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Myers KP, Temple JL. Translational science approaches for food insecurity research. Appetite 2024; 200:107513. [PMID: 38795946 PMCID: PMC11227396 DOI: 10.1016/j.appet.2024.107513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/20/2024] [Accepted: 05/22/2024] [Indexed: 05/28/2024]
Abstract
Food insecurity is a pervasive problem that impacts health and well-being across the lifespan. The human research linking food insecurity to poor metabolic and behavioral health outcomes is inherently correlational and suffers from a high degree of variability both between households and even within the same household over time. Further, food insecurity is impacted by societal and political factors that are largely out of the control of individuals, which narrows the range of intervention strategies. Animal models of food insecurity are being developed to address some of the barriers to mechanistic research. However, animal models are limited in their ability to consider some of the more complex societal elements of the human condition. We believe that understanding the role that food insecurity plays in ingestive behavior and chronic disease requires a truly translational approach, and that understanding the health impacts of this complex social phenomenon requires understanding both its psychological and physiological dimensions. This brief review will outline some key features of food insecurity, highlighting those that are amenable to investigation with controlled animal models and identifying areas where integrating animal and human studies can improve our understanding of the psychological burden and health impacts of food insecurity. In the interest of brevity, this review will largely focus on food insecurity in the United States, as the factors that contribute to food insecurity vary considerably across the globe.
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Affiliation(s)
- Kevin P Myers
- Department of Psychology, Animal Behavior & Neuroscience Programs, Bucknell University, Lewisburg, PA, USA.
| | - Jennifer L Temple
- Departments of Exercise and Nutrition Sciences, Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
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Taniguchi T, Williams-Nguyen J, Muller CS, Fyfe-Johnson A, Henderson A, Umans JG, Standridge J, Shackleford T, Rosenman R, Buchwald D, Jernigan VB. Pilot study of a heart-healthy food box intervention for Native Americans with uncontrolled hypertension: methods and results from the Chickasaw Healthy Eating Environments Research Study. HEALTH EDUCATION RESEARCH 2024:cyae023. [PMID: 38965030 DOI: 10.1093/her/cyae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/30/2024] [Accepted: 06/21/2024] [Indexed: 07/06/2024]
Abstract
We sought to evaluate the acceptability and feasibility of a culturally tailored food box intervention for improving blood pressure (BP), food security and Body Mass Index (BMI) among Chickasaw Nation adults with uncontrolled hypertension. As part of the Chickasaw Healthy Eating Environments Research Study (CHEERS), we administered a group randomized pilot study in four tribal communities (two intervention, two control). Participants in the intervention communities received six heart-healthy food boxes, culturally tailored to traditional Chickasaw diet and current food context. Outcomes were measured over 6 months. We enrolled 262 participants, and 204 with complete data on key variables were included in the analysis. The food boxes were very popular, and we achieved high retention for follow-up data collection. Intervention community participants had 2.6 mmHg lower mean systolic BP and improved diet quality and BMI compared with control participants, although, as expected for a pilot study, the differences were not statistically significant. The culturally tailored diet intervention and randomized trial study design were acceptable and feasible for Chickasaw Nation adults with uncontrolled hypertension. Our findings support the value of tribal-food bank partnerships as a potential approach for reducing food insecurity and hypertension-related disparities in Native American communities.
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Affiliation(s)
- Tori Taniguchi
- Center for Indigenous Health Research and Policy, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Jessica Williams-Nguyen
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA, USA
| | - Clemma S Muller
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA, USA
| | - Amber Fyfe-Johnson
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA, USA
| | - Austin Henderson
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA, USA
| | - Jason G Umans
- MedStar Health Research Institute, Hyattsville, MD, USA
- Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, USA
| | | | | | - Robert Rosenman
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA, USA
| | | | - Valarie Bluebird Jernigan
- Center for Indigenous Health Research and Policy, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
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Tucker AC, Bresnahan C, John S, Johnson J, Leung CW, Mui Y, Hager ER, Wolfson JA. Food (in)security in relation to nutrition (in)security in a national cross-sectional sample of Supplemental Nutrition Assistance Program participants: considerations of an emerging construct. Am J Clin Nutr 2024; 119:1475-1484. [PMID: 38839196 PMCID: PMC11196887 DOI: 10.1016/j.ajcnut.2024.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 03/12/2024] [Accepted: 03/22/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Food insecurity, lack of access to sufficient food for an active, healthy life, is a persistent problem in the United States. Recently, nutrition security has emerged as a new concept. However, limited research exists examining how nutrition security relates to the established concept of food security. OBJECTIVES This study assessed a recent metric of nutrition security and explored how well it describes the underlying construct among a sample of Supplemental Nutrition Assistance Program (SNAP) participants. We examined the correlation between food and nutrition security and demographic predictors of joint food and nutrition security status. METHODS We conducted a national, web-based survey (Qualtrics; 30 September-19 October, 2022) in English and Spanish of adults aged ≥18 y (n = 1454) who reported receiving SNAP benefits in the past 12 mo. We measured food security using the US Department of Agriculture 6-item Food Security Survey and assessed nutrition security using the Gretchen Swanson Center for Nutrition Household Nutrition Security measure. We used multinominal logistic regression to examine demographic predictors of food and nutrition security. RESULTS The majority (80.4%) of SNAP participants experienced food insecurity, and 59.1% reported experiencing nutrition insecurity. Food and nutrition security were moderately correlated (0.41); 55.6% of SNAP participants were both food and nutrition insecure, 3.5% were food secure but nutrition insecure, 24.8% were food insecure but nutrition secure, and 16.1% were both food and nutrition secure. Of SNAP participants, 24.8% reported experiencing food insecurity but not nutrition insecurity. Hispanic ethnicity and Southern residence were associated with joint food and nutrition insecurity. CONCLUSIONS These findings raise questions about how nutrition security is conceptualized and measured and its added value beyond existing food security measurement scales. Further research is needed to understand differences in food and nutrition security experiences and risk factors and determine a validated definition and measure of nutrition security for future policy solutions.
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Affiliation(s)
- Anna C Tucker
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | - Carolyn Bresnahan
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Sara John
- Center for Science in the Public Interest, Washington, DC, United States
| | - Joelle Johnson
- Center for Science in the Public Interest, Washington, DC, United States
| | - Cindy W Leung
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Yeeli Mui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Erin R Hager
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Julia A Wolfson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Brega AG, Stotz SA, Moore KR, McNulty MC, Jiang L. Reliability and Validity of Diabetes Nutrition Self-Efficacy and Behavior Measures for the "What Can I Eat" Diabetes Nutrition Education Program for American Indian and Alaska Native Adults With Type 2 Diabetes. J Acad Nutr Diet 2024:S2212-2672(24)00218-1. [PMID: 38735529 DOI: 10.1016/j.jand.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 05/01/2024] [Accepted: 05/07/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND American Indian and Alaska Native (AI/AN) people have high rates of diabetes and limited access to nutrition education. The "What Can I Eat? Healthy Choices for People With Type 2 Diabetes" (WCIE) diabetes nutrition education program was culturally adapted for AI/AN adults. OBJECTIVE This analysis was designed to evaluate the reliability and validity of items developed to measure diabetes nutrition self-efficacy (ie, confidence one can engage in specific behaviors) and diabetes nutrition behavior among participants in the WCIE program for AI/AN adults. DESIGN This study was a secondary analysis of data from a randomized controlled trial designed to evaluate the WCIE program for AI/AN adults. Baseline data were used to assess the reliability and validity of the self-efficacy and behavior items, which were collected via survey. Due to COVID-19 safety protocols, the intervention was conducted via Zoom (Zoom Video Communications), and both survey and clinical data were collected at home by participants. PARTICIPANTS/SETTING The study was conducted from January to December 2021 with 5 AI/AN-serving health care programs in Oklahoma, Illinois, North Carolina, California, and New York. AI/AN adults with type 2 diabetes who spoke English and had internet access were eligible. Sixty people participated. MAIN OUTCOME MEASURES Analyses examined validity and reliability of diabetes nutrition self-efficacy and behavior items. STATISTICAL ANALYSIS PERFORMED To test reliability, internal consistency and factor structures of the scales were examined. To evaluate convergent validity, Pearson correlations were computed to examine the association of the self-efficacy and behavior measures with each other and with clinical indicators (ie, body mass index, blood pressure, and hemoglobin A1c). RESULTS Two self-efficacy factors were identified. Each showed strong internal consistency (Cronbach α ≥ 0.85; McDonald ω ≥ 0.88) and was directly associated with diabetes nutrition behavior (P < .001). The factor assessing Confidence in Using the Diabetes Plate was inversely associated with hemoglobin A1c (Pearson correlation = -0.32, P = .0243). The behavior measure capturing Healthy Nutrition Behavior showed strong internal consistency (α = 0.89; ω = 0.92) and was inversely associated with hemoglobin A1c (Pearson correlation = -0.38, P = .0057). CONCLUSIONS Diabetes nutrition self-efficacy and behavior items developed for the WCIE program for AI/AN adults are valid and reliable. These items can facilitate rigorous and consistent evaluation of the AI/AN WCIE program.
