Understanding the Role of the Food Environment on Diet and Health in Rural American Indian Communities: the Strong Heart Food Environment Study

本申请中提出的研究活动解决了美国印第安人(AI)的迫切需求 社区以更好地了解社区中的多层次(即社区、家庭和个人)因素 影响饮食和心血管疾病的物质和社会文化环境。其前提是 提出项目的依据是：(1)我们之前在强心研究(SHS)和强心研究中的工作 家庭研究(SHFS)--关于AIS心血管疾病风险因素的最大多部落队列研究 美国-强调认可机构肥胖负担过重及饮食质素低劣；及(2) 我们的健康食品，健康家庭可行性研究的结果--SHS/SHFS的一项小型试点研究 社区评估了健康饮食的主要障碍和促进者。尽管SHS/SHFS有 在过去的34年里跟踪了来自12个农村社区的4000多个人工智能，所有数据都是作为 研究的重点是与心血管相关的个体水平的生物和行为因素 疾病；没有收集到关于物质或社会文化食品的多层次组成部分的数据 这个队列中的环境。因此，我们对这些领域对 这些农村人工智能社区的饮食和心血管健康。为了弥补这些差距，我们将利用现有的 来自SHS/SHFS的数据，并添加与物理相关的多层次因素的综合评估 和社会文化环境(根据以前的试点工作选定的因素)，可能影响饮食和 12个农村人工智能社区即将举行的SHS/SHFS考试对心血管健康的影响。 对于这个项目，我们将评估社区层面的关联(例如，食品供应、食品成本、 关于健康饮食的规范)、家庭一级(例如，粮食不安全、食品销售点的可及性；食品 偏好)，以及个人层面(例如，感知的营养环境)方面的物理和社会- 饮食的文化环境(报告的水果和蔬菜的摄入量；含糖饮料)和 来自12个部落的SHS/SHFS参与者的心血管危险因素(BMI；空腹血糖)。我们还将 评估参与营养援助方案(即补充营养援助)的影响 关于饮食和心血管风险的计划(SNAP)或印第安人保留地的食品分配计划 因素(即，报告的水果和蔬菜摄入量；含糖饮料；体重指数；空腹血糖)。 研究结果包括：高密度脂蛋白胆固醇、甘油三酯、收缩压、糖尿病和 突发心血管疾病。 需要更大的努力来了解影响饮食和心血管疾病的最显著因素 农村部落社区的卫生问题。这项辅助研究将利用社会科学及人文科学部门/卫生和公众服务部的现有资源， 同时增加了全面的膳食评估，粮食安全措施和营养评估 以经济和邻里环境为研究对象。

The research activities proposed in this application address a pressing need in American Indian (AI) communities to better understand multi-level (i.e., community- , household- , and individual- level) factors in the physical and socio-cultural environment that impact diet and cardiovascular diseases. The premise of the proposed project was informed by: (1) our previous work in the Strong Heart Study (SHS) and the Strong Heart Family Study (SHFS)—the largest multi-tribal cohort studies of risk factors for cardiovascular disease in AIs in the USA—that highlighted the exceedingly high burden of obesity and poor diet quality among AIs; and (2) findings from our Healthy Food, Healthy Families Feasibility Study—a small pilot study in a SHS/SHFS community that assessed the major barriers and facilitators to eating healthy. Although the SHS/SHFS has followed more than 4,000 AIs from 12 rural communities for the past 34 years, all data collected as part of the study has focused on individual-level biological and behavioral factors associated with cardiovascular diseases; no data has been collected on multi-level components of the physical or sociocultural food environments in this cohort. As such, we have incomplete knowledge about the influence of these domains on diet and cardiovascular health in these rural AI communities. To address these gaps, we will leverage existing data from the SHS/SHFS, and add comprehensive assessments of multi-level factors related to the physical and socio-cultural environment (factors selected based on previous pilot work) that may impact diet and cardiovascular health to the upcoming SHS/SHFS exam in 12 rural AI communities. For this project, we will assess associations of community-level (e.g., food outlet availability, food cost, norms around healthy eating), household-level (e.g., food insecurity, food outlet accessibility; food preferences), and individual-level (e.g., perceived nutrition environment) aspects of the physical and socio- cultural environment with diet (reported intake of fruits and vegetables; sugar-sweetened beverages) and cardiovascular risk factors (BMI; fasting glucose) among SHS/SHFS participants from 12 tribes. We will also assess the influence of participation in nutrition assistance programs (i.e., supplemental nutrition assistance program (SNAP) or the Food Distribution Program on Indian Reservations) on diet and cardiovascular risk factors (i.e., reported intake of fruits and vegetables; sugar-sweetened beverages; BMI; fasting glucose). Exploratory outcomes include: HDL cholesterol, triglycerides, systolic blood pressure, incident diabetes and incident cardiovascular diseases. Greater efforts are needed to understand the most salient factors that impact diet and cardiovascular health in rural Tribal communities. This ancillary study will leverage existing resources from the SHS/SHFS, while adding a comprehensive dietary assessment, measures of food security, and assessments of nutrition economic and neighborhood environments to the study.