Osage Community Supported Agriculture Study (OCSA)

项目总结/摘要 粮食系统由粮食生产、获取和销售组成。公共卫生工作已经 鉴于不良饮食是可预防疾病的头号风险因素， 在美国美国印第安人（AI）经历了与饮食相关的健康差异：AI成年人 肥胖的可能性增加50%，高血压的可能性增加30%，糖尿病的可能性增加两倍 与白人相比。2013年，俄克拉荷马州的奥塞奇民族发起了鸟溪农场（BCF）的使命 促进土著人民的粮食主权，即土著人民享有健康的权利和责任 以及通过传统土著做法生产的文化上适当的食物。到2015年，BCF有12个 开始为部落计划提供食物。同年，与BCF合作，我们的团队 启动了NIMHD资助的FRESH农场到学校计划（R 01 MD 011266）。初步调查结果显示， 一项由部落驱动的基于社区的参与性研究（CBPR）显示， 儿童和成人的摄入量以及粮食不安全状况的减少。基于我们八年的CBPR 伙伴关系，拟议的研究将实施一个新的社区支持农业（CSA）计划，其中 奥塞奇公民将在6个月内每周获得新鲜种植的农产品。CSA得到改善 非AI人群的饮食和健康，并且是中心推荐的基于证据的策略， 疾病控制和预防研究所和医学研究所，以减少健康差距，但没有随机 在AI人群中进行了CSA计划的对照试验。因此，我们将测试 CSA计划与针对文化的营养和烹饪教育相结合， 在奥塞治成人中，评估其成本效益，并开发一个多媒体工具包，用于传播调查结果。 我们的具体目标是：1）进行随机对照试验，以测试新开发的CSA程序的 对饮食、血压和血脂（主要结局）以及对体重指数（BMI）、血红蛋白的影响 600名AI成人（18-75岁）中的糖化血红蛋白（HbA 1c）、食物不安全和健康状况（次要结局）， 超重/肥胖; 2）对个体进行经济评估（例如，与健康有关的生活质量）， 组织（例如，医疗保健利用成本），以及社区水平（例如，预防心脏代谢 疾病）结果; 3）使用参与式视频记录和传播研究过程和结果 方法，并为其他人工智能社区编制基于网络的工具包，以使用CBPR来改善部落的粮食系统。 这项研究是第一个严格干预食物系统的所有组成部分，以解决不良饮食和 AI的健康在CBPR和土著食品的指导下，以Osage Nation资产和优先事项为基础 以主权为导向，并根据建议的消除差距战略，研究结果将 为研究和政策工作提供信息，以便在慢性病发病率高的保留地创造可持续的粮食供应 疾病以及城市AI社区，其中CSA可用并可针对AI量身定制。

PROJECT SUMMARY/ABSTRACT The food system is comprised of food production, access, and marketing. Public health efforts have been increasingly focused on food systems given that poor diet is the number one risk factor for preventable disease in the United States. American Indians (AIs) experience substantial diet-related health disparities: AI adults are 50% more likely to be obese, 30% more likely to have hypertension, and twice as likely to have diabetes compared to Whites. In 2013, the Osage Nation in Oklahoma launched Bird Creek Farm (BCF) with the mission to facilitate Indigenous food sovereignty, defined as the right and responsibility of Indigenous peoples to healthy and culturally appropriate foods produced through traditional Indigenous practices. By 2015, BCF had 12 employees and began providing food to tribal programs. In the same year, in collaboration with BCF, our team launched the NIMHD-funded FRESH farm-to-school program (R01MD011266). Preliminary findings from this tribally-driven community-based participatory research (CBPR) study show an increase in vegetable and fruit intake among children and adults and a decrease in food insecurity. Building upon our eight-year CBPR partnership, the proposed study will implement a new community supported agriculture (CSA) program in which Osage citizens will receive a weekly share of freshly grown farm produce for 6 months. CSAs have improved diet and health in non-AI populations, and are evidence-based strategies recommended by the Centers for Disease Control and Prevention and the Institute of Medicine to reduce health disparities, but no randomized controlled trial of a CSA program has been conducted in the AI population. Accordingly, we will test the efficacy of a CSA program combined with culturally-tailored nutrition and cooking education on diet and health outcomes among Osage adults, evaluate its cost-effectiveness, and develop a multimedia toolkit for disseminating findings. Our specific aims are to: 1) Conduct a randomized controlled trial to test the newly developed CSA program’s effect on diet, blood pressure, and blood lipids (primary outcomes) and on body mass index (BMI), hemoglobin A1c (HbA1c), food insecurity, and health status (secondary outcomes) among 600 AI adults (aged 18-75) with overweight/obesity; 2) Perform an economic evaluation for individual (e.g., health-related quality of life), organizational (e.g., healthcare utilization costs), and community-level (e.g., prevention of cardiometabolic diseases) outcomes; and 3) Document and disseminate study processes and findings using participatory video methods, and compile a web-based toolkit for other AI communities to use CBPR to improve tribal food systems. This study is the first to rigorously intervene across all components of the food system to address poor diet and health among AIs. Building upon Osage Nation assets and priorities, guided by a CBPR and Indigenous food sovereignty orientation, and based upon recommended strategies to eliminate disparities, study findings will inform research and policy efforts to create sustainable food access in reservations with high rates of chronic disease as well as urban AI communities where CSAs are available and could be tailored to AIs.