Bonnie Holy Rock

University of Minnesota Duluth, Duluth, Minnesota, United States

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Publications (15)46.47 Total impact

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    ABSTRACT: Prevalence of obesity among American Indian children is higher than the general US population. The school environment and teachers play important roles in helping students develop healthy eating habits. The aim of this prospective study was to examine teachers' classroom and school food practices and beliefs and the effect of teacher training on these practices and beliefs. Data were used from the Bright Start study, a group-randomized, school-based trial that took place on the Pine Ridge American Indian reservation (fall 2005 to spring 2008). Kindergarten and first-grade teachers (n=75) from 14 schools completed a survey at the beginning and end of the school year. Thirty-seven survey items were evaluated using mixed-model analysis of variance to examine the intervention effect for each teacher-practice and belief item (adjusting for teacher type and school as random effect). At baseline, some teachers reported classroom and school food practices and beliefs that supported health and some that did not. The intervention was significantly associated with lower classroom use of candy as a treat (P=0.0005) and fast-food rewards (P=0.008); more intervention teachers disagreed that fast food should be offered as school lunch alternatives (P=0.019), that it would be acceptable to sell unhealthy foods as part of school fundraising (P=0.006), and that it would not make sense to limit students' food choices in school (P=0.035). School-based interventions involving teacher training can result in positive changes in teachers' classroom food practices and beliefs about the influence of the school food environment in schools serving American Indian children on reservations.
    Journal of the American Academy of Nutrition and Dietetics 08/2013; 113(8):1076-83. · 3.80 Impact Factor
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    ABSTRACT: Assess cross-sectional and prospective associations between food responsiveness and parental food control and anthropometric outcomes among American Indian children. Parents/caregivers completed psychosocial surveys and trained staff measured children's anthropometry at baseline (kindergarten) and at follow-up (1st grade) as part of a school-based obesity prevention trial (Bright Start). On/near the Pine Ridge Indian reservation. 422 child (51% female, mean age=5.8 years, 30% overweight/obese) and parent/caregiver (89% mothers) dyads. Two independent variables (child's Food Responsiveness and Parental Control scales) and six child anthropometric dependent variables (overweight status, body mass index z-score, % body fat, waist circumference, triceps skinfold, subscapular skinfold). Linear regression analyses, stratified by sex and adjusted for age and treatment condition. Baseline Food Responsiveness scale scores were positively associated with all six baseline anthropometric outcomes among boys (P's all <.01), but not girls. Parental Control scale scores were not significantly associated with outcomes and no prospective associations were statistically significant. Responsiveness to food may be associated with excess adiposity in young American Indian boys, however, the effects are not detectable over time. Obesity prevention programs for American Indian children may benefit by addressing eating without hunger among boys.
    Ethnicity & disease 01/2013; 23(2):136-42. · 1.12 Impact Factor
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    ABSTRACT: We sought to better understand the prevalence and consequences of food insecurity among American Indian families with young children. Parents or caregivers of kindergarten-age children enrolled in the Bright Start study (dyad n=432) living on the Pine Ridge Reservation in South Dakota completed a questionnaire on their child's dietary intake, the home food environment, and food security. We assessed food security with a standard 6-item scale and examined associations of food insecurity with family sociodemographic characteristics, parents' and children's weight, children's dietary patterns, and the home food environment. Almost 40% of families reported experiencing food insecurity. Children from food-insecure households were more likely to eat some less healthful types of foods, including items purchased at convenience stores (P= .002), and food-insecure parents reported experiencing many barriers to accessing healthful food. Food security status was not associated with differences in home food availability or children's or parents' weight status. Food insecurity is prevalent among families living on the Pine Ridge Reservation. Increasing reservation access to food that is high quality, reasonably priced, and healthful should be a public health goal.
