Food Insecurity and Associated Challenges to Healthy Eating Among American Indians and Alaska Natives With Type 2 Diabetes: Multiple Stakeholder Perspectives

2021 ◽  
Vol 33 (7-8_suppl) ◽  
pp. 31S-39S
Author(s):  
Sarah Stotz ◽  
Angela G. Brega ◽  
J. Neil Henderson ◽  
Steven Lockhart ◽  
Kelly Moore ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Food Insecurity ◽  
American Indians ◽  
Healthy Eating ◽  
Alaska Native ◽  
Fruits And Vegetables ◽  
Healthy Food ◽  
Stakeholder Perspectives ◽  
Healthcare Administrators

Objective: To examine stakeholder perspectives on food insecurity and associated challenges to healthy eating among American Indian and Alaska Native (AI/AN) adults with type 2 diabetes (T2D). Methods: Focus groups and interviews were conducted with purposively selected stakeholders: AI/ANs with T2D, their family members, healthcare administrators, nutrition and diabetes educators, and national content experts on AI/AN health. Two coders analyzed transcripts using the constant-comparison method. Results: Key themes included (1) rural- and urban-dwelling AI/ANs experience different primary food security and associated challenges; (2) factors contributing to food insecurity extend beyond cost of healthy food; and (3) barriers to consuming fresh, healthy food include cost, preparation time, limited cooking knowledge, and challenges with gardening. Discussion: Resources for AI/ANs with T2D who experience food insecurity and associated challenges to healthy eating should be tailored based on urban versus rural location and should address cost and other barriers to consumption of fresh fruits and vegetables.

662-P: Facilitators and Barriers to Healthy Eating among American Indian/Alaska Native Adults with Type 2 Diabetes: Stakeholder Perspectives

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 662-P
Author(s):  
KELLY R. MOORE ◽  
SARAH A. STOTZ ◽  
ANGELA G. BREGA ◽  
KELLY L. GONZALES
Keyword(s):  
Type 2 Diabetes ◽  
American Indian ◽  
Healthy Eating ◽  
Alaska Native ◽  
Stakeholder Perspectives ◽  
Facilitators And Barriers

673-P: Food Insecurity and Intervention Opportunities for American Indians and Alaska Natives with Type 2 Diabetes: A Qualitative Analysis

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 673-P
Author(s):  
SARAH A. STOTZ ◽  
STEVEN LOCKHART ◽  
ANGELA G. BREGA ◽  
KELLY R. MOORE
Keyword(s):  
Type 2 Diabetes ◽  
Qualitative Analysis ◽  
Food Insecurity ◽  
American Indians ◽  
Alaska Natives

scholarly journals Development of a Cooking, Food Budgeting, and Nutrition intervention for American Indians with Type 2 Diabetes: Rationale and Study Protocol for the Cooking for Healthy Study

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1301-1301
Author(s):  
Amanda Fretts ◽  
Caitie Hawley ◽  
Meagan Brown ◽  
India Ornelas ◽  
Lyle Best ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
American Indians ◽  
Diabetes Management ◽  
Food Resource ◽  
Healthy Food ◽  
Healthy Diet ◽  
Health Study ◽  
Cooking Skills ◽  
Written Materials

Abstract Objectives Type 2 diabetes is a leading cause of morbidity among American Indians (AIs). Although healthy diet is a key component of diabetes management, many AIs face barriers to adopting a healthy diet. Preliminary work in an AI community in the north-central USA indicated that the most salient factors that influence healthy diet are: difficulty budgeting for food, low literacy/numeracy when purchasing food, and limited cooking skills. The Cooking for Health Study is a randomized controlled trial developed in partnership with the community that will evaluate the efficacy of a culturally-tailored healthy food budgeting, purchasing, and cooking program on: (1) intake of sugar-sweetened beverages and processed foods; and (2) healthy food budgeting and cooking skills, among AIs with diabetes. Methods The curriculum was informed by focus groups and meetings with community members and in partnership with the tribal diabetes program. The curriculum comprises a 12-month online/distance-learning program delivered through video and written materials. Over one year, we will recruit 165 AI participants with diabetes who are members of the community and reside on the reservation. Individuals will be randomized (using a 1:1 ratio) to intervention or control arm (i.e., delayed intervention). Participants in the intervention arm will receive the curriculum over a year. At baseline, month 6, and month 12, all participants will complete in-person study visits that include food frequency questionnaires, and assessments of food resource management and cooking confidence. Results The curriculum focuses on cooking and budgeting skills, and optimal diet for diabetes management. Lessons include: getting healthy foods; vegetables; fruits; dairy; protein and meats; grains; food budgeting and meal planning; empty calories; snacking; traditional foods; and celebrations. Each lesson comprises 3–8 videos paired with written materials. Enrollment will commence in early 2020. Conclusions Poorly controlled diabetes disproportionately affects the health of AIs compared to other racial/ethnic groups, and has profound effects on healthcare costs. Improving healthy food budgeting, purchasing, and cooking skills among AIs with diabetes should improve diet/diabetes management. Funding Sources NIH/NIMHD R01MD011596.