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Affiliation(s)
- Angela G Brega
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| | - Sarah A Stotz
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, Colorado
| | - Kelly R Moore
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Monica C McNulty
- Adult and Child Center for Outcomes Research and Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Luohua Jiang
- Department of Epidemiology and Biostatistics, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, California
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Henderson A, Rosenman R, Fyfe-Johnson AL, Taniguchi T, Standridge J, Shackleford T, Muller CJ, Umans JG, Jernigan VBB. The cost-efficacy of a healthy food box for managing hypertension within a native American population: a group randomized controlled trial. Arch Public Health 2024; 82:59. [PMID: 38671533 PMCID: PMC11046939 DOI: 10.1186/s13690-024-01274-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/18/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Dietary interventions are used for the treatment of hypertension. We evaluated the cost-efficacy of delivering boxes of healthy, culturally tailored foods and checks that can only be spent on produce in a Native American population. METHODS We conducted a group randomized controlled trial from 2018 to 2020 with N = 2 treatment counties and N = 2 control counties and a total of N = 160 Native American adults with baseline stage 1 or stage 2 hypertension. Participants in the intervention group received monthly boxes of food that adheres to the Dietary Approaches to Stop Hypertension diet as well as checks that could only be spent on produce for 6 months. We measured blood pressure and quality of life at baseline and at a 6-month follow-up in both intervention and control groups. We used ordered logistic regression to estimate the effect of treatment on probability of blood pressure improvements. We then conducted a cost-efficacy analysis. RESULTS We found that treatment was effective in reducing blood pressure in women with stage 1 hypertension at baseline. Based on this finding, we also estimate that this intervention satisfies normative cost-effectiveness thresholds, even when lifetime treatment is needed to preserve the impact, so long as treatment is only continued in those who respond to treatment. CONCLUSIONS Direct delivery of healthy foods and checks that can only be spent on produce are a potentially cost-effective intervention for the management of hypertension among Native American women with stage 1 hypertension. Further research is needed to understand why we found an impact only for this group.
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Affiliation(s)
- Austin Henderson
- Institute for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle, Washington, United States of America.
| | - Robert Rosenman
- School of Economic Sciences, Washington State University, Pullman, Washington, United States of America
| | - Amber L Fyfe-Johnson
- Institute for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle, Washington, United States of America
| | - Tori Taniguchi
- Center for Indigenous Health Research and Policy, Oklahoma State University Center for Health Sciences, Stillwater, Oklahoma, United States of America
| | - Joy Standridge
- Nutrition Services Department, Chickasaw Nation, Ada, Oklahoma, United States of America
| | - Tyra Shackleford
- Nutrition Services Department, Chickasaw Nation, Ada, Oklahoma, United States of America
| | - Clemma J Muller
- Institute for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle, Washington, United States of America
| | - Jason G Umans
- Hyattsville MD and Georgetown-Howard Universities Center for Clinical and Translational Science, MedStar Health Research Institute, Washington DC, United States of America
| | - Valarie Blue Bird Jernigan
- Center for Indigenous Health Research and Policy, Oklahoma State University Center for Health Sciences, Stillwater, Oklahoma, United States of America
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Nelson K, Jackson AM, Nguyen CJ, Noonan C, Muller C, MacLehose RF, Manson SM, Dillard DA, Buchwald D. Food insecurity in urban American Indian and Alaska Native populations during the COVID-19 pandemic. BMC Public Health 2024; 24:903. [PMID: 38539099 PMCID: PMC10967146 DOI: 10.1186/s12889-024-18390-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/19/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Food insecurity is an important social determinant of health that was exacerbated by the COVID-19 pandemic. Both food insecurity and COVID-19 infection disproportionately affect racial and ethnic minority groups, particularly American Indian and Alaska Native communities; however, there is little evidence as to whether food insecurity is associated with COVID-19 infection or COVID-19 preventive behaviors such as vaccination uptake. The purpose of this study was to evaluate associations between food insecurity, COVID-19 infection, and vaccination status among urban American Indian and Alaska Native adults seen at 5 clinics serving urban Native people. METHODS In partnership with health organizations in Alaska, Colorado, Kansas, Minnesota, and New Mexico, the study team conducted a cross-sectional survey in 2021 to assess food security status and attitudes, barriers, and facilitators for COVID-19 testing and vaccination. Logistic regression was used to examine the association of food security status with sociodemographic factors and COVID-19 infection and vaccination status. Marginal standardization was applied to present results as prevalence differences. RESULTS Among 730 American Indian and Alaska Native adults, the prevalence of food insecurity measured during the pandemic was 38%. For participants who reported persistent food security status before and during the pandemic (n = 588), the prevalence of food insecurity was 25%. Prevalence of COVID-19 infection and vaccination did not vary by food security status after adjustment for confounders. CONCLUSIONS High rates of food insecurity among American Indian and Alaska Native communities likely increased during the COVID-19 pandemic. However, despite the high prevalence of food insecurity, community-led efforts to reduce COVID-19 infection and increase vaccination uptake across Indian Health Service and Tribal healthcare facilities may have mitigated the negative impacts of the pandemic for families experiencing food insecurity. These successful approaches serve as an important reference for future public health efforts that require innovative strategies to improve overall health in American Indian and Alaska Native communities.
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Affiliation(s)
- Katie Nelson
- Institute for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Ste 1200, Seattle, WA, 98101, USA.
| | | | - Cassandra J Nguyen
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Carolyn Noonan
- Institute for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Ste 1200, Seattle, WA, 98101, USA
| | - Clemma Muller
- Institute for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Ste 1200, Seattle, WA, 98101, USA
| | - Richard F MacLehose
- Division of Epidemiology and Community Health, Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Spero M Manson
- Colorado School of Public Health, Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Denise A Dillard
- Institute for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Ste 1200, Seattle, WA, 98101, USA
| | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Ste 1200, Seattle, WA, 98101, USA
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Henderson A, Rosenman R, Fyfe-Johnson AL, Taniguchi T, Standridge J, Shackleford T, Muller CJ, Umans JG, Jernigan VBB. The Cost-Efficacy of a Healthy Food Box for Managing Hypertension Within a Native American Population: The Chickasaw Healthy Eating Environment Research Study. RESEARCH SQUARE 2024:rs.3.rs-3901299. [PMID: 38352591 PMCID: PMC10862957 DOI: 10.21203/rs.3.rs-3901299/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Background Dietary interventions are used for the treatment of hypertension. We evaluated the cost-efficacy of delivering boxes of healthy, culturally tailored foods and checks that can only be spent on produce in a Native American population. Methods We conducted a group randomized controlled trial from 2018-2020 with N = 2 treatment counties and N = 2 control counties and a total of N = 160 Native American adults with baseline stage 1 or stage 2 hypertension. Participants in the intervention group received monthly boxes of food that adheres to the Dietary Approaches to Stop Hypertension diet as well as checks that could only be spent on produce for 6 months. We measured blood pressure and quality of life at baseline and at a 6-month follow-up in both intervention and control groups. We used ordered logistic regression to estimate the effect of treatment on probability of blood pressure improvements. We then conducted a cost-efficacy analysis. Results We found that treatment was effective in women with stage 1 hypertension at baseline. Based on this finding, we also estimate that this intervention satisfies normative cost-effectiveness thresholds, even when lifetime treatment is needed to preserve the impact, so long as treatment is only continued in those who respond to treatment. Conclusions Direct delivery of healthy foods and checks that can only be spent on produce are a potentially cost-effective intervention for the management of hypertension among Native American women with stage 1 hypertension. Further research is needed to understand why we found an impact only for this group.
