Exploring Food Insecurity and Pilot Testing a Diabetes Nutrition Education Program and Healthy Food Access Service for American Indian and Alaska Native Adults with Type 2 Diabetes

项目摘要/摘要 健康的营养习惯是管理2型糖尿病(T2D)的关键。然而，美国印第安人和阿拉斯加 原住民(人工智能/人工智能)往往无法获得健康食品，并不成比例地经历粮食不安全。食物 不安全，定义为无法持续获得足够的食物以维持积极、健康的生活，这会产生负面影响 控制血糖和体重的能力。我正在攻读一名K01指导研究科学家 发展奖，以填补干预研究定量数据分析领域的关键培训空白 实效性和实践性研究设计。为了有效地将我之前的培训和研究联系起来 为了获得我的第一个R01，我仔细制定了一个有指导的培训计划，从战略上支持 我的研究目标是获得这个K01奖。我目前是一个研究团队的联合调查员，该团队开发了一种文化上的 针对患有T2D的AI/AN成人的响应性糖尿病营养教育课程，题为“我能吃什么？”健康 具有T2D的AI/ANS的选择“(WCIE)。WCIE包括互动的、动手的营养教育学习活动， 包括控制摄入量，减少含糖饮料和饱和脂肪，以及解决障碍 健康饮食。2020年1月，我们启动了WCIE的传统支持、6个站点、等待名单控制设计测试。 2021年6月，我们将与150名患有T2D的AI/AN成年人完成数据收集。数据将包括3个时间点 立即干预，5名等待干预参与者超过6个月进行调查(营养 知识、行为、自我效能)和临床结果(BMI、血压和糖化血红蛋白)。尽管WCIE有 不包括具体的粮食不安全干预，我们包括所有数据的家庭粮食不安全衡量 收集时间点。在拟议的K01的目标1中，我将审查粮食不安全和 通过二次分析利用我的新干预措施在现有数据集中的临床WCIE结果 定量数据分析技能和对粮食不安全的缓解作用的深入了解 AI/ANS患者的糖尿病营养教育和T2D结局。在目标2中，我将设计/试点测试WCIE，并添加 改善健康食品获取的服务，并评估其可行性/对城市人工智能/AN的T2D结果的影响- 俄克拉荷马城的服务诊所。我们将与俄克拉荷马城诊所合作，确定他们对健康的需求 以下领域的食品获取服务：运输、健康食品的可获得性或健康食品的负担能力 食物。Aim#2将为我提供利用我在有效性和语用试验研究方面的新培训的机会 干预研究的设计和定量数据分析。我的详细培训计划包括正式的 科罗拉多大学安舒茨医学院的课程、研讨会、讲习班/会议 AI/AN健康研究，以及来自我的导师的支持，他们是AI/AN糖尿病领域的专家和领导者 健康、人工智能/人工智能健康干预、T2D和粮食不安全干预，以及定量/研究设计 方法论。拟议的培训计划和目标将为我提供一套所需的技能和专业知识 成功获得R01基金，成为糖尿病健康差距干预科学的领导者。

PROJECT SUMMARY / ABSTRACT Healthy nutrition habits are key to managing type 2 diabetes (T2D). However, American Indian and Alaska Natives (AI/ANs) often lack access to healthy food and disproportionately experience food insecurity. Food insecurity, defined as lack of consistent access to enough food for an active, healthy life, negatively impacts one’s ability to manage blood sugar and body weight. I am pursuing a K01 Mentored Research Scientist Development Award to fill critical training gaps in the areas of quantitative data analysis of intervention studies and effectiveness and pragmatic study design. In order to effectively bridge my prior training and research experience to obtain my first R01, I have carefully developed a mentored training plan that strategically supports my research aims for this K01 award. I am currently Co-Investigator on a study team that developed a culturally responsive diabetes nutrition education curriculum for AI/AN adults with T2D, entitled “What Can I Eat? Healthy Choices for AI/ANs with T2D” (WCIE). WCIE includes interactive, hands-on nutrition education learning activities, including portion control, decreasing sugary beverages and saturated fat, and problem solving for barriers to healthful eating. In January 2020 we launched a tribally-supported, 6-site, waitlist control design test of WCIE. In June 2021, we will complete data collection with 150 AI/AN adults who have T2D. Data will include 3 timepoints for immediate intervention and 5 for waitlist intervention participants over 6 months with surveys (nutrition knowledge, behavior, self-efficacy) and clinical outcomes (BMI, blood pressure, and HbA1c). Though WCIE does not include a specific food insecurity intervention, we included a household food insecurity measure at all data collection timepoints. In Aim #1 of this proposed K01 I will examine the relationship between food insecurity and clinical WCIE outcomes in the existing dataset through secondary analysis to utilize my new intervention quantitative data analysis skills and advance understanding of the moderating effect of food insecurity on diabetes nutrition education and T2D outcomes among AI/ANs. In Aim #2 I will design/pilot test WCIE with added service to improve healthy food access and evaluate its feasibility/impact on T2D outcomes at an urban AI/AN- serving clinic in Oklahoma City, OK. We will work with the Oklahoma City clinic to identify their need for a healthy food access service in the following domains: transportation, availability of healthy food, or affordability of healthy food. Aim #2 will provide me the opportunity to utilize my new training in effectiveness and pragmatic trials study design and quantitative data analysis of intervention studies. My detailed training plan includes formal coursework at the University of Colorado Anschutz Medical Campus, seminars, workshops/conferences on AI/AN health research, and support from my mentors who are experts and leaders in the area of AI/AN diabetes health, AI/AN health interventions, T2D and food insecurity interventions, and quantitative/study design methodology. The proposed training plan and aims will provide me with a set of skills and expertise needed to successfully obtain R01 funding and become a leader in diabetes health disparities intervention science.