scholarly journals Strong Men, Strong Communities: Design of a Randomized Controlled Trial of a Diabetes Prevention Intervention for American Indian and Alaska Native Men

2020 ◽  
Vol 14 (4) ◽  
pp. 155798832094545
Author(s):  
Ka‘imi Sinclair ◽  
Cara Carty ◽  
Kelly Gonzales ◽  
Cassandra Nikolaus ◽  
Lucas Gillespie ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Randomized Controlled Trial ◽  
American Indians ◽  
Alaska Native ◽  
Diabetes Prevention ◽  
Controlled Trial ◽  
Recruitment And Retention ◽  
Virtual Absence ◽  
Randomized Controlled

Type 2 diabetes is a serious global epidemic that disproportionately affects disadvantaged populations. American Indians and Alaska Natives (AIs/ANs) have the highest rates of diabetes in the nation with a prevalence of 14.7% in 2018, more than twice that of non-Hispanic Whites. AI/AN men have the highest prevalence of diagnosed type 2 diabetes (14.5%) compared to non-Hispanic Black (11.4%), non-Hispanic Asian (10.0%), and non-Hispanic White (8.6%) men. Several landmark clinical trials have shown that lifestyle interventions can effectively prevent or delay the onset of diabetes among those at risk, including in AIs/ANs. Despite positive outcomes for AIs/ANs in these studies, very few were men. To date, there have been no concerted efforts to recruit and retain AI/AN men in interventions that promote weight loss and healthy lifestyles to prevent diabetes, and they remain underrepresented in these types of studies. This article describes the design and methods of the first randomized controlled trial of a diabetes prevention program with a study sample comprised entirely of AI/AN men. Research to date has demonstrated suboptimal patterns of recruitment and retention of AI/AN men, resulting in their virtual absence in health and intervention research. Effective methods to recruit and retain AI/AN men, and potential benefit gained from participation in diabetes prevention research, are unknown for this population who experience a high prevalence of type 2 diabetes. The study design presented in this article offers promising insights to help remedy these important shortcomings in the science of recruitment and retention of AI/AN men in research.

scholarly journals Cooking for Health: a healthy food budgeting, purchasing, and cooking skills randomized controlled trial to improve diet among American Indians with type 2 diabetes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Caitlin N. Hawley ◽  
Corrine M. Huber ◽  
Lyle G. Best ◽  
Barbara V. Howard ◽  
Jason Umans ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Distance Learning ◽  
American Indians ◽  
Underserved Populations ◽  
Healthy Food ◽  
Health Study ◽  
Unhealthy Food ◽  
Cooking Skills ◽  
Food Purchases

Abstract Background The prevalence of poor diet quality and type 2 diabetes are exceedingly high in many rural American Indian (AI) communities. Because of limited resources and infrastructure in some communities, implementation of interventions to promote a healthy diet is challenging—which may exacerbate health disparities by region (urban/rural) and ethnicity (AIs/other populations). It is critical to adapt existing evidence-based healthy food budgeting, purchasing, and cooking programs to be relevant to underserved populations with a high burden of diabetes and related complications. The Cooking for Health Study will work in partnership with an AI community in South Dakota to develop a culturally-adapted 12-month distance-learning-based healthy food budgeting, purchasing, and cooking intervention to improve diet among AI adults with type 2 diabetes. Methods The study will enroll 165 AIs with physician-diagnosed type 2 diabetes who reside on the reservation. Participants will be randomized to an intervention or control arm. The intervention arm will receive a 12-month distance-learning curriculum adapted from Cooking Matters® that focuses on healthy food budgeting, purchasing, and cooking skills. In-person assessments at baseline, month 6 and month 12 will include completion of the Nutrition Assessment Shared Resources Food Frequency Questionnaire and a survey to assess frequency of healthy and unhealthy food purchases. Primary outcomes of interest are: (1) change in self-reported intake of sugar-sweetened beverages (SSBs); and (2) change in the frequency of healthy and unhealthy food purchases. Secondary outcomes include: (1) change in self-reported food budgeting skills; (2) change in self-reported cooking skills; and (3) a mixed-methods process evaluation to assess intervention reach, fidelity, satisfaction, and dose delivered/received. Discussion Targeted and sustainable interventions are needed to promote optimal health in rural AI communities. If effective, this intervention will reduce intake of SSBs and the purchase of unhealthy foods; increase the purchase of healthy foods; and improve healthy food budgeting and cooking skills among AIs with type 2 diabetes – a population at high risk of poor health outcomes. This work will help inform future health promotion efforts in resource-limited settings. Trial registration This study was registered on ClinicalTrials.gov on October 9, 2018 with Identifier NCT03699709.

