Growing Resilience in Wind River Indian Reservation: an RCT on gardens for health

 描述（由申请人提供）：风河印第安保留地的恢复力不断增长面对历史创伤和严重的健康差距，美洲原住民（NA）社区需要健康促进干预措施，使他们能够控制和改善他们的健康。家庭花园可能是这样一种干预。增长的弹性（GR）的长期目标是建立部落的能力，以改善NA的健康，确定和评估适当的，可扩展的和可持续的健康促进干预措施，旨在结束健康差距。目标是与部落保健专业人员和社区组织合作，建立、评价和维持家庭食品园艺，作为一种健康干预措施，改善风河印第安人保留地对园艺和本地食品生产感兴趣的北方阿拉帕霍和东部肖肖尼家庭的健康。园艺干预将使用随机对照试验（RCT）设计进行评估。在GR试点研究的基础上，中心假设是，经过两年的家庭园艺，干预家庭成员的身体质量指数（BMI）和其他客观可验证的健康指标将显示出积极和显着的差异，从控制家庭。其理由是，在RCT确认GR试点中关于花园对健康影响的观察数据和积极数据趋势后，支持家庭花园将成为一种文化相关的和增强权能的健康促进战略，以解决部落家庭的健康差距。来自部落卫生组织的社区卫生代表将在家庭和社区组织提供的促进健康服务（如园艺）之间架起桥梁。GR将实现两个目标，以实现这些目标，并测试这一假设：（1）建立一个可持续的和可扩展的干预，使部落卫生专业人员和社区组织，以支持部落家庭在成功的食品园艺;（2）确定家庭园艺的健康影响，通过随机对照试验与成人体重指数作为主要结果。GR的创新包括与NA家庭一起开发一种赋权，可扩展和可持续的以家庭为基础的健康促进干预措施，并成为第一个评估家庭花园健康影响的RCT。我们还将从最近的NHANES数据中为5至74岁的人生成LMS z分数参考数据集。如果这在生物学和统计学上证明与比较不同年龄儿童的z分数的常见做法一样合理，那么这项研究还将为预期影响所有家庭成员BMI的干预措施提供第一个内部一致的单一健康结果指标。拟议的研究是重要的，因为它预计将创建一个可扩展的，可持续的，文化上适当的健康促进干预，以减少NA的健康差距，利用，可以说，重建部落福祉的最强有力的基础：家庭，土地，文化和精神传统，以及部落卫生保健专业人员和机构。

 DESCRIPTION (provided by applicant): Growing Resilience in Wind River Indian Reservation In the face of historical trauma and gross health disparities, Native American (NA) communities need health promotion interventions that enable them to control and improve their health. Home gardens may be such an intervention. The long-term goal of Growing Resilience (GR) is to build tribal capacity to improve NA health by identifying and evaluating suitable, scalable and sustainable health promotion interventions aimed at ending health disparities. The objective is to collaborate with tribal health professionals and community-based organizations to establish, evaluate, and sustain home food gardening as a health intervention that improves health of Northern Arapaho and Eastern Shoshone families of Wind River Indian Reservation who are interested in gardening and native food production. The gardening intervention will be evaluated using a randomized controlled trial (RCT) design. Building on the GR pilot study, the central hypothesis is that, after two years of home gardening, the body mass index (BMI) and other objectively verifiable health indicators in intervention family members will show positive and significant differences from those of control families. The rationale is that upon RCT confirmation of observational data and positive data trends in the GR pilot about the impacts of gardens on health, supporting home gardens will become a culturally relevant and empowering health promotion strategy for tackling health disparities with tribal families. Community health representatives (CHRs) from tribal health organizations will form the bridge between families and health promoting services (such as gardening) that are provided by community-based organizations (CBO). GR will accomplish two aims to achieve these goals and test this hypothesis: (1) establish a sustainable and scalable intervention that enables tribal health professionals and CBOs to support tribal families in successful food gardening; and (2) identify health impacts of home gardening in NA families via an RCT with adult BMI as the primary outcome. GR innovations include developing an empowering, scalable and sustainable family-based health promotion intervention with, by, and for NA families, and being the first RCT to assess health impacts of home gardens. We will also generate an LMS z-score reference data set from recent NHANES data for people aged 5 to 74. Should this prove biologically and statistically as reasonable as the common practice of comparing z-scores among children of varying ages, then this study will also provide the first internally consistent single health outcome measure for interventions expected to impact BMI of all family members. The proposed research is significant because it is expected to create a scalable, sustainable, and culturally appropriate health promotion intervention to reduce NA health disparities that leverages, arguably, the strongest foundations for rebuilding tribal wellbeing: family, land, cultural and spiritual traditions, and tribal health care professionals and institutions.