Delivery of Turtle Island Tales to Promote Family Wellness

项目2：项目总结 美国印第安人(AI)群体在一生中经历了严重的健康和经济不平等， 包括肥胖、癌症、粮食不安全(FI)和贫困的风险增加。压倒性的证据表明 肥胖预防循证干预(EBI)降低了癌症风险，但EBI对 以与文化相关的方式发展或接触到大量人工智能家庭是极其有限的。 社区参与传播和实施(CEDI)战略需要跨越多个社会 生态级别，以增加人工智能社区中EBI的采用、实施和维护。我们的目标 是增加EBI在持续生活的人工智能家庭中用于癌症和肥胖预防的覆盖面 贫困地区(PPA)。拟议的项目，通过公平实施海龟岛故事#年 AI社区(REI-Turtle Island)是一个参与性行动研究项目，旨在改善当地 持续EBI影响的能力。海龟岛故事是一个以家庭为中心，以家庭为基础的儿童EBI 肥胖预防被命名为承认龟岛是许多人工智能使用的北美术语 社区。海龟岛将在四个州合作推广系统中进行，这些系统包括 人工智能社区中的补充营养援助计划教育(SNAP-ED)机构，约有4,000人 农村和边境地区PPA中的儿童及其家庭。REI-海龟岛参与了系统、社区、 和组织合作伙伴，以确定、完善和制定CEDI战略，以解决疾病预防 菲尔。项目指导委员会和当地社区咨询委员会将进行反复规划和 使用REACH、有效性、采用、实施和维护中指定的结果进行评估 (re-AIM)框架。对于目标1，我们将促进和评估T-Tale在人工智能内的PPA中的覆盖范围 蒙大拿州、俄勒冈州、南达科他州和威斯康星州的社区，由扩展/SNAP-ED提供； 确定T-Tales对健康行为改变的有效性，并评估FI的减少 通过促进与社区和系统级资源(例如，SNAP， WIC)。对于目标2，我们将评估国家层面的采用、实施和组织维护 扩展/SNAP和人工智能社区的T-Tale能力，并确定实施的预算影响 T-Tales进入持续延期/SNAP-ED交付。我们希望生成一个新的CEDI战略工具包来 将肥胖和癌症预防EBI转移到可持续的社区实施中，并说明 PPA中人工智能社区独特的社会和文化背景。这些发现将推动雪松科学领域的发展 通过共同制定战略来影响EBI的采用、实施和维护 利用社会生态、传播和实施的创新概念框架， 预防PPA人工智能家庭肥胖和癌症的行为、健康和公平框架。

PROJECT 2: PROJECT SUMMARY American Indian (AI) communities experience profound health and economic inequities across the lifespan, including increased risk for obesity, cancer, food insecurity (FI), and poverty. Overwhelming evidence indicates obesity prevention evidence-based interventions (EBIs) reduce cancer risk, but the degree to which EBIs have been developed in culturally relevant ways or to reach large numbers of AI families is extremely limited. Community engaged dissemination and implementation (CEDI) strategies are needed across multiple social ecological levels to increase EBI adoption, implementation, and maintenance in AI communities. Our objective is to increase the reach of EBIs for cancer and obesity prevention among AI families who live in persistent poverty areas (PPAs). The proposed project, Reach through Equitable Implementation of Turtle Island Tales in AI Communities (REI-Turtle Island), is a participatory action research project designed to improve local capacity for sustained EBI impact. Turtle Island Tales is a family-focused, home-based EBI for childhood obesity prevention named to acknowledge Turtle Island as the term for North America used by many AI communities. REI-Turtle Island will be conducted across four state Cooperative Extension Systems serving as Supplemental Nutrition Assistance Program Education (SNAP-Ed) agencies in AI communities with ~4,000 children and their families in PPAs in rural and frontier areas. REI-Turtle Island engages system, community, and organizational partners to identify, refine, and develop CEDI strategies to address both disease prevention FI. A Project Steering Committee and Local Community Advisory Boards will conduct iterative planning and evaluation using outcomes specified in the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. For Aim 1, we will facilitate and evaluate the reach of T-Tales in PPAs within AI communities in Montana, Oregon, South Dakota, and Wisconsin when delivered by Extension/SNAP-Ed; determine the effectiveness of T-Tales for health behavior change, and evaluate the reduction in FI among participating families by facilitating connections with community and system-level resources (e.g., SNAP, WIC). For Aim 2, we will evaluate the state-level adoption, implementation, and organizational maintenance capacity of Extension/SNAP and AI communities for T-Tales and determine budget impacts of implementing T-Tales into sustained Extension/SNAP-Ed delivery. We expect to generate a novel CEDI Strategies Toolkit to move obesity and cancer prevention EBIs into sustained community implementation and account for the unique social and cultural contexts in AI communities in PPAs. Findings will advance the field of CEDI science through the co-production of strategies to influence EBI adoption, implementation, and maintenance using an innovative conceptual framework that leverages social ecological, dissemination and implementation, behavioral, and health equity frameworks to prevent obesity and cancer in AI families in PPAs.