A novel sugar-sweetened beverage reduction intervention for Native American men

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Project Summary In the United States, sugar-sweetened beverages (SSB) is the largest single food source of calories. The intake of SSB is disproportionately high among Native Americans (NA). There are strong and consistent data documenting relationships among high SSB consumption and numerous health issues (e.g. obesity, diabetes, cancers, heart disease); NA bear a disproportionate burden of all of these health issues, particularly NA men. NA health must be considered within a broader historical context of colonialism that has contributed to the existing social determinants of health landscape in which NAs live. Incorporating this historical context is critical to meaningfully address health inequities within NA populations. Yet few studies have integrated NA values with social determinants of health, historical context, and dietary change using a tribally-guided, culturally-appropriate approach. We will target the major dietary risk factor of SSB, in addition to noticeable gaps in understanding the role of colonialism in NA health behavior inequities. Developed and tested by this research team, SIPsmartER is an SSB intervention that reduced SSB intake by 227kcal (-326,-127) per day in a rural, predominately White and female population from baseline to 6 months. We propose to adapt and integrate SIPsmartER within the traditional NA activity of lacrosse through a theoretical framework that connects NA historical context with health inequities to create SIPsmartER Lacrosse. Among NA, lacrosse is an ancestral activity associated with well-being. Our tribal leaders have asked for a dietary intervention that would target multiple health conditions while acknowledging social determinants of health. These leaders suggested building on the game of lacrosse, as this activity engages NA men regularly. We will adapt SIPsmartER into SIPsmartER Lacrosse. We will develop a theoretical framework that links the historical consequences of colonialism with current inequities in NA health outcomes, including SSB intake. We will then use a cluster RCT that targets 60 men nested within six lacrosse teams from two rural reservations/territories from the Seneca Nation of Indians. The overall goal is to the examine the preliminary efficacy of SIPsmartER Lacrosse in a 2 group (SIPsmartER Lacrosse vs. alternative treatment control) by 3 assessment (Baseline, 6-month, 18-month) design. Specific Aim 1: Create an evidence-based culturally appropriate SSB intervention for NA men that integrates their unique historical context in adapting SIPsmartER to SIPsmartER Lacrosse. Specific Aim 2: Implement and determine the initial efficacy of SIPsmartER Lacrosse to reduce SSB consumption.