Tribal Health and Resilience in Vulnerable Environment (Thrive) Study

背景：食物不安全增加了一个人患肥胖、糖尿病、高血压和癌症的风险（通过其与不良饮食和营养的联系），这些疾病在俄克拉何马州的印第安人中非常普遍（肥胖42%，糖尿病15%，高血压38%）我们的试点研究表明，俄克拉何马州的土著人食物不安全的人数是白人的3倍（分别为21.3%和7.3%）然而，很少或没有研究评估土著人食物不安全的个人和环境层面的相关性，也没有研究在俄克拉何马州的部落国家中开发干预措施或广泛的教育材料目的和方法：本研究由美国原住民乔克托族调查员领导，目的1：评估俄克拉荷马州契卡索族和乔克托族食品不安全的相关因素（社会人口统计学、健康行为、感知食物环境）和结果（包括蔬菜和水果的饮食摄入量、BMI、糖尿病和高血压）。一项电话调查将对从部落登记处随机抽取的500名美国土著成年人（18岁以上）进行。将对使用部落诊所电子保健的200名受访者的临床措施进行验证

DESCRIPTION (provided by applicant): Background: Food insecurity increases one's risk for obesity, diabetes, hypertension, and cancer (via its links to poor diet and nutrition), conditions highly prevalent among Native Americans in Oklahoma (obesity 42%, diabetes 15%, and hypertension 38%).1 Our pilot study shows that 3 times as many Natives in Oklahoma are food insecure as Whites (21.3% vs. 7.3% respectively).2 Yet few or no studies have assessed individual- and environmental-level correlates of food insecurity among Natives and none have developed interventions or broad-based educational materials within Oklahoma tribal nations.3,4 Aims and Methods: This study, led by a Native American Choctaw Investigator will, Aim #1: Assess correlates (sociodemographics, health behaviors, perceived food environment) and outcomes (dietary intake including vegetables and fruits, BMI, diabetes, and hypertension) of food insecurity in the Chickasaw and Choctaw nations in Oklahoma. A telephone survey will be administered to 500 Native American adults (18+) randomly sampled from tribal registries. Clinical measures will be validated for 200 of those surveyed using tribal clinic electronic health records. Perceptions of food environments will be compared to objective store measures using GIS data. Aim #2: Design, implement, and evaluate a convenience store intervention to increase the availability and intake of vegetables and fruits among tribal members. Using a cluster-randomized design with 20 matched tribally owned convenience stores (5 cases and 5 controls in each tribe), we will implement evidence-based strategies (increased availability and variety, point of purchase information, reduced prices/coupons) to increase the sales and intake of vegetables and fruits among tribal members. Store-level changes will be measured by pre/post sales records and the Nutrition Environment Measures Survey; individual-level changes by two cross-sectional surveys, administered to 300 convenience store shoppers before and 300 shoppers after the intervention. Tribal members will use video voice,3 an action-oriented participatory media research method to collect qualitative and environmental data (e.g. types of foods/beverages sold and promoted in the convenience stores) to facilitate community planning and channel recommendations to policy makers. Aim #3: Create a multimedia manual, co-developed with tribal members, guiding tribes in food environment changes, and disseminated over a free and open source Website allowing for tribal user- created content. Innovation: Each of the 3 aims builds on our preliminary data and/or best practices, and leverages tribal resources and partnerships to enhance survey participation rates and convenience store "healthy makeovers." Significance and Impact: The knowledge from surveys on food insecurity correlates and health outcomes will inform the design of the convenience store intervention to increase availability of vegetables and fruits. The resulting multimedia manual will guide food environment changes among tribes nationally to address the critically high rates of obesity, diabetes, and hypertension within this population.