    American Journal of Public Health 05/2012; 102(7):1346-52. · 3.93 Impact Factor
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    ABSTRACT: The aim of the Bright Start study was to develop and test the effectiveness of a school environment intervention, supplemented with family involvement, to reduce excessive weight gain by increasing physical activity and healthy eating practices among kindergarten and first grade American Indian children. Bright Start was a group-randomized, school-based trial involving 454 children attending 14 schools on the Pine Ridge Reservation in South Dakota. Children were followed from the beginning of their kindergarten year through the end of first grade. Main outcome variables were mean BMI, mean percent body fat, and prevalence of overweight/obese children. The goals of the intervention were to: increase physical activity at school to at least 60 min/day; modify school meals and snacks; and involve families in making behavioral and environmental changes at home. At baseline, 32% of boys and 25% of girls were overweight/obese. While the intervention was not associated with statistically significant change in mean levels of BMI, BMI-Z, skinfolds or percentage body fat, the intervention was associated with a statistically significant net decrease of 10% in the prevalence of overweight. Intervention children experienced a 13.4% incidence of overweight, while the control children experienced a corresponding incidence of 24.8%; a difference of -11.4% (p=0.033). The intervention significantly reduced parent reported mean child intakes of sugar-sweetened beverages, whole milk and chocolate milk. Changes in duration of school physical activity were not significant. Because obesity is the most daunting health challenge facing American Indian children today, more intervention research is needed to identify effective approaches.
    Obesity 04/2012; · 3.92 Impact Factor
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    ABSTRACT: OBJECTIVE: To evaluate associations between home environmental factors and BMI of young American-Indian children. DESIGN: Cross-sectional and prospective study. SETTING: School-based obesity prevention trial (Bright Start) on a Northern Plains Indian reservation in South Dakota. Mixed model multivariable analysis was used to examine associations between child BMI categories (normal, overweight and obese) and home food availability, children's dietary intake and physical activity. Analyses were adjusted for age, gender, socio-economic status, parent BMI and school; prospective analyses also adjusted for study condition and baseline predictor and outcome variables. SUBJECTS: Kindergarten children (n 424, 51 % male; mean age = 5·8 years, 30 % overweight/obese) and parents/caregivers (89 % female; 86 % overweight/obese) had their height and weight measured and parents/caregivers completed surveys on home environmental factors (baseline and 2 years later). RESULTS: Higher fast-food intake and parent-perceived barriers to physical activity were marginally associated with higher probabilities of a child being overweight and obese. Vegetable availability was marginally associated with lower probabilities of being overweight and obese. The associations between home environmental factors and child weight status at follow-up were not significant. CONCLUSIONS: Findings indicate that selected aspects of the home environment are associated with weight status of American-Indian children. Obesity interventions with this population should consider helping parents to engage and model healthful behaviours and to increase availability of healthful foods at home.
    Public Health Nutrition 02/2012; · 2.25 Impact Factor
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    ABSTRACT: Obesity is highly prevalent among American Indians, and effective prevention efforts require caregiver involvement. We examined American Indian (AI) parents' assessment of and level of concern about their kindergarten child's weight status. We collected baseline data (fall of 2005 and fall of 2006) on children and their parents or caregivers for a school-based obesity prevention trial (Bright Start) on an AI reservation in South Dakota. The current study uses 413 parent-child pairs. Age- and sex-adjusted body mass index percentiles were categorized as very underweight (<5th percentile), slightly underweight (5th to <15th percentile), normal weight (15th to <85th percentile), overweight (85th to <95th percentile), and obese (≥ 95th percentile). Parents or caregivers reported their assessment of and concerns about their child's weight status as well as sociodemographic characteristics. We used mixed-model multivariable analysis to examine associations between sociodemographic characteristics and the probability of parents underclassifying or overclassifying their child's weight status; analyses were adjusted for school as a random effect. Children were evenly divided by sex and had a mean age of 5.8 years. Twenty-nine percent of children and 86% of parents were overweight or obese. Approximately 33% (n = 138) of parents underclassified and 7% (n = 29) of parents overclassified their child's weight status. Higher parental weight status and higher concern about their child's weight status increased the probability of underclassification (P for trend = .02 for both). In this sample of at-risk children, one-third of parents underclassified their child's weight status. Childhood obesity prevention programs need to increase awareness and recognition of childhood obesity and address parental weight issues.
