Regular articleThe impact of the Pathways intervention on psychosocial variables related to diet and physical activity in American Indian schoolchildren
Introduction
Although American Indians are not a homogeneous group, overall they have a higher prevalence of overweight and obesity compared to the U.S. general population. Prevalence rates are higher not just in adults, but also in children and adolescents [1]. The causes of obesity are complex and incompletely understood, but it appears that determinants are rooted in multiple factors associated with genetics and the environment as well as behaviors [2], [3]. Most American Indian populations developed obesity only in the past few generations, and it is believed to be related to the relative abundance of high-fat, high-calorie foods accompanied by rapid changes from an active to a sedentary lifestyle [4], [5]. Obesity is an important modifiable risk factor for cardiovascular disease and type 2 diabetes, which are occurring in epidemic proportions in American Indians [1].
The Pathways study [6], [7] was designed to evaluate the effectiveness of a school-based, multicomponent intervention to reduce obesity in American Indian children in grades 3–5. Social learning theory was selected as the overall theoretical framework for the Pathways intervention [8], [9]. The intervention promoted a healthful lifestyle by positively influencing three types of interacting factors: (a) personal, (b) behavioral, and (c) environmental. As summarized by Davis et al. [10] the Pathways intervention combined constructs from social learning theory and cultural concepts that included American Indian customs and practices.
The conceptual framework of Pathways was based on the premise that psychosocial factors mediate dietary and physical activity behaviors and those in turn influence percentage body fat. The primary outcome in the Pathways study, percentage body fat, was not different in the intervention and control groups at the end of the trial. However, individual-level psychosocial factors were more proximal targets of the intervention and, therefore, might be considered more likely to be affected. The purpose of this paper was to examine the impact of the Pathways intervention on psychosocial variables related to physical activity and diet in American Indian children.
Section snippets
The Pathways study
The Pathways intervention had four major components: (a) a food service intervention which modified foods served in the school cafeteria; (b) a physical education component which increased physical activity at school; (c) a classroom curriculum that focused on knowledge and practices related to healthy eating and lifestyle habits; and (d) a family component aimed at involving parents of children participating in the program, to create a positive and supportive environment for modifying dietary
Results
Table 1 shows mean KAB scores at baseline in intervention and control groups by gender. Also shown are the differences in the scores between children randomized to the intervention and the control treatments. As might be expected by chance, 1 of the 16 differences shown was significant at the P < 0.05 level (food self-efficacy among girls). Scores on the scales that were standardized to a 0 to 1 scale ranged from 0.34 to 0.73. This indicated that there was potential for improvement in all of
Discussion
The conceptual framework of Pathways assumed that individual-level psychosocial factors would impact dietary and physical activity behaviors and those in turn would influence percentage body fat. Thus, psychosocial variables measured here were among the most proximal variables targeted by the intervention and, therefore, might be considered the variables most likely to be affected.
The combined exposure to a classroom curriculum, a food service program, a physical education program, and a
Acknowledgements
We express our deepest appreciation and sincere thanks to the students, parents, leaders, school staff/administration, and American Indian communities in the following locations: Gila River Indian Community (Akimel O'odham), Tohono O'odham Nation, Navajo Nation (Dine); Oglala Sioux Tribe (Oglala Lakota), Rosebud Sioux Tribe (Sicangu Lakota), San Carlos Apache Tribe (Dee'), and White Mountain Apache Tribe (Ndee') and to all the staff who assisted in the development, implementation, and
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