Tribal Health and Resilience in Vulnerable Environment (Thrive) Study

描述（申请人提供）：背景：食物不安全会增加肥胖、糖尿病、高血压和癌症的风险（通过其与饮食和营养不良的联系），条件高度流行的土著美国人在俄克拉荷马州（肥胖42%，糖尿病15%，高血压38%）。1我们的初步研究表明，俄克拉荷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%）。2然而，很少或没有研究评估土著人粮食不安全的个人和环境水平的相关性，也没有研究在俄克拉荷马州部落民族中制定干预措施或基础广泛的教育材料。这项研究由一名美洲土著乔托族调查员领导，目的1：评估俄克拉荷马州的奇克索族和乔托族食物不安全的相关性（社会人口统计学、健康行为、感知的食物环境）和结果（饮食摄入量，包括蔬菜和水果、BMI、糖尿病和高血压）。将对从部落登记处随机抽样的500名美洲原住民成年人（18岁以上）进行电话调查。临床措施将被验证为200人调查使用部落诊所电子健康 记录食品环境的看法将比较客观的存储措施，使用地理信息系统数据。目标二：设计，实施和评估便利店干预措施，以增加部落成员中蔬菜和水果的可用性和摄入量。使用20个匹配的部落拥有的便利店（每个部落5例和5个对照）的群集随机设计，我们将实施循证策略（增加可用性和品种，购买点信息，降低价格/优惠券），以增加部落成员之间的蔬菜和水果的销售和摄入量。商店层面的变化将通过销售前/销售后记录和营养环境措施调查来衡量;个人层面的变化通过两项横断面调查来衡量，在干预前和干预后分别对300名便利店购物者进行调查。部落成员将使用视频语音，3这是一种面向行动的参与性媒体研究方法，收集定性和环境数据（例如便利店销售和促销的食品/饮料类型），以促进社区规划和向决策者提出建议。目标3：创建一个多媒体手册，与部落成员共同开发，在食品环境变化中指导部落，并通过一个免费和开放源代码的网站传播，允许部落用户创建内容。创新：这三个目标中的每一个都建立在我们的初步数据和/或最佳实践的基础上，并利用部落资源和伙伴关系来提高调查参与率和便利店的健康改造。“意义和影响：从粮食不安全相关性和健康结果的调查中获得的知识将为便利店干预措施的设计提供信息，以增加蔬菜和水果的供应。由此产生的多媒体手册将指导全国部落之间的食物环境变化，以解决该人群中肥胖，糖尿病和高血压的高发病率。

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.