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Mendez I, Strassle PD, Rodriquez EJ, Ponce S, Le R, Green A, Martinez E, Pérez-Stable EJ, Nápoles AM. Racial and ethnic disparities in the association between financial hardship and self-reported weight change during the first year of the pandemic in the U.S. Int J Equity Health 2024; 23:12. [PMID: 38254081 PMCID: PMC10804602 DOI: 10.1186/s12939-023-02093-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/30/2023] [Indexed: 01/24/2024] Open
Abstract
Studies have shown that financial hardship can impact weight change; however, it is unclear what the economic impact of the COVID-19 pandemic has had on weight change in U.S. adults, or whether racial-ethnic groups were impacted differentially. We estimated the association between financial hardship and self-reported weight change using data from the cross-sectional COVID-19's Unequal Racial Burden (CURB) survey, a nationally representative online survey of 5,500 American Indian/Alaska Native, Asian, Black/African American, Latino (English- and Spanish-speaking), Native Hawaiian/Pacific Islander, White, and multiracial adults conducted from 12/2020 to 2/2021. Financial hardship was measured over six domains (lost income, debt, unmet general expenses, unmet healthcare expenses, housing insecurity, and food insecurity). The association between each financial hardship domain and self-reported 3-level weight change variable were estimated using multinomial logistic regression, adjusting for sociodemographic and self-reported health. After adjustment, food insecurity was strongly associated with weight loss among American Indian/Alaska Native (aOR = 2.18, 95% CI = 1.05-4.77), Black/African American (aOR = 1.77, 95% CI = 1.02-3.11), and Spanish-speaking Latino adults (aOR = 2.32, 95% CI = 1.01-5.35). Unmet healthcare expenses were also strongly associated with weight loss among Black/African American, English-speaking Latino, Spanish-speaking Latino, and Native Hawaiian/Pacific Islander adults (aORs = 2.00-2.14). Other domains were associated with weight loss and/or weight gain, but associations were not as strong and less consistent across race-ethnicity. In conclusion, food insecurity and unmet healthcare expenses during the pandemic were strongly associated with weight loss among racial-ethnic minority groups. Using multi-dimensional measures of financial hardship provides a comprehensive assessment of the effects of specific financial hardship domains on weight change among diverse racial-ethnic groups.
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Affiliation(s)
- Izabelle Mendez
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland), USA.
| | - Paula D Strassle
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland), USA
| | - Erik J Rodriquez
- Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland), USA
- Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland), USA
| | - Stephanie Ponce
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland), USA
| | - Randy Le
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland), USA
| | - Alexis Green
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland), USA
| | - Emma Martinez
- Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland), USA
| | - Eliseo J Pérez-Stable
- Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland), USA
- Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland), USA
| | - Anna M Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland), USA
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Lee AJ, Herron LM, Rainow S, Wells L, Kenny I, Kenny L, Wells I, Kavanagh M, Bryce S, Balmer L. Improving economic access to healthy diets in first nations communities in high-income, colonised countries: a systematic scoping review. Nutr J 2024; 23:10. [PMID: 38225569 PMCID: PMC10790425 DOI: 10.1186/s12937-023-00895-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 11/23/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Affordability of healthy food is a key determinant of the diet-related health of First Nations Peoples. This systematic scoping review was commissioned by the Ngaanyatjarra Pitjantjatjara Yankunytjatjara Women's Council (NPYWC) in Central Australia to identify interventions to improve economic access to healthy food in First Nations communities in selected high-income, colonised countries. METHODS Eight databases and 22 websites were searched to identify studies of interventions and policies to improve economic access to healthy food in First Nations communities in Australia, Canada, the United States or New Zealand from 1996 to May 2022. Data from full text of articles meeting inclusion criteria were extracted to a spreadsheet. Results were collated by descriptive synthesis. Findings were examined with members of the NPYWC Anangu research team at a co-design workshop. RESULTS Thirty-five publications met criteria for inclusion, mostly set in Australia (37%) or the US (31%). Interventions (n = 21) were broadly categorised as price discounts on healthy food sold in communities (n = 7); direct subsidies to retail stores, suppliers and producers (n = 2); free healthy food and/or food vouchers provided to community members (n = 7); increased financial support to community members (n = 1); and other government strategies (n = 4). Promising initiatives were: providing a box of food and vouchers for fresh produce; prescriptions for fresh produce; provision/promotion of subsidised healthy meals and snacks in community stores; direct funds transfer for food for children; offering discounted healthy foods from a mobile van; and programs increasing access to traditional foods. Providing subsidies directly to retail stores, suppliers and producers was least effective. Identified enablers of effective programs included community co-design and empowerment; optimal promotion of the program; and targeting a wide range of healthy foods, particularly traditional foods where possible. Common barriers in the least successful programs included inadequate study duration; inadequate subsidies; lack of supporting resources and infrastructure for cooking, food preparation and storage; and imposition of the program on communities. CONCLUSIONS The review identified 21 initiatives aimed at increasing affordability of healthy foods in First Nations communities, of which six were deemed promising. Five reflected the voices and experiences of members of the NPYWC Anangu research team and will be considered by communities for trial in Central Australia. Findings also highlight potential approaches to improve economic access to healthy foods in First Nations communities in other high-income colonised countries. TRIAL REGISTRATION PROSPERO CRD42022328326.
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Affiliation(s)
- Amanda J Lee
- School of Public Health, The University of Queensland, 288 Herston Rd, Herston, QLD, 4029, Australia.
| | - Lisa-Maree Herron
- School of Public Health, The University of Queensland, 288 Herston Rd, Herston, QLD, 4029, Australia
| | - Stephan Rainow
- Nganampa Health Council, 3 Wilkinson St, Alice Springs, NT, 0871, Australia
| | - Lisa Wells
- Anangu research team, Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Women's Council, 3 Wilkinson St, Alice Springs, NT, 0871, Australia
| | - Ingrid Kenny
- Anangu research team, Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Women's Council, 3 Wilkinson St, Alice Springs, NT, 0871, Australia
| | - Leon Kenny
- Anangu research team, Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Women's Council, 3 Wilkinson St, Alice Springs, NT, 0871, Australia
| | - Imogen Wells
- Anangu research team, Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Women's Council, 3 Wilkinson St, Alice Springs, NT, 0871, Australia
| | - Margaret Kavanagh
- Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Women's Council, 3 Wilkinson St, Alice Springs, NT, 0871, Australia
| | - Suzanne Bryce
- Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Women's Council, 3 Wilkinson St, Alice Springs, NT, 0871, Australia
| | - Liza Balmer
- Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Women's Council, 3 Wilkinson St, Alice Springs, NT, 0871, Australia
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Nelson K, Jackson AM, Nguyen CJ, Noonan C, Muller C, MacLehose RF, Manson SM, Dillard D, Buchwald D. Food Insecurity in Urban American Indian and Alaska Native Populations During the COVID-19 Pandemic. RESEARCH SQUARE 2023:rs.3.rs-3711655. [PMID: 38168406 PMCID: PMC10760224 DOI: 10.21203/rs.3.rs-3711655/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Background Food insecurity is an important social determinant of health that was exacerbated by the COVID-19 pandemic. Both food insecurity and COVID-19 infection disproportionately affect racial and ethnic minority groups, particularly American Indian and Alaska Native communities; however, there is little evidence as to whether food insecurity is associated with COVID-19 infection or COVID-19 preventive behaviors such as vaccination uptake. The purpose of this study was to evaluate associations between food insecurity, COVID-19 infection, and vaccination status among urban American Indian and Alaska Native adults seen at 5 clinics serving urban Native people. Methods In partnership with health organizations in Alaska, Colorado, Kansas, Minnesota, and New Mexico, the study team conducted a cross-sectional survey in 2021 to assess food security status and attitudes, barriers, and facilitators for COVID-19 testing and vaccination. Logistic regression was used to examine the association of food security status with sociodemographic factors and COVID-19 infection and vaccination status. Marginal standardization was applied to present results as prevalence differences. Results Among 730 American Indian and Alaska Native adults, the prevalence of food insecurity measured during the pandemic was 38%. For participants who reported persistent food security status before and during the pandemic (n=588), the prevalence of food insecurity was 25%. Prevalence of COVID-19 infection and vaccination did not vary by food security status after adjustment for confounders. Conclusions High rates of food insecurity among American Indian and Alaska Native communities likely increased during the COVID-19 pandemic. However, despite the high prevalence of food insecurity, community-led efforts to reduce COVID-19 infection and increase vaccination uptake across Indian Health Service and Tribal healthcare facilities may have mitigated the negative impacts of the pandemic for families experiencing food insecurity. These successful approaches serve as an important reference for future public health efforts that require innovative strategies to improve overall health in AIAN communities.
