4):A109. Epub 2007 Sep 15.PMCID: PMC2099274.