Yappalli Choctaw Road To Health

描述（由申请人提供）：肥胖和药物滥用越来越普遍，昂贵，致命-助长了美国的双重流行病。同时解决肥胖和酒精和其他药物（AOD）使用的重要性部分得到了NIDA最近研究的支持，该研究将促进药物成瘾和强迫性饮食行为的大脑机制联系起来。虽然AOD预防和滥用模式因地区和部落而异，但美国印第安人（AI）与毒品有关的死亡率是美国所有其他种族群体的1.5倍。特别是人工流产妇女在肥胖和急性阻塞性肺病患病率方面与其他妇女存在显著差异，因此过早死亡率和发病率较高。基于初步研究，我们开发了Yappalli乔托健康之路，这是一个以文化为重点，以力量为基础的户外体验式肥胖-AOD风险预防和健康领导计划。3个月的干预（即，3次单独会议; 8个小组会议+ 2天的文化靴子营+ 10天的乔托眼泪之路步行）是在PI的最愤怒的压力应对模型和信息动机行为技能框架的基础上，与动机面试和领导力发展原则相一致的活动。本RO 1申请是根据PAR-11-346（美国土著居民健康促进和疾病预防干预措施）编写的，建议在俄克拉荷马州（CNO）乔托族5个地区的150名高危成年乔托妇女中评估该计划，该地区的土著妇女是美国肥胖、缺乏运动和过度饮酒流行率最高的地区。我们将采用整群随机阶梯楔形设计进行一项纵向研究，以评价干预对AOD和肥胖预防主要目标的影响：（1）减少物质使用危害（苏尔）和AOD使用和使用意图;（2）减轻体重/BMI，增加休闲时间体力活动和健康饮食习惯。该项目是华盛顿大学和明尼苏达大学经验丰富的人工智能研究人员与乔托行为健康领导者和提供者之间的多学科社区参与式研究合作。拟议项目的一个独特之处是乔克托人在大学和部落两级的指导。项目 由试点和部落可接受性数据支持;解决了关键的公共卫生问题， 一个群体经历相当大的健康差距;并加强与部落的伙伴关系的研究基础设施。如果有效，它具有广泛传播的潜力，并且可以推广到其他慢性同时发生的精神健康和身体健康状况（例如，糖尿病和抑郁症）。

DESCRIPTION (provided by applicant): Obesity and substance abuse are increasingly prevalent, costly, and deadly--fueling a twin epidemic in the United States. The importance of addressing obesity and alcohol and other drug (AOD) use simultaneously is supported in part by recent research at NIDA linking the brain mechanisms that fuel drug addiction and compulsive eating behaviors. Although AOD abstention and abuse patterns vary considerably by region and tribe, American Indian (AI) drug-related deaths are 1.5 times higher than for all other ethnic groups in the US. AI women in particular exhibit significant disparities with other women in obesity and AOD prevalence and higher rates of premature mortality and morbidity as a result. Based on preliminary research, we have developed the Yappalli Choctaw Road to Health, a culturally focused, strengths-based outdoor experiential obesity-AOD risk prevention and health leadership program. The 3-month intervention (i.e., 3 individual meetings; 8 group-sessions + 2-day culture boot camp + 10-day Choctaw Trail of Tears walk) is grounded in the PI's Indiginest Stress-Coping Model and the Information-Motivational- Behavioral Skills framework, with activities consistent with Motivational Interviewing and leadership development principles. This RO1 application, prepared in response to PAR-11-346 (Interventions for Health Promotion and Disease Prevention in Native American Populations), proposes to evaluate the program among 150 at-risk adult Choctaw women across 5 regions of the Choctaw Nation of Oklahoma (CNO), where Native women have some of the highest obesity, physical inactivity, and excessive drinking prevalence in the country. We will conduct a longitudinal study using a cluster randomized stepped-wedge design to evaluate the intervention impact on the AOD and obesity prevention primary aims of: (1) substance use harm reduction (SUHR) and AOD use and intentions to use; and (2) reduction in weight/BMI and increase in leisure-time physical activity and healthful food habits. The project is multidisciplinary community-based participatory research collaboration among experienced AI researchers at the Universities of Washington and Minnesota and Choctaw behavioral health leaders and providers. A unique feature of the proposed project is its direction at both the university and tribal levels by Choctaws. The project is supported by pilot and tribal acceptability data; addresses a critical public health issue among a group experiencing considerable health disparities; and strengthens the research infrastructure in partnership with the Tribe. If efficacious, it has the potential for widespread dissemination and could be generalizable to other chronic co-occurring mental health and physical health conditions (e.g., diabetes and depression).