    Preventing chronic disease 02/2012; 9:E56. · 1.82 Impact Factor
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    ABSTRACT: Overweight and obesity are highly prevalent among American Indian children, especially those living on reservations. There is little scientific evidence about the effects of summer vacation on obesity development in children. The purpose of this study was to investigate the effects of summer vacation between kindergarten and first grade on growth in height, weight, and body mass index (BMI) for a sample of American Indian children. Children had their height and weight measured in four rounds of data collection (yielded three intervals: kindergarten, summer vacation, and first grade) as part of a school-based obesity prevention trial (Bright Start) in a Northern Plains Indian Reservation. Demographic variables were collected at baseline from parent surveys. Growth velocities (Z-score units/year) for BMI, weight, and height were estimated and compared for each interval using generalized linear mixed models. The children were taller and heavier than median of same age counterparts. Height Z-scores were positively associated with increasing weight status category. The mean weight velocity during summer was significantly less than during the school year. More rapid growth velocity in height during summer than during school year was observed. Obese children gained less adjusted-BMI in the first grade after gaining more than their counterparts during the previous two intervals. No statistically significant interval effects were found for height and BMI velocities. There was no indication of a significant summer effect on children's BMI. Rather than seasonal or school-related patterns, the predominant pattern indicated by weight-Z and BMI-Z velocities might be related to age or maturation. Bright Start: Obesity Prevention in American Indian Children Clinical Trial Govt ID# NCT00123032.
    BMC Public Health 12/2011; 11:951. · 2.08 Impact Factor
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    ABSTRACT: American Indian children have high rates of overweight and obesity, which may be partially attributable to screen-time behavior. Young children's screen-time behavior is strongly influenced by their environment and their parents' behavior. We explored whether parental television watching time, parental perceptions of children's screen time, and media-related resources in the home are related to screen time (ie, television, DVD/video, video game, and computer use) among Oglala Lakota youth residing on or near the Pine Ridge Reservation in South Dakota. We collected baseline data from 431 child and parent/caregiver pairs who participated in Bright Start, a group-randomized, controlled, school-based obesity prevention trial to reduce excess weight gain. Controlling for demographic characteristics, we used linear regression analysis to assess associations between children's screen time and parental television watching time, parental perceptions of children's screen time, and availability of media-related household resources. The most parsimonious model for explaining child screen time included the children's sex, parental body mass index, parental television watching time, how often the child watched television after school or in the evening, parental perception that the child spent too much time playing video games, how often the parent limited the child's television time, and the presence of a VCR/DVD player or video game player in the home (F(7,367) = 14.67; P < .001; adjusted R(2) = .37). The presence of a television in the bedroom did not contribute significantly to the model. Changes in parental television watching time, parental influence over children's screen-time behavior, and availability of media-related resources in the home could decrease screen time and may be used as a strategy for reducing overweight and obesity in American Indian children.
    Preventing chronic disease 09/2011; 8(5):A105. · 1.82 Impact Factor
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    ABSTRACT: Pathways, a multisite school-based study aimed at promoting healthful eating and increasing physical activity, was a randomized field trial including 1704 American Indian third to fifth grade students from 41 schools (21 intervention, 20 controls) in seven American Indian communities. The intervention schools received four integrated components: a classroom curriculum, food service, physical activity, and family modules. The curriculum and family components were based on Social Learning Theory, American Indian concepts, and results from formative research. Process evaluation data were collected from teachers (n=235), students (n=585), and families. Knowledge, Attitudes, and Behavior Questionnaire data were collected from 1150 students including both intervention and controls. There were significant increases in knowledge and cultural identity in children in intervention compared to control schools with a significant retention of knowledge over the 3 years, based on the results of repeating the third and fourth grade test items in the fifth grade. Family members participated in Family Events and take-home activities, with fewer participating each year. A culturally appropriate school intervention can promote positive changes in knowledge, cultural identity, and self-reported healthful eating and physical activity in American Indian children and environmental change in school food service.