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Affiliation(s)
| | | | | | | | | | | | - Spero M Manson
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus
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11
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Abu-Saad K, Accos M, Ziv A, Collins F, Shepherd C, Eades S, Kalter-Leibovici O. Development and Functionality of a Parsimonious Digital Food Frequency Questionnaire for a Clinical Intervention among an Indigenous Population. Nutrients 2023; 15:5012. [PMID: 38068870 PMCID: PMC10707983 DOI: 10.3390/nu15235012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/21/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
Nutrition-related chronic diseases are a major problem among Indigenous populations. Appropriate dietary intake assessment tools are needed for nutritional surveillance and intervention; however, tools designed to measure the habitual dietary intake of Indigenous persons are largely lacking. We developed a digital food frequency questionnaire (FFQ) to measure habitual consumption among Australian Aboriginal adults and support personalized nutrition counseling. The primary contributors to energy, select nutrients, and inter-person variation (83 food groups) were identified from nationally representative 24 h recall (24HR) data, and they accounted for >80% of the total intake and inter-person variation of the nutrients of interest. Based on community input, a meal-based FFQ format was adopted, with a main food/beverage list of 81 items and the capacity to report on >300 additional items via the digital platform. The nutrient database was based on the Australian Food and Nutrient Database. Data for the first 60 study participants (70% female; median age: 48 years) were used to assess the FFQ's utility. The participants' median [IQR] reported energy intake (10,042 [6968-12,175] kJ/day) was similar to their median [IQR] estimated energy expenditure (10,197 [8636-11,551] kJ/day). Foods/beverages on the main FFQ list accounted for between 66% and 90% of the participants' reported energy and nutrient intakes; the remainder came from participant-selected extra items. The digital FFQ platform provides a potentially valuable resource for monitoring habitual dietary intake among Aboriginal adults and supporting chronic disease prevention and management interventions.
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Affiliation(s)
- Kathleen Abu-Saad
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan 52126, Israel
| | - Moran Accos
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan 52126, Israel
| | - Arnona Ziv
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan 52126, Israel
| | - Fiona Collins
- South West Aboriginal Medical Service, Bunbury, WA 6230, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia;
| | - Carrington Shepherd
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia;
| | - Sandra Eades
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Ofra Kalter-Leibovici
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan 52126, Israel
- Epidemiology & Preventive Medicine Department, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
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12
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Gatton ML, Gallegos D. A 5-year review of prevalence, temporal trends and characteristics of individuals experiencing moderate and severe food insecurity in 34 high income countries. BMC Public Health 2023; 23:2215. [PMID: 37946172 PMCID: PMC10636923 DOI: 10.1186/s12889-023-17139-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Due to the relatively low numbers of households in high income countries experiencing food insecurity most studies conflate the levels of severity, which masks between- and within-country differences. This study aims to describe the characteristics of individuals living in high income countries who were moderately or severely food insecure and investigates temporal trends in prevalence. It assesses these characteristics in comparison to those who were food secure. METHODS This is a secondary analysis of data collected by the FAO Voices of the Hungry between 2014-2018. The data were collected during the annual Gallup World Polls of nationally representative samples using the Food Insecurity Experience Scale. Data from 34 highly developed, wealthy countries were analysed. The age, gender, income, education, area of residence and household structure of individuals experiencing moderate/severe food insecurity (FI), and severe FI, were compared using ANOVA, Welch's F, Pearson's Chi-square, and Linear-by-Linear Association, dependent on the variable of interest. Hierarchical cluster analysis was used to group countries according to their prevalence of moderate/severe FI, and severe FI. RESULTS Overall, 6.5% of the weighted sample were moderately/severely food insecure (M-SFI), while 1.6% were severely food insecure. M-SFI individuals were present in all 34 countries, in all years and across all education levels and income quintiles. The proportion of individuals experiencing moderate/severe FI varied between years and countries. Fifteen countries showed a significant downward temporal trend in prevalence of moderate/severe FI (p < 0.001), while three countries demonstrated an increasing temporal trend driven by increasing prevalence in those aged 65 years or less (p < 0.001). Comparing individuals experiencing moderate versus severe FI showed over-representation of males, single adult households and lower household income in the severe FI group. CONCLUSIONS Individuals across all income, education and age categories living in high income countries are experiencing moderate/severe food insecurity, but with higher prevalence in those experiencing more disadvantage. Over the study period some countries experienced escalating while others demonstrated decreasing moderate/severe FI trends. This comparison of countries with similar economic and human development indices highlights an opportunity to investigate subtle variations in social, economic and education policy that could have profound impacts on food insecurity.
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Affiliation(s)
- Michelle L Gatton
- Centre for Immunology and Infection Control, Faculty of Health, Queensland University of Technology (QUT), Victoria Park Rd, Kelvin Grove, QLD, 4059, Australia.
| | - Danielle Gallegos
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology (QUT), Victoria Park Rd, Kelvin Grove, QLD, 4059, Australia
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology (QUT), Graham St, South Brisbane, QLD, 4101, Australia
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13
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Bleich SN, Koma JW, Jernigan VBB. The Worsening Problem of Food Insecurity. JAMA HEALTH FORUM 2023; 4:e234974. [PMID: 38032678 DOI: 10.1001/jamahealthforum.2023.4974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
This JAMA Forum discusses disparities and food insecurity among underserved populations in the US, the actions being taken by states, tribal actions, and additional steps to ensure food and nutrition security.
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Affiliation(s)
- Sara N Bleich
- Department of Health Policy and Management, T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - J Wyatt Koma
- Interdisciplinary PhD Program in Health Policy, Harvard University, Boston, Massachusetts
| | - Valarie Blue Bird Jernigan
- Center for Indigenous Health Research and Policy, Oklahoma State University Center for Health Sciences, Tulsa
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14
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Maudrie TL, Nguyen CJ, Wilbur RE, Mucioki M, Clyma KR, Ferguson GL, Jernigan VBB. Food Security and Food Sovereignty: The Difference Between Surviving and Thriving. Health Promot Pract 2023; 24:1075-1079. [PMID: 37877640 DOI: 10.1177/15248399231190366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
Previous research in American Indian and Alaska Native (AI/AN) communities has documented high prevalence of food insecurity. Yet many AI/AN scholars and communities have expressed concerns that the dominant societal conceptions of food security are not reflective of the teachings, priorities, and values of AI/AN communities. Food security initiatives often focus on access to food and, at times, nutrition but little consideration is given to cultural foods, the spirituality carried through foods, and whether the food was stewarded in a way that promotes well-being not just for humans but also for plants, animals, land, and water. Despite the concerns of AI/AN communities that their needs are not centered in dominant societal food conceptualizations and food security programming, the food sovereignty efforts of AI/AN communities have captured national attention as a solution to modern food system inequities. Indigenous Food Sovereignty (IFS) is a holistic approach to food that incorporates values of relationality, reciprocity, and relationships. Fundamental differences exist between food security and food sovereignty, yet dominant society often reduces IFS as a solution to food security, rather than an entirely different food system that is predicated on values that contrast with that of dominant society. Despite calls to decolonize the definition and measurement of food security, we explore whether fixing the concept of food security is a worthy endeavor or whether efforts would be better spent supporting the resurgence and revitalization of AI/AN food values, food knowledge, and community food sovereignty initiatives.
