A study protocol for rural tribal school partnerships for the primary prevention of obesity among American Indian youth (P2)

Obesity among American Indian youth remains a critical health disparity, placing them at elevated risk for chronic diseases such as diabetes, cardiovascular disease, and obesity-related cancers. School environments in Tribal communities are uniquely positioned to support obesity prevention through structured health education, physical activity opportunities, and school meal programs and school wellness policy initiatives. Yet, school-based obesity prevention research in American Indian communities remains limited, and have not been as successful in improving weight status in AIAN youth, particularly in leveraging the requirement of school wellness policies as participants in the National School Lunch Program. We describe the procedure and rationale for evaluating the Rural Tribal School Partnership for the Primary Prevention of Obesity (P2) project, a multi-component health promotion curriculum intervention addressing nutrition and physical activity through three integrated components – classroom, food services and policy. We will evaluate the efficacy of P2 for improving BMI, nutrition and physical activity knowledge and behaviors (primary outcomes) among American Indian 4th grade students in rural, Tribal communities. We will employ a cluster, non-randomized design across four schools, with one intervention arm and one control arm. Enrolled 4th grade youth will complete pre- (start of school year) and post-intervention (end of school year) measurements. Secondary outcomes include physical activity tracking, dietary recall, student perception of school environment policies and practices, objective fruit and vegetable intake using Veggie Meter ® . Study findings will inform best practices and a scalable culturally responsive health promotion curriculum model for rural and American Indian serving schools. Clinical trials registration NCT06864468, https://register.clinicaltrials.gov/prs/beta/records .