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Community-academic partnership works to improve tribal health

University-community support can improve health equity and reduce childhood obesity

January 5, 2015

In preventing childhood obesity, the odds are stacked against American Indian communities.

But over the past 15 years, Dr. Alexandra Adams has worked to level the playing field. She’s partnered with Wisconsin tribal nations to battle high rates of obesity and early heart disease risk factors through improved nutrition and increased activity.

A professor in the department of family medicine at the University of Wisconsin School of Medicine and Public Health, Adams has long had an interest in preventing diabetes and cardiac disease among American Indian tribes.

“I came to Wisconsin specifically because of the tribal communities and the chance to work with tribes on wellness issues, particularly the prevention of obesity,” says Adams.

Dr. Alexandra Adams
Dr. Alexandra Adams

Her interest in American Indian health was piqued when she served as a resident physician on the Menominee reservation in northeastern Wisconsin and then with indigenous communities in Alaska and South Dakota.

When Adams returned to Wisconsin, she partnered with the Great Lakes Inter-Tribal Council, with support from the Wisconsin Department of Public Health and the National Institutes of Health (NIH), to study childhood obesity on the Menominee, Bad River and Lac du Flambeau reservations.

She found high rates of early childhood obesity and risk factors for cardiovascular disease, thus beginning her long-term partnerships with the state’s tribal communities.

“Overall, minority children have much higher rates of childhood obesity compared to non-minority,” says Adams. “But specifically for American Indians, there are several factors that contribute to high rates of obesity.”

Poverty, lack of job opportunities, isolation, historic trauma and environmental factors such as lack of activity space and access to healthy food play into the problem.

Adams is searching for solutions through a bottom-up model that utilizes community-based participatory research.

“I don’t tell them what to do,” she explains. “All along the way, we work with our tribal partners to identify and solve problems. We work with communities to figure out how they would best like to get things done.”

That was Adams’ approach behind Healthy Children, Strong Families, established in 2005 to promote healthy lifestyles for young American Indian children and their families, and identify community-based interventions. The five-year project, funded by the Wisconsin Partnership Program and NIH, created interventions for young children, ages two to five, and their parents, as well as additional community supports for healthy choices.

The plan was centered in community based interventions developed by tribal advisory boards on each reservation. Each community identified challenges to healthy lifestyles and found unique interventions to overcome them.

The success of Healthy Children,
Strong Families launched a second
iteration of the project that, thanks
to NIH support, is now up and
running in tribal communities
in five states: Wisconsin,
Minnesota, New Mexico,
Montana and New York.

For example, Bad River lacked a suitable early childhood playground and decided to build a natural play space. Samuel Dennis Jr., a UW-Madison associate professor of landscape architecture and collaborator on the project, worked with tribal elders to design a playground that incorporated a willow lodge and a canoe like those used to harvest rice – strong cultural influences that made it unique.

In addition to community-based interventions, Adams and her team studied the most effective ways to share health information with families. The research was randomized to provide an in-home mentor or information by mail, in the form of a monthly toolkit.

“Each kit contained a book for the children, information for their parents and something for the kids that was educational and fun,” says Adams. “For example, when we designed a kit around outside activity, we included a pedometer for adults and a ball for the kids.”

The research yielded surprising, and encouraging, results.

A home mentor didn’t provide any advantage over mailed information. In both groups there was significant weight loss in overweight children over a two-year period. Both children and adults ate more fruits and vegetables. Both cut down on television watching. And the toolkits, themed around a different focus each month, were a big hit with the families.

The success of Healthy Children, Strong Families launched a second iteration of the project that, thanks to NIH support, is now up and running in tribal communities in five states: Wisconsin, Minnesota, New Mexico, Montana and New York.

“We took lessons from the original project and improved it. We know that home mentoring is expensive and didn’t work very well, but the mailed toolkits did make a difference,” says Adams.

The team has come up with several new ways to engage families. For instance, families now receive text messages twice a week, and a Facebook page connects them to the community. Community liaisons also visit with each participant every six months for surveys, weighing and measuring.

The Bad River playground, designed by tribal elders and UW-Madison faculty as part of Healthy Children, Strong Families, incorporates cultural influences like a willow lodge
The Bad River playground, designed by tribal elders
and UW faculty, incorporates cultural influences.

But Dr. Adams isn’t finished with her work on obesity in underserved populations.

She serves as the director of the Collaborative Center for Health Equity, part of the UW Institute for Clinical and Translational Research. The center’s mission is an extension of Adams’ earlier work: to build relationships with underserved communities by engaging both university and community partners to improve health equity in Wisconsin. 

And her experience in tribal communities recently launched a broader, statewide approach to obesity – an emerging epidemic in Wisconsin. The Wisconsin Partnership Program has granted $8.6 million over five years to Adams and a team of UW investigators, including Dr. Brian Christens, an associate professor of human ecology, to create the Obesity Prevention Initiative. Part of the community-based work includes a phase-one project with Marathon and Menominee counties to examine the collective impact of community engagement in obesity prevention.

“The long-range mission of our work is to help communities promote their own wellness,” says Adams.

Reflecting on the past 15 years, Adams says there is more work to be done in collaboration with communities.

“Have we had a big impact on obesity rates? No. But we have had an impact with many increased supports for changing obesity in the community,” she concludes. “Things are better. But things are not where communities want them to be by any stretch of the imagination.”

Adams hopes the next several years will set the table for further reductions in obesity. 

Toni Morrissey is a senior media specialist with the UW School of Medicine and Public Health. Photos courtesy Healthy Children, Strong Families.