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Affiliation(s)
- Tara L Maudrie
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Megan Mucioki
- The Pennsylvania State University, University Park, PA, USA
| | - Kaylee R Clyma
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
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15
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Jernigan VBB, Nguyen CJ, Maudrie TL, Demientieff LX, Black JC, Mortenson R, Wilbur RE, Clyma KR, Lewis M, Lopez SV. Food Sovereignty and Health: A Conceptual Framework to Advance Research and Practice. Health Promot Pract 2023; 24:1070-1074. [PMID: 37877639 DOI: 10.1177/15248399231190367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
Settler colonialism disrupted traditional Indigenous foodways and practices and created high rates of diet-related disease among Indigenous peoples. Food sovereignty, the rights of Indigenous peoples to determine their own food systems, is a culturally centered movement rooted in traditional Indigenous knowledge. This approach directly intervenes upon systems-level barriers to health, making it an important strategy for health equity. While food sovereignty initiatives can be found within many Indigenous communities, the conceptual linkages between food sovereignty and health have not been well documented within the public health literature. We present a practice-informed conceptual framework developed as part of the Center for Indigenous Innovation and Health Equity (CIIHE) initiative, a community-academic partnership with the goal of strengthening Indigenous food systems and practices to promote health and well-being. The framework emphasizes connectedness, including the transmission of knowledge across generations and the restoration of relational responsibilities, as central to Indigenous concepts of health and wellness.
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Affiliation(s)
- Valarie Blue Bird Jernigan
- Center for Indigenous Health Research and Policy, Oklahoma State University Center for Health Sciences, Tulsa, OK USA
| | | | - Tara L Maudrie
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Jessica C Black
- Center for Indigenous Health Research and Policy, Oklahoma State University Center for Health Sciences, Tulsa, OK USA
| | | | | | - Kaylee R Clyma
- Center for Indigenous Health Research and Policy, Oklahoma State University Center for Health Sciences, Tulsa, OK USA
| | | | - Susanna V Lopez
- Center for Indigenous Health Research and Policy, Oklahoma State University Center for Health Sciences, Tulsa, OK USA
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16
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Jernigan VBB, Taniguchi T, Nguyen CJ, London SM, Henderson A, Maudrie TL, Blair S, Clyma KR, Lopez SV, Jacob T. Food Systems, Food Sovereignty, and Health: Conference Shares Linkages to Support Indigenous Community Health. Health Promot Pract 2023; 24:1109-1116. [PMID: 37877645 DOI: 10.1177/15248399231190360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
The Center for Indigenous Innovation and Health Equity (CIIHE) at Oklahoma State University Center for Health Sciences (OSU-CHS) is a community-academic partnership with Indigenous peoples from Alaska, Hawai'i, and Oklahoma. The CIIHE supports communities to strengthen traditional food practices and food sovereignty and evaluate the impact of those efforts on health. In February 2022, the CIIHE sponsored and hosted a virtual conference to better understand how food sovereignty initiatives can improve health. More than 600 participants gathered to hear the latest research and practice in the areas of public health and agriculture, nutrition, community-based and Indigenous knowledge, and health economics. Community-led food sovereignty initiatives being implemented as part of the CIIHE were featured along with other Indigenous initiatives in urban, rural, and reservation communities. A survey was administered to conference participants to assess food sovereignty topics and priorities for future research. In this Practice Note, we describe innovative community-led initiatives presented as part of the conference and recommendations for action emerging from qualitative and quantitative data collected from conference participants.
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Affiliation(s)
- Valarie Blue Bird Jernigan
- Center for Indigenous Health Research and Policy, Oklahoma State University Center for Health Sciences, Tulsa, OK USA
| | - Tori Taniguchi
- Center for Indigenous Health Research and Policy, Oklahoma State University Center for Health Sciences, Tulsa, OK USA
| | | | | | | | - Tara L Maudrie
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Kaylee R Clyma
- Center for Indigenous Health Research and Policy, Oklahoma State University Center for Health Sciences, Tulsa, OK USA
| | - Susanna V Lopez
- Center for Indigenous Health Research and Policy, Oklahoma State University Center for Health Sciences, Tulsa, OK USA
| | - Tvli Jacob
- Center for Indigenous Health Research and Policy, Oklahoma State University Center for Health Sciences, Tulsa, OK USA
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17
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Nguyen CJ, French BF, Maudrie TL, Ferguson GL, Blue Bird Jernigan V, Sinclair KIA. Measuring Food Security among American Indian and Alaska Native Adults: Validity Evidence Supports the Use of the US Department of Agriculture Module. J Acad Nutr Diet 2023; 123:S76-S88. [PMID: 37730308 DOI: 10.1016/j.jand.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 02/17/2023] [Accepted: 02/28/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Inequities in access, availability, and affordability of nutritious foods produced by settler colonialism contribute to high rates of food insecurity among American Indian and Alaska Native (AI/AN) households. Efforts to understand the influences of food security programming among AI/AN individuals in the United States are constrained by the absence of validity evidence for food security assessments for this population. OBJECTIVE This study assessed whether AI/AN adult responses on the Food Security Survey Module provide an accurate assessment of food security prevalence, especially when compared with other racial and ethnic groups. DESIGN A correlational design with the cross-sectional 2019 National Health Interview Survey was used to address the research objective. PARTICIPANTS AND SETTING The 2019 National Health Interview Survey contains a sample (N = 30,052) representative of the resident civilian noninstitutionalized population. MAIN OUTCOME MEASURES The primary outcome was food security, as characterized by the 10-item US Department of Agriculture Adult Food Security Survey Module. The module evaluates whether insufficient finances result in perceived food shortages and a reduction in the quantity and/or quality of food intake during the prior 30 days. STATISTICAL ANALYSES PERFORMED Data were analyzed by racial and ethnic subsamples to assess scale dimensionality (confirmatory factor analysis), Item Response Theory item analysis, differential item functioning, and external validity (χ2 tests). RESULTS Results supported the use of the 10-item module for racial and ethnic groups. However, differential item functioning effect sizes exceeded criteria for the Asian, AI/AN, and Hispanic respondents when compared with White respondents. Food security was not significantly related to all expected correlates in the AI/AN subsample. CONCLUSIONS Compelling evidence is presented for validity of the FSSM scores in determining food security status of AI/AN adults. Qualitative inquiry that explores how culture influences the way food security is conceptualized and experienced is warranted.
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Affiliation(s)
- Cassandra J Nguyen
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, Washington; Elson S. Floyd College of Medicine, Washington State University, Seattle, Washington.
| | - Brian F French
- College of Education, Washington State University, Pullman, Washington
| | - Tara L Maudrie
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Gary L Ferguson
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, Washington
| | - Valarie Blue Bird Jernigan
- Center for Indigenous Health Research and Policy, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Ka Imi A Sinclair
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, Washington; College of Nursing, Washington State University, Seattle, Washington
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18
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Vu M, Trinh D, Kandula NR, Pham NHT, Makelarski J, Seligman HK. Low-Income Asian Americans: High Levels Of Food Insecurity And Low Participation In The CalFresh Nutrition Program. Health Aff (Millwood) 2023; 42:1420-1430. [PMID: 37729587 PMCID: PMC11184507 DOI: 10.1377/hlthaff.2023.00116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Little is known about food insecurity and the extent of Supplemental Nutrition Assistance Program (SNAP) participation in the heterogeneous Asian American population. Using California Health Interview Survey data from the period 2011-20, we examined both issues among low-income Asian American adults from six origin groups: Chinese, Filipino, Japanese, Korean, South Asian, and Vietnamese. We found high and varied levels of overall food insecurity, with the highest burden among Filipino adults (40 percent). Food insecurity by severity was also heterogenous; very low food security affected 2 percent of Chinese adults but 9 percent and 10 percent of Filipino and Japanese adults, respectively. Participation in CalFresh (California-implemented SNAP) ranged from 11 percent and 12 percent among Korean and Chinese adults, respectively, to 20 percent among Vietnamese adults. Compared with English-proficient low-income Asian American adults, those with limited English proficiency were no less likely to participate in CalFresh, possibly reflecting language assistance required by California law and provided by community-based organizations. These results underscore the importance of collecting and reporting disaggregated data by Asian origin group that could inform targeted outreach and interventions.
