Wakaya: Rising Up for Choctaw Youth Health

经验数据表明，由于不利的社会人口因素，美国印第安青年容易受到健康状况不佳的影响。 指数和很少的身体活动，久坐不动的行为和营养不足。这些因素构成了 有毒三角风险，是由行为风险因素，如酒精，烟草和其他药物的使用， （ATOD）。如果目前的模式持续下去，到2050年，俄克拉荷马州的乔托族三分之一的年轻人， 第三大人工智能部落，将生活在2型糖尿病和70%的国家将是肥胖。Wakaya：Rising 为乔托青年健康，是一个经验，户外，以自然为基础的计划在乔托价值观的基础上。 这是一个多层次的干预，整合了动机性访谈的组成部分，信息- 动机行为技能模型，积极的青年领导力发展框架，以及NIMHD 多层次社会生态研究框架。采用前瞻性两组随机等待名单对照 在176名高危乔托青少年（14-18岁）中进行试验设计，我们将评估文化基础 干预对体力活动、久坐行为和健康食品等主要结果的影响 习惯;以及体重/BMI的次要结局;和ATOD。此外，在NIMHD的指导下， 多层次的社会生态框架，我们将通过分析如何研究变化的潜在机制 途径变量（例如，自然连通性）介导干预效应。最后，通过主题建模， 定性访谈数据和通过青年参与者和部落领袖焦点小组绘制的涟漪效应图（n=64）， 我们将探索Wakaya的社区影响，并创建一个可视化地图， 对社区的干预产生涟漪反应。该计划得到了以下方面有希望的初步数据的支持 这种方法在成年人和可接受的数据，从青年，涉及3个月的户外干预（与4 个人课程，每周一次的小组课程，2个过夜的文化沉浸营（共7天），和一个为期4天的 乔托人的眼泪之路。此外，干预措施建立了青年健康领导和社区 组织能力。该研究小组由来自哥伦比亚的美洲印第安人健康专家以及 乔托民族和两个部落部门之间的合作努力-历史保护和行为 健康调查结果将被科学地传播，并与部落分享， 实施.如果有效，这种干预将为促进身体健康的干预措施提供证据。 针对绿色空间、社区花园、自然/自然小径和建筑的活动和营养计划 环境.拟议的研究在若干领域提供了重要和实用的信息，包括 在以自然为基础的环境中跨多层次利益攸关方提供干预措施的可行性。它应该是 该方案是有效的，具有广泛适应和传播到其他部落社区的潜力 并且可以推广到其他慢性同时发生的身体活动和饮食习惯相关的病症。

Empirical data indicate American Indian youth are vulnerable to ill health due to adverse socio-demographic indices and little physical activity, sedentary behaviors and inadequate nutrition. These factors, which form a toxic triangle of risk, are compounded by behavioral risks factors such as alcohol, tobacco, and other drug use (ATOD). If current patterns persist, by 2050 one out of three youth from the Choctaw Nation of Oklahoma, the third largest AI tribe, will be living with Type 2 diabetes and 70% of the Nation will be obese. Wakaya: Rising Up for Choctaw Youth Health, is an experiential, outdoor, nature-based program grounded in Choctaw values. It is a multi-level intervention that integrates components of motivational interviewing, the information- motivation-behavioral skills model, the Positive Youth Leadership Development framework, and the NIMHD Multilevel Socio-Ecological Research Framework. With a prospective two-group randomized waitlist-control trial design among 176 at-risk Choctaw youth (ages 14-18 years), we will assess the culturally grounded intervention's impact on the primary outcomes of physical activity, sedentary behavior, and healthful food habits; as well as the secondary outcomes of weight/BMI; and ATOD. Additionally, guided by the NIMHD Multilevel Socioecological Framework, we will examine the potential mechanisms of change by analyzing how pathway variables (e.g., nature connectedness) mediate intervention effects. Finally, through Topic Modeling of qualitative interview data and Ripple Effect Mapping via youth participant and tribal leader focus groups (n=64), we will explore the community-level impact of Wakaya and create a visual map representing the interconnected ripple effects of the intervention into the community. The program, supported by promising preliminary data on this approach among adults and acceptability data from youth, involves a 3-month outdoor intervention (with 4 individual sessions, weekly group sessions, 2 overnight culture immersion camps (7 days total), and a 4-day Choctaw Trail of Tears walk. Additionally, the intervention builds youth health leadership and community organizing skills. The research team comprises experts in American Indian health from academe as well as Choctaw Nation and collaborative efforts among two tribal Departments- Historic Preservation and Behavioral Health. Findings will be disseminated scientifically as well as shared with the tribe for programmatic implementation. If efficacious, this intervention will provide evidence for interventions that promote physical activity and nutrition programs that target green spaces, community gardens, natural/nature trails, and built environments. The proposed study provides significant and practical information in several areas, including the feasibility of delivering interventions in nature-based settings across multilevel stakeholders. Should it be efficacious, the program has potential for widespread adaptation and dissemination to other tribal communities and could be generalizable to other chronic co-occurring physical activity and food habit-related conditions.