    Preventive Medicine 01/2004; 37(6 Pt 2):S24-34. · 3.50 Impact Factor
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    ABSTRACT: Pathways, a multicenter study to test the effect of a school-based program to prevent obesity in American Indian children, yielded many benefits and encountered many challenges. This paper explores what we have learned from this study and examines possible future directions. Information presented in this paper is based on formative research, study results, and discussions with staff and investigators. Some of the lessons learned relate to having a strong relationship with the tribes, how best to engage the communities, the importance of formative research and achieving standardization in culturally diverse settings, how to incorporate cultural information into curricula, and the importance of family involvement. One of the strengths of the study was the collaborative process that teamed American Indian and non-American Indian investigators and staff. Researchers recognized that they must work in cooperation with research participants including their schools and communities to address challenges, to ensure accurate findings and analyses, and to share benefits. The lessons learned from Pathways offer valuable insights for researchers into successful approaches to the challenges inherent in research in American Indian communities, particularly in schools, and how to maximize the benefits of such a study.
    Preventive Medicine 01/2004; 37(6 Pt 2):S107-12. · 3.50 Impact Factor
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    ABSTRACT: American Indians of all ages and both sexes have a high prevalence of obesity. The health risks associated with obesity are numerous and include Type 2 diabetes mellitus, hypertension, dyslipidemia, and respiratory problems. Obesity has become a major health problem in American Indians only in the past few generations and it is believed to be associated with the relative abundance of high-fat, high-calorie foods and the rapid change from active to sedentary lifestyles. The authors reviewed selected literature on prevalence of obesity in American-Indian children, and health consequences of obesity. Obesity is now one of the most serious public health problems facing American-Indian children, and it has grave implications for the immediate and long-term health of American-Indian youth. Unless this pattern is reversed, American-Indian populations will be burdened by an increased incidence of chronic diseases. Intervention studies are urgently needed in American-Indian communities to develop and test effective strategies for obesity prevention and treatment. To be effective, educational and environmental interventions must be developed with full participation of the American-Indian communities.
    Preventive Medicine 01/2004; 37(6 Pt 2):S3-12. · 3.50 Impact Factor
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    ABSTRACT: Childhood obesity is a major public health problem in the United States, particularly among American Indian communities. The objective was to evaluate the effectiveness of a school-based, multicomponent intervention for reducing percentage body fat in American Indian schoolchildren. This study was a randomized, controlled, school-based trial involving 1704 children in 41 schools and was conducted over 3 consecutive years, from 3rd to 5th grades, in schools serving American Indian communities in Arizona, New Mexico, and South Dakota. The intervention had 4 components: 1) change in dietary intake, 2) increase in physical activity, 3) a classroom curriculum focused on healthy eating and lifestyle, and 4) a family-involvement program. The main outcome was percentage body fat; other outcomes included dietary intake, physical activity, and knowledge, attitudes, and behaviors. The intervention resulted in no significant reduction in percentage body fat. However, a significant reduction in the percentage of energy from fat was observed in the intervention schools. Total energy intake (by 24-h dietary recall) was significantly reduced in the intervention schools but energy intake (by direct observation) was not. Motion sensor data showed similar activity levels in both the intervention and control schools. Several components of knowledge, attitudes, and behaviors were also positively and significantly changed by the intervention. These results document the feasibility of implementing a multicomponent program for obesity prevention in elementary schools serving American Indian communities. The program produced significant positive changes in fat intake and in food- and health-related knowledge and behaviors. More intense or longer interventions may be needed to significantly reduce adiposity in this population.
