The Northwest Portland Area Indian Health Board (NPAIHB) continues a partnership with six Northwest tribes in a follow up study to The TOTS Study (Toddler Obesity and Tooth Decay) Study), an early childhood obesity and oral caries prevention program. The goal of this study is to survey and conduct dental exams with the original cohort of toddlers to test whether interventions delivered in the TOTS will influence the prevalence of oral caries in older children.  Through qualitative approaches, the study will also assess current community, environmental and familial factors that can influence older health in children to understand any maintenance of preventive behaviors over the last ten years within the entire family.


The overall aim of the TOTS to Tweens study is to test whether interventions delivered by staff to toddler/community/caregivers 8 years earlier will influence the prevalence of caries in older AI children (“Tweens”). We also plan to assess current community, environmental and familial factors that can influence the oral health of older children via qualitative and quantitative approaches.

This study is innovative in its focus is on keeping children healthy from the very beginning as opposed to combating disease once it has occurred.  It is also innovative because it focuses the most vulnerable members of the community, infants and toddlers, using a multi-level approach of interventions.  If successful, the intervention would have great significance for the many tribal communities facing these problems.

woven basket

In 2000, a team of investigators both at the Northwest Portland Area Indian Health Board and The Kaiser Center for Health Research put their heads together to respond to tribal leaders’ requests to develop “upstream” intervention strategies to prevent the increasing prevalence of Type II Diabetes.  In late 2000 an opportunity arose to develop a proposal for a National Institute of Health(NIH)/Indian Health Service funding initiative called Native American Research Centers for Health (NARCH).  NPAIHB was one of the first Indian Organizations be awarded funding to create a NARCH.  The original NARCH proposal included a research study aimed at reducing early childhood overweight.  This study which came to be known as TOTS (The Toddler Obesity and Tooth Decay Study) collaborated with five northwest tribes to develop community–based and family–based interventions aimed at reducing the early childhood overweight.  The results of this study are still being written up, but the successful collaboration and process, was followed by the funding of an additional research grant funded by another institute of NIH,  the National Heart Lung and Blood Institute (NHLBI).  The NHLBI Study, coined PTOTS or Primordial Prevention of Toddler Overweight Study, built on the strengths of TOTS and incorporated more comprehensive nutrition and physical activity components into the study.  PTOTS recruited six tribal communities to participate, three will serve as intervention sites and three will serves as control sites.  PTOTS is in the implementation phase in the three intervention sites and is in the planning phase for the control sites.

National Heart Lung and Blood Institute

Kaiser Permanente Center for Health Research


Related Associations:

American Dietetic Association

American Diabetes Association

American Academy of Pediatrics


Bright Future’s in Practice: Nutrition

Program Contacts

Tam Lutz, Jr. Investigator/Project Director
Phone: (503) 416-3271


Nicole Smith, Biostatistician
Phone: (503) 416-3292


Candice Jimenez, Research Coordinator
Phone: (503) 416-3264


Mailing Address:
NPAIHB c/o TOTS to Tweens
2121 SW Broadway, Suite 300
Portland, OR 97201


More NPAIHB Programs

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