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Affiliation(s)
- Milkie Vu
- Milkie Vu , Northwestern University, Chicago, Illinois
| | - Duy Trinh
- Duy Trinh, Princeton University, Princeton, New Jersey
| | | | - Nhat-Ha Tran Pham
- Nhat-Ha Tran Pham, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Hilary K Seligman
- Hilary K. Seligman, University of California San Francisco, San Francisco, California
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19
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Stotz SA, Hebert LE, Charron-Prochownik D, Scarton L, Moore KR, Sereika SM. Relationship between food insecurity and a gestational diabetes risk reduction intervention: outcomes among American Indian and Alaska Native adolescent and young adult females. Transl Behav Med 2023; 13:645-665. [PMID: 37353950 PMCID: PMC10496435 DOI: 10.1093/tbm/ibad029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023] Open
Abstract
American Indian and Alaska Natives (AI/ANs) are disproportionately impacted by gestational diabetes mellitus (GDM), subsequent type 2 diabetes, and food insecurity. It is prudent to decrease risk of GDM prior to pregnancy to decrease the intergenerational cycle of diabetes in AI/AN communities. The purpose of this project is to describe and examine food insecurity, healthy eating self-efficacy, and healthy eating behaviors among AI/AN females (12-24 years old) as related to GDM risk reduction. Methods included: secondary analysis of healthy eating self-efficacy and behaviors, and household-level food insecurity measures from an randomized controlled trial that tested the effect of engagement in a GDM risk reduction educational intervention on knowledge, behavior, and self-efficacy for GDM risk reduction from baseline to 3-month follow-up. Participants were AI/AN daughters (12-24 years old) and their mothers (N = 149 dyads). Researchers found that more than one-third (38.1%) reported food insecurity. At baseline food insecurity was associated with higher levels of eating vegetables and fruit for the full sample (p = .045) and cohabitating dyads (p = .002). By 3 months healthy eating self-efficacy (p = .048) and limiting snacking between meals (p = .031) improved more in the control group than the intervention group only for cohabitating dyads. For the full sample, the intervention group had increases in times eating vegetables (p = .022) and fruit (p = .015), whereas the control group had declines. In the full sample, food insecurity did not moderate the group by time interaction for self-efficacy for healthy eating (p ≥ .05) but did moderate the group by time interaction for times drinking soda (p = .004) and days eating breakfast (p = .013). For cohabitating dyads, food insecurity did moderate self-efficacy for eating 3 meals a day (p = .024) and days eating breakfast (p = .012). These results suggest food insecurity is an important factor regarding the efficacy of interventions designed to reduce GDM risk and offer unique insight on "upstream causes" of GDM health disparities among AI/AN communities.
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Affiliation(s)
- Sarah A Stotz
- University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Centers for American Indian and Alaska Native Health, Aurora, CO, USA
| | - Luciana E Hebert
- Institute for Research and Education Advancing Community Health (IREACH) at the Elson S. Floyd College of Medicine at Washington State University, Seattle, WA, USA
| | - Denise Charron-Prochownik
- Department of Health Promotion and Development, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Lisa Scarton
- University of Florida, School of Nursing, Department of Family, Community and Health Systems Science, Gainsville, FL, USA
| | - Kelly R Moore
- University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Centers for American Indian and Alaska Native Health, Aurora, CO, USA
| | - Susan M Sereika
- Department of Health Promotion and Development, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
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Eberly LA, Shultz K, Merino M, Brueckner MY, Benally E, Tennison A, Biggs S, Hardie L, Tian Y, Nathan AS, Khatana SAM, Shea JA, Lewis E, Bukhman G, Shin S, Groeneveld PW. Cardiovascular Disease Burden and Outcomes Among American Indian and Alaska Native Medicare Beneficiaries. JAMA Netw Open 2023; 6:e2334923. [PMID: 37738051 PMCID: PMC10517375 DOI: 10.1001/jamanetworkopen.2023.34923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/17/2023] [Indexed: 09/23/2023] Open
Abstract
Importance American Indian and Alaska Native persons face significant health disparities; however, data regarding the burden of cardiovascular disease in the current era is limited. Objective To determine the incidence and prevalence of cardiovascular disease, the burden of comorbid conditions, including cardiovascular disease risk factors, and associated mortality among American Indian and Alaska Native patients with Medicare insurance. Design, Setting, and Participants This was a population-based cohort study conducted from January 2015 to December 2019 using Medicare administrative data. Participants included American Indian and Alaska Native Medicare beneficiaries 65 years and older enrolled in both Medicare part A and B fee-for-service Medicare. Statistical analyses were performed from November 2022 to April 2023. Main Outcomes and Measures The annual incidence, prevalence, and mortality associated with coronary artery disease (CAD), heart failure (HF), atrial fibrillation/flutter (AF), and cerebrovascular disease (stroke or transient ischemic attack [TIA]). Results Among 220 598 American Indian and Alaska Native Medicare beneficiaries, the median (IQR) age was 72.5 (68.5-79.0) years, 127 402 were female (57.8%), 78 438 (38.8%) came from communities in the most economically distressed quintile in the Distressed Communities Index. In the cohort, 44.8% of patients (98 833) were diagnosed with diabetes, 61.3% (135 124) were diagnosed with hyperlipidemia, and 72.2% (159 365) were diagnosed with hypertension during the study period. The prevalence of CAD was 38.6% (61 125 patients) in 2015 and 36.7% (68 130 patients) in 2019 (P < .001). The incidence of acute myocardial infarction increased from 6.9 per 1000 person-years in 2015 to 7.7 per 1000 patient-years in 2019 (percentage change, 4.79%; P < .001). The prevalence of HF was 22.9% (36 288 patients) in 2015 and 21.4% (39 857 patients) in 2019 (P < .001). The incidence of HF increased from 26.1 per 1000 person-years in 2015 to 27.0 per 1000 person-years in 2019 (percentage change, 4.08%; P < .001). AF had a stable prevalence of 9% during the study period (2015: 9.4% [14 899 patients] vs 2019: 9.3% [25 175 patients]). The incidence of stroke or TIA decreased slightly throughout the study period (12.7 per 1000 person-years in 2015 and 12.1 per 1000 person-years in 2019; percentage change, 5.08; P = .004). Fifty percent of patients (110 244) had at least 1 severe cardiovascular condition (CAD, HF, AF, or cerebrovascular disease), and the overall mortality rate for the cohort was 19.8% (43 589 patients). Conclusions and Relevance In this large cohort study of American Indian and Alaska Native patients with Medicare insurance in the US, results suggest a significant burden of cardiovascular disease and cardiometabolic risk factors. These results highlight the critical need for future efforts to prioritize the cardiovascular health of this population.
