Cheyenne River Sioux Tribe Cooking for Health

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-根据文化定制的健康食品预算的设计、实施和评估， 购买，烹饪干预，以改善2型糖尿病患者的饮食和健康。前提是 社区中与健康食品供应有关的试点工作为拟议项目提供了信息， 饮食选择和食物购买模式，以及先前的研究表明 对其他成年人的饮食和健康进行预算和烹饪技能培训。目前，没有证据表明- 基于预算或烹饪技能的计划可以在低资源环境中实施，例如 农村人工智能社区。此外，尽管饮食是控制糖尿病的基石，但没有预算或烹饪 现有的技能计划侧重于2型糖尿病患者。 使用随机对照试验，我们将测试为文化量身定做的健康食品预算的有效性， 采购和烹饪计划：(1)饮食(即SSB、加工食品的摄入量)和(2)健康食品本身 居住在一起的2型糖尿病患者的疗效、预算和烹饪技能以及健康食品购买 关于夏延河苏人保留地--美国第四大人工智能保留地。次要的 结果将包括其他饮食因素(即蔬菜和水果、豆类和全谷物的摄入量)， 健康食品知识、营养标签阅读、饮食敏感的心脏代谢危险因素(即体重、腰围 周长、血压、血脂)和糖尿病控制(即空腹血糖、糖化血红蛋白、糖尿病药物 使用/剂量)。此外，我们将进行混合方法过程评估，以评估干预范围， 忠诚度、参与者满意度和有效性。课程将为患有糖尿病的人工智能人群量身定做， 并直接解决社区成员和部落确定的健康饮食的主要障碍 最近重点小组的领导人包括：(1)对低收入者的粮食预算困难；(2)识字率低和 在购买食品时的算术能力(例如，无法使用店内秤将定价为“每磅”的食品转换为 美元价值)；(3)烹饪技能有限。我们期待着制定和实施一项符合文化特点的 饮食干预将有效地促进积极的饮食变化，提高健康食品的自我效能， 预算和烹饪技巧，以及健康食品的购买。 糖尿病控制不佳会影响患者的健康/寿命，并对医疗保健产生深远影响 成本。需要做出更大的努力，在服务不足、负担沉重的社区鼓励健康饮食 糖尿病的症状。改善糖尿病患者的健康食品预算、购买和烹饪技能 改善饮食和糖尿病管理。如果成功，这个项目可以扩展到其他人工智能社区。

The research activities proposed in this application address a pressing need in American Indian (AI) communities – the design, implementation, and evaluation of a culturally-tailored healthy food budgeting, purchasing, and cooking intervention to improve diet and health among AIs with type 2 diabetes. The premise of the proposed project was informed by pilot work in the community related to the availability of healthy foods, dietary choices, and food purchasing patterns, and previous studies that indicate positive relationships of budgeting and cooking skills training on diet and health in other adult populations. Currently, no evidence- based budgeting or cooking skills programs exist that can be implemented in low-resource settings, such as rural AI communities. Moreover, despite diet being a cornerstone of diabetes control, no budgeting or cooking skills programs exist that focus on individuals with type 2 diabetes. Using a randomized controlled trial, we will test the effectiveness of a culturally-tailored healthy food budgeting, purchasing, and cooking program on: (1) diet (i.e., intake of SSBs, processed foods) and (2) healthy food self- efficacy, budgeting and cooking skills, and healthy food purchases among AIs with type 2 diabetes who reside on the Cheyenne River Sioux reservation—the fourth largest AI reservation in the United States. Secondary outcomes will include other dietary factors (i.e., intake of vegetables and fruit, legumes, and whole grains), healthy food knowledge, nutrition label reading, diet sensitive cardio-metabolic risk factors (i.e., weight, waist circumference, blood pressure, lipids) and diabetes control (i.e., fasting glucose, HbA1c, diabetes medication use/dosage). Additionally, we will conduct a mixed methods process evaluation to assess intervention reach, fidelity, participant satisfaction, and effectiveness. Curriculum to be tailored to an AI population with diabetes, and directly address major barriers to healthy eating that were identified by community members and tribal leaders in recent focus groups including: (1) difficulty budgeting for food on low-incomes; (2) low literacy and numeracy when purchasing food (e.g., inability to use in-store scales to convert foods priced “per pound” to dollar values); (3) limited cooking skills. We expect that development and implementation of a culturally-tailored diet intervention will be effective in promoting positive diet change, and increase healthy food self-efficacy, budgeting and cooking skills, and healthy food purchases. Poorly controlled diabetes affects the health/longevity of those afflicted, and has profound effects on healthcare costs. Greater efforts are needed to encourage healthy eating in underserved communities with a high burden of diabetes. Improving healthy food budgeting, purchasing, and cooking skills among AIs with diabetes should improve diet and diabetes management. If successful, this program can be extended to other AI communities.