scholarly journals Food choices and distress in reservation-based American Indians and Alaska Natives with type 2 diabetes

2018 ◽  
Vol 21 (13) ◽  
pp. 2367-2375
Author(s):  
Nicolette I Teufel-Shone ◽  
Luohua Jiang ◽  
Jennifer Rockell ◽  
Jennifer Chang ◽  
Janette Beals ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
American Indians ◽  
Food Choice ◽  
Alaska Natives ◽  
Healthy Food ◽  
Bivariate Analysis ◽  
Unhealthy Food ◽  
Linear Regression Models ◽  
Distress Scale

AbstractObjectiveTo examine the association between food choice and distress in a large national sample of American Indians/Alaska Natives (AI/AN) with type 2 diabetes.DesignParticipants completed a sociodemographic survey, an FFQ and the Kessler-6 Distress Scale. Foods were identified as ‘healthy’ or ‘unhealthy’ using a classification grounded in the health education provided by the programme case managers; healthy and unhealthy food scores were calculated using reported intake frequencies. Pearson’s correlation coefficients for distress and food scores were calculated for all participants and by gender. Multiple linear regression models stratified by gender assessed the association between distress and food scores, controlling for sociodemographics and duration of type 2 diabetes.SettingRural AI reservations and AN villages.SubjectsAI/AN (n 2484) with type 2 diabetes.ResultsBoth males (34·9 %) and females (65·1 %) had higher healthy food scores than unhealthy scores. In bivariate analysis, distress level had a significant negative correlation with healthy food scores among female participants, but the association was not significant among males. Significant positive correlations between distress and unhealthy food scores were found in both genders. In the final multivariate models, healthy food scores were not significantly related to distress; however, unhealthy food scores showed significant positive relationships with distress for both genders (females: β=0·078, P=0·0007; males: β=0·139, P<0·0001).ConclusionsHealth professionals working with AI/AN diagnosed with type 2 diabetes should offer food choice strategies during difficult times and recognize that males may be more likely than females to select unhealthy foods when distressed.

scholarly journals Suporte telefônico na adesão á alimentação saudável de pacientes com diabetes mellitus tipo 2

2018 ◽  
Vol 17 (2) ◽  
pp. 153-184
Author(s):  
Rosana Cristina Franco ◽  
Tânia Alves Canata Becker ◽  
Paula Parisi Hodniki ◽  
Maria Lúcia Zanetti ◽  
Paula B. de Oliveira Sígoli ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Healthy Eating ◽  
Fruits And Vegetables ◽  
Fasting Blood Glucose ◽  
Control Group ◽  
Telephone Support ◽  
Significant Difference