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Affiliation(s)
- Lauren A. Eberly
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia
- Penn Cardiovascular Center for Health Equity and Social Justice, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Kaitlyn Shultz
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Maricruz Merino
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
| | | | - Ernest Benally
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
| | - Ada Tennison
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
| | - Sabor Biggs
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
| | - Lakotah Hardie
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
| | - Ye Tian
- Division of Pulmonary and Critical Care, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania
| | - Ashwin S. Nathan
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Sameed Ahmed M. Khatana
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Judy A. Shea
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia
| | - Eldrin Lewis
- Division of Cardiovascular Medicine, Stanford University Medical Center, Palo Alto, California
| | - Gene Bukhman
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Global Health and Social Medicine, Program in Global Noncommunicable Diseases and Social Change, Harvard Medical School, Boston, Massachusetts
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Sonya Shin
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Peter W. Groeneveld
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Alhomsi A, Quintero SM, Ponce S, Mendez I, Stewart AL, Napoles AM, Strassle PD. Racial/Ethnic Disparities in Financial Hardship During the First Year of the Pandemic. Health Equity 2023; 7:453-461. [PMID: 37771448 PMCID: PMC10523407 DOI: 10.1089/heq.2022.0196] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 09/30/2023] Open
Abstract
Introduction The economic impact of the COVID-19 pandemic has been substantial, yet little is known about the financial effects resulting from lost employment or financial hardship racial-ethnic disparities. Methods We conducted a nationally representative, online survey of 5500 English- and Spanish-speaking American Indian/Alaska Native, Asian, Black/African American, Native Hawaiian/Pacific Islander, Latino, White, and multiracial adults, from December 2020 to February 2021. Six financial hardship domains were measured (lost income, debt, unmet expenses, unmet health care expenses, housing insecurity, and food insecurity). Prevalence of financial hardship among each racial-ethnic group was estimated using multivariable Poisson regression. Results Overall, 70.3% reported experiencing financial hardship; debt (57.6%), lost income (44.5%), and unmet expenses (33.7%) were most common. American Indian/Alaska Native (adjusted prevalence ratio [aPR]=1.19, 95% confidence interval [CI]=1.04 to 1.35), Black/African American (aPR=1.18, 95% CI=1.06 to 1.32), Latino (English-speaking: aPR=1.15, 95% CI=1.01 to 1.31; Spanish-speaking: aPR=1.27, 95% CI=1.12 to 1.45), and Native Hawaiian/Pacific Islander (aPR=1.21, 95% CI=1.06 to 1.38) adults were more likely to experience financial hardship, compared with White adults. American Indian/Alaska Native, Black/African American, Spanish-speaking Latino, and Native Hawaiian/Pacific Islander adults were also more likely to report hardship in almost all hardship domains (e.g., housing insecurity: aPRs=1.37-1.91). Conclusions Racial/ethnic minorities were more likely to experience financial hardship during the pandemic. The prevalence of lost income was similar across most racial/ethnic groups, suggesting that preexisting wealth disparities led to some groups being less able to handle the economic shocks caused by the COVID-19 pandemic. Financial hardship may be underestimated for communities without English or Spanish fluency. Without intervention, financial hardship will likely exacerbate wealth disparities in the United States.
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Affiliation(s)
- Alia Alhomsi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institute of Health, Bethesda, Maryland, USA
| | - Stephanie M. Quintero
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institute of Health, Bethesda, Maryland, USA
| | - Stephanie Ponce
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institute of Health, Bethesda, Maryland, USA
| | - Izabelle Mendez
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institute of Health, Bethesda, Maryland, USA
| | - Anita L. Stewart
- Center for Aging in Diverse Communities, Institute for Health & Aging, University of California San Francisco, San Francisco, California, USA
| | - Anna Maria Napoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institute of Health, Bethesda, Maryland, USA
| | - Paula D. Strassle
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institute of Health, Bethesda, Maryland, USA
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22
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Davies A, Gwynn J, Allman-Farinelli M, Flood V, Dickson M, Turner N, Porykali B, Lock Ngiyampaa M. Programs Addressing Food Security for First Nations Peoples: A Scoping Review. Nutrients 2023; 15:3127. [PMID: 37513545 PMCID: PMC10384335 DOI: 10.3390/nu15143127] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/11/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
Access to food is a right that every individual must have to ensure a standard of living that is sufficient for maintaining good health and wellbeing. This review, developed and implemented by a team of First Nations and non-First Nations peoples, aimed to scope the literature on programs addressing food security for First Nations peoples in Australia, Aotearoa/New Zealand, Canada, and the United States of America. Collectively, First Nations groups share continued traumas, disadvantages, and devastation brought upon them as a result of British colonisation. Despite the impacts of colonial conquest, the resilience of First Nations peoples continues through the fight for self-determination, sovereignty, equity, and equality. Three databases and grey literature were searched from 2010. Two reviewers completed screening, data extraction, and critical appraisal. Nine food security programs were included in this review. Five were from the United States of America and four from Canada, with no program from Australia or Aotearoa/New Zealand meeting the inclusion criteria. The programs that appear to be most suitable for addressing food security for First Nations peoples were participatory in design, had community governance, integrated cultural knowledge and food systems to increase the accessibility and availability of cultural foods, incorporated educational components, and utilized collaborations among various agencies. Findings showed that while it is important to address short-term emergency food relief, the aim should be sustainable food security through a longer-term system and policy change underpinned by co-designed research and evaluation.
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Affiliation(s)
- Alyse Davies
- Discipline of Nutrition and Dietetics, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
| | - Josephine Gwynn
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Margaret Allman-Farinelli
- Discipline of Nutrition and Dietetics, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
| | - Victoria Flood
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- University Centre for Rural Health, Northern Rivers, Faculty of Medicine and Health, The University of Sydney, Lismore, NSW, 2480, Australia
| | - Michelle Dickson
- The Poche Centre for Indigenous Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Nicole Turner
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
| | - Bobby Porykali
- Aboriginal and Torres Strait Islander Health Program, George Institute for Global Health, Sydney, NSW 2042, Australia
| | - Mark Lock Ngiyampaa
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Melbourne, VIC 3220, Australia
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23
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Sinclair K, Nguyen CJ, Wetherill MS, Nelson K, Jackson AM, Taniguchi T, Jernigan VBB, Buchwald D. Native opportunities to stop hypertension: study protocol for a randomized controlled trial among urban American Indian and Alaska Native adults with hypertension. Front Public Health 2023; 11:1117824. [PMID: 37333529 PMCID: PMC10272533 DOI: 10.3389/fpubh.2023.1117824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/11/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction American Indian and Alaska Native (AI/AN) adults experience disproportionate cardiovascular disease (CVD) morbidity and mortality compared to other races, which may be partly attributable to higher burden of hypertension (HTN). Dietary Approaches to Stop Hypertension (DASH) is a high-impact therapeutic dietary intervention for primary and secondary prevention of CVD that can contribute to significant decreases in systolic blood pressure (BP). However, DASH-based interventions have not been tested with AI/AN adults, and unique social determinants of health warrant independent trials. This study will assess the effectiveness of a DASH-based intervention, called Native Opportunities to Stop Hypertension (NOSH), on systolic BP among AI/AN adults in three urban clinics. Methods NOSH is a randomized controlled trial to test the effectiveness of an adapted DASH intervention compared to a control condition. Participants will be aged ≥18 years old, self-identify as AI/AN, have physician-diagnosed HTN, and have elevated systolic BP (≥ 130 mmHg). The intervention includes eight weekly, tailored telenutrition counseling sessions with a registered dietitian on DASH eating goals. Intervention participants will be provided $30 weekly and will be encouraged to purchase DASH-aligned foods. Participants in the control group will receive printed educational materials with general information about a low-sodium diet and eight weekly $30 grocery orders. All participants will complete assessments at baseline, after the 8-week intervention, and again 12 weeks post-baseline. A sub-sample of intervention participants will complete an extended support pilot study with assessments at 6- and 9-months post-baseline. The primary outcome is systolic BP. Secondary outcomes include modifiable CVD risk factors, heart disease and stroke risk scores, and dietary intake. Discussion NOSH is among the first randomized controlled trials to test the impact of a diet-based intervention on HTN among urban AI/AN adults. If effective, NOSH has the potential to inform clinical strategies to reduce BP among AI/AN adults. Clinical trials registration https://clinicaltrials.gov/ct2/show/NCT02796313, Identifier NCT02796313.