    American Journal of Clinical Nutrition 12/2003; 78(5):1030-8. · 6.50 Impact Factor
  • L Harnack, M Story, B H Rock
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    ABSTRACT: This study assessed specific dietary practices and overall physical activity patterns of Lakota adults residing on Indian reservations in South Dakota. Perceived barriers to changing dietary and physical activity behaviors were also examined. A convenience sample of Lakota adults was surveyed. Data on consumption of higher-fat foods, fruit and vegetable intake, use of sugar-sweetened beverages, physical activity patterns, and barriers to change in diet and physical activity were collected via in-person interviews. A total of 219 adults from 2 adjacent reservations in South Dakota participated. Higher-fat foods consumed most frequently included margarine and butter (32.0% > or = 5 times per week); eggs (30.1% > or = 5 times per week); whole milk (25.7% > or = 5 times per week); potato chips, corn chips, and popcorn (15.1% > or = 5 times per week); and bacon and sausage (13.3% > or = 5 times per week). Few subjects reported consuming fruit on a daily basis. Vegetables were consumed somewhat more frequently. Most subjects reported engaging in mild or moderate physical activities 3 or more times per week, although women were found to engage in moderate and strenuous physical activities less frequently than men. Major barriers to fruit intake included expense (16.4%), quality (14.2%), and availability (13.2%). Barriers to vegetable intake mentioned most frequently included availability (11.4%), cost (10.4%), and quality (9.1%). Taste was the most frequently mentioned barrier to cutting intake of high-fat foods (27.9%). Lack of child care (15.8%), lack of time (14.7%), and safety concerns (14.6%) were the most salient barriers to regular exercise. Nutrition interventions are needed that address the major barriers to diet change reported by Lakota adults. Efforts to increase physical activity should focus on Lakota women and should address the identified barriers to regular exercise.
    Journal of the American Dietetic Association 07/1999; 99(7):829-35. · 3.80 Impact Factor
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    ABSTRACT: Primary objectives were to describe beliefs about diet and health, weight perceptions, and weight loss practices among Lakota Indian adults. In-person interviews were conducted with a total of 219 adults from two reservations in South Dakota. Overall, 55.5% of the sample was overweight. When asked how they perceived their body weight, 6% felt they were “too thin,” 43.4% thought they were “about right,” and 50.2% felt they were “too fat.” When asked what they were doing about their weight, 74% said they were either trying to lose weight or trying to keep from gaining more weight. Reducing the amount of food eaten (90%), eating more fruits and vegetables (86%), increasing physical activity (84%), and skipping meals (82%) were reported to have been used by most of those who had dieted. Of those who felt they needed to lose weight, 78% said they would join a weight loss program if one were offered. Findings indicate that most Lakota adults are concerned about obesity and are attempting to either lose excess weight or avoid gaining weight. Intervention efforts for this population should focus on providing individuals with guidance on effective strategies for weight loss or obesity prevention. Weight loss programs should include features identified as important by survey participants, such as information on how to fit a healthful diet and exercise into daily life.
    Journal of Nutrition Education. 01/1999;
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    ABSTRACT: To examine the agreement between school children's intended food choices and observed food choices. Native American students in the second through fifth grade completed a questionnaire that asked them to select from 10 paired food choices for a given meal or snack. Three weeks later students chose among foods identical to those on the questionnaire as part of their usual school lunch or breakfast over three consecutive days; afternoon snacks were also offered. Agreement between students' intended food choices and observed food choices was examined across 10 food pairs. The composite kappa coefficient between intended and observed food choices was 0.09 (95% confidence interval 0.06, 0.012), including virtually no agreement above that expected by chance. There were no differences in agreement by sex or grade. Intended food choices were not significantly associated with observed food choices. It is unclear whether intended food choices reflect nutrition knowledge, socially desirable responses, food preferences, or some other dimension of eating behavior. Although responsive to school-based nutrition interventions, the interpretation of changes in intended food choices must be clarified in future research.
    Obesity research 04/1997; 5(2):87-92. · 4.95 Impact Factor

Publication Stats

388 Citations
46.47 Total Impact Points


  • 1997–2013
    • University of Minnesota Duluth
      • Department of Family Medicine and Community Health
      Duluth, Minnesota, United States
  • 1999–2011
    • University of Minnesota Twin Cities
      • • Division of Epidemiology and Community Health
      • • School of Public Health
      Minneapolis, MN, United States
  • 2004
    • Johns Hopkins University
      • Center for Human Nutrition
      Baltimore, MD, United States