Objetivo: Investigar los efectos de la asistencia telefónica en la adhesión a la práctica de una dieta saludable de los pacientes con diabetes mellitus tipo 2.Métodos: Se realizó un ensayo clínico que involucró a 63 pacientes con diabetes mellitus tipo 2, 36 pacientes asignados al grupo de intervención (G1) y 27 en el grupo control (G2). Para el G1 se llevó a cabo una intervención de asistencia telefónica que correspondía a cuatro llamadas telefónicas que abordan: la planificación de comidas, tipos y porciones de comida y la comida sana. Para G2, se llevó a cabo la atención habitual en sus unidades. Los efectos de la asistencia telefónica en la dieta sana se midieron al inicio del estudio (T1) y después de la intervención (T2) en cuatro meses.Resultados: En  G1, 16 (44,44%) pacientes se unieron en T1, disminuyendo para 14 (38.88%) en T2. En el  G2, 08 (29,62%) pacientes se unieron en T1 y aumentó a 09 (33,33%) en T2. Hubo un aumento del consumo de frutas y verduras, reducción el consumo de alimentos ricos en grasas y alta en la tasa de azúcar, así como un aumento en el fraccionamiento de las comidas después de la intervención en G1. Hubo una diferencia significativa en la reducción de los niveles de glucosa en ayuno en los pacientes no adherentes y em la reducción de Hb1Ac entre los pacientes adherente G1.Conclusión: Los efectos de la asistencia telefónica después de la intervención de cuatro meses resultó insuficiente para aumentar la adherencia a una alimentación sana, pero observó un aumento del consumo de frutas y verduras y la disminución del consumo de alimentos ricos en grasas y alto contenido de azúcar y refrescos. Objective: To verify the effects of telephone support on adherence to healthy eating practices among patients with type 2 diabetes mellitus. Methods: This was a clinical trial with 63 patients with type 2 diabetes mellitus; 36 patients were allocated to the intervention group (G1) and 27 patients to the control group (G2). For G1, telephone support was provided, consisting of four telephone calls addressing food planning, types and portions of food, and healthy foods. For G2, normal care was given in their health facility. The effects of telephone support on healthy eating were measured at baseline (T1) and at four months after the intervention (T2).Results: In G1, 16 (44.44%) patients joined at T1, which dropped to 14 (38.88%) by T2. In G2, 8 (29.62%) patients started at T1 and the number rose to 9 (33.33%) by T2. After the G1 intervention, there was an increase in the consumption of fruits and vegetables, a reduction in the consumption of fatty foods and foods high in sugar, and an increase in meal frequency. A significant difference was noted in reduced fasting blood glucose among non-adherent patients and reduced Hb1Ac among adherent patients from G1. Conclusion: The four-month intervention using telephone support proved insufficient to increase adherence to healthy eating. However, there was an increase in consumption of fruits and vegetables and a decrease in the consumption of fatty foods, foods high in sugar, and soft drinks. Objetivo: Verificar os efeitos do suporte telefônico na adesão á prática de uma alimentação saudável de pacientes com diabetes mellitus tipo 2. Métodos: Tratou-se de um ensaio clínico do qual participaram 63 pacientes com diabetes mellitus tipo 2, sendo 36 pacientes alocados para o grupo intervenção (G1) e 27 para o grupo controle (G2). Para o G1, foi conduzida uma intervenção de suporte telefônico que correspondeu a quatro ligações telefônicas abordando: planejamento alimentar, tipos e porções de alimentos e alimentos saudáveis. Para o G2, foi conduzido o cuidado usual em sua unidade de saúde. Os efeitos do suporte telefônico na alimentação saudável foram medidos no início (T1) e após a intervenção (T2) em quatro meses.Resultados: No G1, 16 (44,44%) pacientes aderiram no T1, diminuindo para 14 (38,88%) no T2. No G2, 08 (29,62%) pacientes aderiram no T1 e aumentou para 09 (33,33%) no T2. Houve aumento do consumo de frutas, verduras e legumes, redução do consumo de alimentos gordurosos e ricos em açúcar além de aumento no fracionamento das refeições após a intervenção no G1. Observou-se diferença significativa na redução da glicemia de jejum entre os pacientes não aderentes e na redução da Hb1Ac entre os pacientes aderentes do G1. Conclusão: Os efeitos do suporte telefônico após a intervenção de quatro meses mostrou-se insuficiente para aumentar a adesão à alimentação saudável, porém observamos o aumento de consumo de frutas, verduras e legumes e diminuição do consumo de alimentos gordurosos e ricos em açúcar e refrigerantes.

1715-P: Identifying Potentially Functional Variants in Regulatory Regions in KCNQ1 that Associate with Type 2 Diabetes in American Indians

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 1715-P
Author(s):  
YUNHUA L. MULLER ◽  
SAMANTHA E. DAY ◽  
SAYUKO KOBES ◽  
WILLIAM C. KNOWLER ◽  
ROBERT L. HANSON ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
American Indians ◽  
Regulatory Regions ◽  
Functional Variants

1709-P: Assessing the Role of 211 “Established” Type 2 Diabetes Variants in American Indians

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 1709-P
Author(s):  
ROBERT L. HANSON ◽  
LAUREN E. WEDEKIND ◽  
WEN-CHI HSUEH ◽  
SAYUKO KOBES ◽  
LESLIE J. BAIER ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
American Indians
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