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Affiliation(s)
- Ka’imi Sinclair
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA, United States
| | - Cassandra J. Nguyen
- Nutrition Department at University of California, Davis, Davis, CA, United States
| | - Marianna S. Wetherill
- Department of Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Tulsa, OK, United States
| | - Katie Nelson
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA, United States
| | | | - Tori Taniguchi
- Center for Indigenous Health Research and Policy, Center for Health Sciences, Oklahoma State University, Tulsa, OK, United States
| | - Valarie Blue Bird Jernigan
- Center for Indigenous Health Research and Policy, Center for Health Sciences, Oklahoma State University, Tulsa, OK, United States
| | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA, United States
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24
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Cothran DJ, Kulinna PH. "He's a little skinny and he's a little wide.": a mixed design investigation of American Indian student perceptions of healthy bodies. BMC Public Health 2023; 23:239. [PMID: 36737762 PMCID: PMC9896662 DOI: 10.1186/s12889-023-15048-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 01/13/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Childhood is a critical developmental time of wellness patterns, yet little is known about what children know and believe. Even less is known about non-majority cultures like American Indian youth. The purpose of this study was to explore American Indian students' understandings of nutrition and physical activity. METHODS This mixed methods study took place in 10 schools in an American Indian community in the Southwestern U.S. Ninety American Indian students in grades 3-12 (8-19 years old) were interviewed. The interview included an 8-point body size chart. Numerical data were analyzed via t-test statistics while a constant comparison process and analysis was used for the interview data. RESULTS Students rated approximately 85% of students in Category 5 or smaller on the scale while placing 60% of adults at or above that size. There was a general trend of a larger body type for boys seen as healthy compared to that for girls. Students generally believed that their classmates were larger than the healthy body size. For students, a healthy body was the result of compliance with "eat right and exercise" rules. They exhibited little understanding of nutrition or physical activity and there were few developmental differences in understanding. Health was a corporeal concept and violators of the eat right and exercise rules were seen as lazy. CONCLUSIONS Students held narrow and corporeal focused notions of health focused on simple rules. People who violated the rules were "lazy", a concept that seemed to underlie multiple constructs and a finding that holds true in other investigations. Students also reported few adult role models, a topic that should be explored with expanded family groups to better represent the multi-generational (e.g. grandparents, uncles, aunts) family housing common in the community. The findings are limited to a single American Indian community and a mixed design of relatively small numbers. This addition to the literature from a non-majority cultural group expands our knowledge of student perspectives on health. These findings can be used to create more effective curricula and interventions. Schools need more effective, but also alternately framed approaches that promote broader views of health.
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Affiliation(s)
- Donetta J. Cothran
- grid.411377.70000 0001 0790 959XSchool of Public Health, Indiana University, 1025 East 7th Street, 47405 Bloomington, IN USA
| | - Pamela Hodges Kulinna
- grid.215654.10000 0001 2151 2636Arizona State University, 7271 E. Sonoran Arroyo Mall Santa Catalina Hall Rm. 330Q, 85212 Mesa, AZ USA
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25
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Nguyen CJ, Kownacki C, Skaradzinski V, Streitmatter K, Acevedo S, Ericson SD, Hager JE, McCaffrey J. Development and evaluation of the Food Bank Health and Nutrition Assessment. Public Health Nutr 2023; 26:1-10. [PMID: 36710006 PMCID: PMC10131141 DOI: 10.1017/s1368980023000204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 12/09/2022] [Accepted: 01/02/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Efforts to improve the nutritional quality and health promotion in the charitable food system have been undertaken. Though methods exist to track these efforts in terms of food banks' inventory, there are not research-tested tools to assess, monitor and influence policy, systems and environmental (PSE) changes. The study objective was to develop and evaluate a novel assessment tool that could be used to evaluate a food bank's efforts to improve the promotion of health and nutritious foods. DESIGN The study had five phases: (1) initial development; (2) iterative review and revisions; (3) pilot testing; (4) content validity assessment and (5) inter-rater and test-retest assessment. The Food Bank Health and Nutrition Assessment (FB-HANA) was drafted after reviewing existing policies, nutrition-focused charitable food systems guidance and similar tools for food pantries. SETTING Midwestern United States. PARTICIPANTS Eleven food banks. RESULTS Stakeholders and pilot testers provided initial feedback to refine the FB-HANA's flow, ease of completion and collection of contextual information. External experts rated the FB-HANA and each of the eight objectives as content valid. A set of two assessments completed by twenty-six community-based professionals, employed by Extension and fourteen food bank staff across eleven food banks, supported moderate to excellent inter-rater and test-retest reliability for the FB-HANA overall and each of its objectives. CONCLUSIONS Evidence suggests that the FB-HANA can be used by either food bank or community-based professionals, such as Extension staff, to provide a perspective on ways food banks promote health and nutrition through PSE approaches.
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Affiliation(s)
| | - Caitlin Kownacki
- Office of Extension and Outreach, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Veronica Skaradzinski
- Office of Extension and Outreach, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Kaitlyn Streitmatter
- Office of Extension and Outreach, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Stephanie Acevedo
- Office of Extension and Outreach, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | | | | | - Jennifer McCaffrey
- Office of Extension and Outreach, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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Brown MC, Hawley C, Ornelas IJ, Huber C, Best L, Thorndike AN, Beresford S, Howard BV, Umans JG, Hager A, Fretts AM. Adapting a cooking, food budgeting and nutrition intervention for a rural community of American Indians with type 2 diabetes in the North-Central United States. HEALTH EDUCATION RESEARCH 2023; 38:13-27. [PMID: 36342521 PMCID: PMC9853931 DOI: 10.1093/her/cyac033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 09/06/2022] [Accepted: 10/18/2022] [Indexed: 05/24/2023]
Abstract
American Indian (AI) communities experience persistent diabetes-related disparities, yet few nutrition interventions are designed for AI with type 2 diabetes or address socio-contextual barriers to healthy eating. We describe our process of adapting the evidence-based Cooking Matters® program for use by AI adults with type 2 diabetes in a rural and resource-limited setting in the North-Central United States. We conducted three focus groups with AI adults with diabetes to (i) identify Cooking Matters® adaptations and (ii) gather feedback on appropriateness of the adapted intervention using Barrera and Castro's cultural adaptation framework. Transcripts were coded using an inductive, constant comparison approach. Queries of codes were reviewed to identify themes. Contextual considerations included limited access to grocery stores and transportation barriers, reliance on government food assistance and the intergenerational burden of diabetes. Adaptations to content and delivery included incorporating traditional and locally available foods; appealing to children or others in multigenerational households and prioritizing visual over written content. Our use of Barrera and Castro's framework adds rigor and structure to the cultural adaptation process and increases the likelihood of future intervention success. Other researchers may benefit from using this framework to guide the adaptation of evidence-based interventions in AI communities.
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Affiliation(s)
- Meagan C Brown
- Department of Epidemiology, University of Washington School of Public Health, Hans Rosling Center for Population Health, 3980 15th Ave NE, Seattle, WA 98195, USA and Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101, USA
| | - Caitie Hawley
- Department of Medicine, University of Washington, Health Sciences Building, Box 356420, 1959 NE Pacific Street, Seattle, WA 98195-6420, USA
| | - India J Ornelas
- Department of Health Systems and Population Health, University of Washington School of Public Health, Hans Rosling Center for Population Health, 3980 15th Ave NE, Seattle, WA 98195, USA
| | - Corrine Huber
- Missouri Breaks Industries Research Inc., 18 South Willow Street, P.O. Box 1824, Eagle Butte, SD 57625, USA
| | - Lyle Best
- Missouri Breaks Industries Research Inc., 18 South Willow Street, P.O. Box 1824, Eagle Butte, SD 57625, USA
| | - Anne N Thorndike
- Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA and Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Shirley Beresford
- Department of Epidemiology, University of Washington School of Public Health, Hans Rosling Center for Population Health, 3980 15th Ave NE, Seattle, WA 98195, USA
| | - Barbara V Howard
- Field Studies Division, Medstar Health Research Institute, 6525 Belcrest Rd #700c, Hyattsville, MD 20782, USA
- Georgetown and Howard Universities Center for Clinical and Translational Science, 4000 Reservoir Rd NW #7, Washington, DC 20057, USA
| | - Jason G Umans
- Georgetown and Howard Universities Center for Clinical and Translational Science, 4000 Reservoir Rd NW #7, Washington, DC 20057, USA
- Field Studies Division and Biomarker, Biochemistry, and Biorepository Core, Medstar Health Research Institute, 6525 Belcrest Rd #700c, Hyattsville, MD 20782, USA
| | - Arlette Hager
- Cheyenne River Sioux Tribe Adult Diabetes Program, 24276 166th St. Airport Road, P.O. Box 590 Eagle Butte, SD 57625, USA
| | - Amanda M Fretts
- Department of Epidemiology, University of Washington School of Public Health, Hans Rosling Center for Population Health, 3980 15th Ave NE, Seattle, WA 98195, USA
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