Urban American Indian/Alaska Native Cultural Eating Values and Behaviors: Community-based, mixed methods research to inform a holistic and culturally-informed diabetes prevention intervention program

项目总结/摘要 背景2型糖尿病（T2 D）不成比例地影响美国印第安人和阿拉斯加原住民（AI/AN） 社区，对资源不足的城市AI/AN社区造成更大的负担。过去的研究 表明营养对于预防T2 D非常重要，但实现适当的营养需要健康的 精神与饮食的关系，这对于许多经历过一段时间的AI/AN来说可能很难实现。 不成比例的精神疾病负担。改善整体健康的一种有前途的干预措施是直觉 饮食（IE），一种适应性饮食方式，利用积极心理学的各个方面来促进与 饥饿和饱腹感的内在生理线索。IE是一种很有前途的改善心理健康的干预措施。 与食物、饮食行为和心理健康的关系，但迄今为止还没有努力评估 IE与AI/AN文化食品价值观的兼容性 或 AI/AN社区对IE的可接受性。 研究目的和目标。候选人将与明尼阿波利斯的两个城市AI/AN社区合作， 巴尔的摩进行探索性顺序混合方法社区为基础的前瞻性研究 （CBPR）研究。具体目标是：1）定性地探讨AI/AN的文化饮食价值观和IE的感知; 2)在文化上调整直觉饮食量表2（IES-2），以适应城市AI/AN文化和社会背景， 社区参与的方法;（3）检查 构建体 通过调整IES-2的有效性 因子分析及其与健康结果数据的关联。 Approach.本研究的目的1将利用对30-40名城市AI/AN的深入访谈来探索文化饮食 价值观、饮食行为和对IE的看法。这些定性数据将使用归纳法进行分析。 在城市AI/AN中获得对文化饮食价值观和饮食行为的细微了解的方法 社区.目标2将利用CBPR方法，让社区研究委员会（CRC）参与 将目标1的调查结果纳入IES-2。目标3将涉及对经调整的措施进行试点测试， 相关健康数据， 250 AI/AN成人。将使用验证性因素分析来检验 构建体 修改后的IES-2。其次，将使用多元线性和逻辑回归评估 直觉/文化饮食价值观与健康结果数据（心理健康、文化 连通性，水果/蔬菜摄入量，身体活动）。 奖学金信息。拟议中的NRSA研究将作为Maudrie女士的博士论文， 约翰霍普金斯布隆伯格公共卫生学院的一名美国印第安人博士生，她的研究和 培训由AI/AN健康专家指导团队提供支持。NRSA的这项研究建立在 候选人之前对城市AI/AN社区的CBPR研究，并与NIDDK的使命保持一致， 改善T2 D的预防并促进高度优先人群的健康公平（城市AI/ANs）。

PROJECT SUMMARY/ABSTRACT Background. Type 2 diabetes (T2D) disproportionately affects American Indian and Alaska Native (AI/AN) communities, with even greater burden on under-resourced urban AI/AN communities. Past research has shown that nutrition is deeply important for prevention of T2D, yet achieving proper nutrition requires a healthy mental relationship with eating, something that may be difficult to achieve for many AI/ANs who experience a disproportionate burden of mental illness. A promising intervention for improving holistic wellbeing is Intuitive Eating (IE), an adaptive eating style that utilizes aspects of positive psychology to promote connection to internal physiological cues to hunger and satiety. IE is a promising intervention for improving psychological relationships with food, eating behaviors, and mental health but to date there have been no efforts to assess IE’s compatibility with AI/AN cultural food values or the acceptability of IE to AI/AN communities. Study Goals and Aims. The candidate will collaborate with two urban AI/AN communities in Minneapolis and Baltimore to conduct an Exploratory Sequential Mixed Methods Community-Based Participatory Research (CBPR) study. Specific aims are to: 1) qualitatively explore AI/AN cultural eating values and perceptions of IE; 2) Culturally adapt the Intuitive Eating Scale 2 (IES-2) for urban AI/AN cultural and social contexts using community engaged participatory methods; and 3) Examine construct validity of the adapted IES-2 through factor analysis and its associations with health outcome data. Approach. Aim 1 of the study will utilize in-depth interviews with 30-40 urban AI/ANs to explore cultural eating values, eating behaviors, and perceptions of IE. This qualitative data will be analyzed using an inductive approach to gain a nuanced understanding of cultural eating values and eating behaviors within urban AI/AN communities. Aim 2 will utilize CBPR methods to engage community research councils (CRCs) in the integration of Aim 1 findings into the IES-2. Aim 3 will involve pilot testing the adapted measure alongside relevant health data with 250 AI/AN adults. Confirmatory Factor Analysis will be used to examine the construct validity of the adapted IES-2. Secondarily, multiple linear and logistic regression will be used to assess relationships between intuitive/cultural eating values and health outcome data (mental health, cultural connectedness, fruit/vegetable intake, physical activity). Fellowship Information. The proposed NRSA research will serve as the doctoral dissertation of Ms. Maudrie, an American Indian PhD student at the Johns Hopkins Bloomberg School of Public Health, her research and training are supported by a mentorship team of AI/AN health experts. This NRSA research builds upon the candidate’s previous CBPR research with urban AI/AN communities and is aligned with the NIDDK’s mission to improve the prevention of T2D & advance health equity for a high priority population (Urban AI/ANs).