Osage Community Supported Agriculture Study (OCSA)

项目摘要/摘要 食品系统由食品生产、获取和营销三部分组成。公共卫生努力一直是 鉴于不良饮食是可预防疾病的头号风险因素，人们越来越关注食品系统 在美国。美国印第安人(AIS)经历了与饮食相关的健康差距：AI成年人 肥胖的可能性增加50%，患高血压的可能性增加30%，患糖尿病的可能性增加一倍 与白人相比。2013年，俄克拉何马州的奥萨奇民族成立了鸟溪农场(BCF)，肩负着这一使命 促进土著粮食主权，被定义为土著人民健康的权利和责任 以及通过传统土著习俗生产的适合文化的食品。到2015年，BCF拥有12个 并开始向部落项目提供食物。同年，与BCF合作，我们的团队 启动了NIMHD资助的新鲜农场到学校计划(R01MD011266)。由此得出的初步发现 部落驱动的基于社区的参与性研究(CBPR)研究表明，蔬菜和水果的产量增加 儿童和成人的摄入量以及粮食不安全状况的减少。在我们为期八年的CBPR的基础上 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，在该计划中 奥萨奇市民将在6个月内每周获得一份新鲜农产品。CSA已有所改善 饮食和非人工智能人群的健康，这是中心建议的循证战略 疾病预防控制和医学研究所缩小健康差距，但没有随机 在人工智能人群中进行了CSA计划的对照试验。因此，我们将测试其疗效 CSA计划与针对文化定制的营养和饮食和健康结果的烹饪教育相结合 在Osage成人中，评估其成本效益，并开发用于传播研究结果的多媒体工具包。 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计划的 对饮食、血压和血脂(主要结果)的影响以及对体重指数(BMI)和血红蛋白的影响 A1C(HbA1c)、食物不安全和健康状况(次要结果)600名人工智能成年人(年龄18-75岁) 超重/肥胖；2)对个人进行经济评估(例如，与健康有关的生活质量)， 组织(如医疗保健利用成本)和社区一级(如预防心脏代谢 疾病)结果；以及3)使用参与性视频记录和传播研究过程和结果 方法，并编写一个基于网络的工具包，供其他人工智能社区使用CBPR来改善部落食物系统。 这项研究是第一次对食物系统的所有组成部分进行严格干预，以解决不良饮食和 认可机构的健康状况。以奥萨奇民族资产和优先事项为基础，以CBPR和土著粮食为指导 主权取向，并根据建议的消除差异的战略，研究结果将 为研究和政策努力提供信息，以在慢性病发病率较高的保留地创造可持续的食物获取机会 疾病以及城市人工智能社区，在那里可以获得CSA并可以为人工智能量身定做。

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.