Exploring Food Insecurity as a Social Determinant of Health Among American Indian and Alaska Native Adolescents at Risk for Gestational Diabetes

探索粮食不安全作为美洲印第安人和阿拉斯加土著青少年面临妊娠糖尿病风险的健康社会决定因素

• 批准号: 10495335
• 负责人: Sarah A Stotz
• 金额: $ 22.93万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-25 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10495335
• 关键词: Address; Adolescent; Affect; Age; Akwesasne Mohawk Nation; Alaska Native; American Indians; Area; Behavior; Blood Glucose; Body mass index; Characteristics; Communities; Community Health; Counseling; Data; Data Analyses; Data Set; Daughter; Development; Diabetes Mellitus; Diabetes prevention; Diagnosis; Dietitian; Eating; Eating Behavior; Enrollment; Environmental Pollution; Evaluation; Evidence based program; Face; Family Planning; Female; Female Adolescents; Food; Funding; Gestational Diabetes; Habits; Health Food; Health Personnel; Healthy Eating; Household; Individual; Intervention; Interview; Knowledge; Life; Measures; Methodology; Methods; Mothers; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Obesity; Outcome; Physical activity; Poverty; Pregnancy; Pregnancy Complications; Program Effectiveness; Public Health; Qualitative Methods; Randomized Controlled Trials; Recording of previous events; Reduce health disparities; Research; Research Design; Risk; Risk Factors; Risk Reduction; Risk Reduction Behavior; Saints; Self Efficacy; Site; System; Teleconferences; Telephone; Testing; United States Indian Health Service; United States National Institutes of Health; Voice; Water; Weight Gain; Weight maintenance regimen; Woman; Work; base; experience; follow-up; food insecurity; food security; girls; good diet; health disparity; high risk; innovation; intergenerational; member; minority health disparity; obesity prevention; perinatal complications; program dissemination; programs; recruit; reproductive; secondary analysis; social health determinants; stakeholder perspectives; theories

PROJECT SUMMARY / ABSTRACT American Indian and Alaska Native (AI/AN) women are twice as likely to have gestational diabetes mellitus (GDM) and subsequent diagnosis of type 2 diabetes as non-Hispanic White females. GDM and obesity can cause severe perinatal complications for both mother and baby. Weight management through healthy diet and physical activity are key factors in decreasing risk for GDM. However, there are barriers to healthful eating in many AI/AN communities. Food insecurity, defined as the lack of consistent access to enough food for an active, healthy life, is a risk factor for unwanted weight gain. Living in a food insecure household during preconception and pregnancy may increase risk of greater weight gain and perinatal complications for both mother and baby. Our team recently developed and conducted a randomized controlled trial evaluation of an innovative GDM risk reduction and preconception counseling program for AI/AN adolescent girls who are at high risk for GDM. This tribally-supported, online, theory-and evidence-based program, entitled Stopping GDM, focuses on healthy GDM risk reduction behaviors, such as weight management, through healthy eating and physical activity, prior to pregnancy. Our formative findings from this work suggest that AI/AN women view food insecurity as a key barrier to healthful eating, both before and during pregnancy. Currently, however, Stopping GDM does not specifically address food insecurity as a content area of focus. In this proposed project, we will employ a mixed-methods study design to examine the relationship between food insecurity with healthy eating self-efficacy and behaviors among AI/AN adolescent girls (n=149) through secondary analysis of the existing Stopping GDM dataset. We hypothesize that AI/AN adolescent girls who live in food insecure households will have poorer self-efficacy for healthy eating and poorer healthy eating behaviors, both of which are related to increased risk of GDM. After this secondary quantitative data analysis, we will use qualitative inquiry through individual interview methods to engage key stakeholders to assist with the interpretation and implications of these findings. Through teleconference or phone-based interviews, we will recruit AI/AN mothers of adolescent girls, AI/AN adolescent girls, and AI/AN women with a history of GDM from the Stopping GDM trial in two collaborating AI/AN communities (Saint Regis Mohawk of Akwesasne, NY and a multi-tribal urban center in Portland, OR). Additionally, we will recruit nationwide experts on topics such as: AI/AN food insecurity, traditional AI/AN foods, traditional AI/AN food acquisition habits, and health care providers who serve AI/AN girls such as registered dietitians. Using this qualitative method we will reintroduce the voice of AI/AN community members to inform next steps in the adaptation of Stopping GDM to effectively address food insecurity as a contributor to GDM health disparities through innovative, multi-systems approaches. This work is critical to break the intergenerational cycle of diabetes in AI/AN communities, starting during the preconception period.

项目摘要 /摘要 美洲印第安人和阿拉斯加人（AI/AN）妇女患有妊娠糖尿病的可能性是 （GDM）和随后诊断为2型糖尿病为非西班牙裔白人女性。 GDM和肥胖可以 导致母亲和婴儿的严重围产期并发症。通过健康饮食管理体重 体育活动是降低GDM风险的关键因素。但是，有健康饮食的障碍 在许多人工智能/社区中。粮食不安全，被定义为无法持续获得足够的食物来实现 积极，健康的生活是体重增加的危险因素。在食物不安全的家庭中生活 牙王和怀孕可能会增加两者的体重增加和围产期并发症的风险 母亲和婴儿。我们的团队最近开发并进行了随机对照试验评估 为AI/AI/A的创新GDM降低风险和孕妇咨询计划 GDM的高风险。这个由部落支持的，在线，理论和循证计划的名为“停止GDM”， 通过健康的饮食和 体育活动，怀孕前。我们从这项工作中的形成性发现表明，ai/a妇女的观点 粮食不安全是在怀孕之前和怀孕期间成为健康饮食的关键障碍。但是，目前 停止GDM并不能专门针对粮食不安全作为关注的内容领域。在此提议中 项目，我们将采用混合方法研究设计，以研究粮食不安全感与 通过次级分析 现有的停止GDM数据集的。我们假设居住在食品不安全的青春期女孩 家庭对健康饮食和健康饮食行为的自我效能较差，这两者都将 与GDM风险增加有关。在此二次定量数据分析之后，我们将使用定性 通过个人访谈方法进行调查，以吸引关键利益相关者，以协助解释和 这些发现的含义。通过电话会议或基于电话的访谈，我们将招募AI/AN 青春期女孩，AI/一个青春期女孩的母亲和AI/AI/A AI/A A AI/A A A AI/A A AI/A A A AI/A A A AI/A AI WIMS GDM的妇女 GDM试验在两个合作的AI/A AN社区（纽约州Akwesasne的Saint Regis Mohawk和一个多部落 俄勒冈州波特兰市的城市中心。此外，我们还将在全国范围内招募专家，例如：AI/AN食品 不安全感，传统的AI/AN食品，传统的AI/A A AI/AN食品习得习惯以及医疗保健提供者 为AI/AN女孩（例如注册营养师）服务。使用这种定性方法，我们将重新引入 AI/一个社区成员，以适应停止GDM有效解决食物的下一步介绍下一步 通过创新的多系统方法，不安全感作为GDM健康差异的贡献。这项工作 对于打破AI/A/A社区中糖尿病的代际周期至关重要，从 孕前期。

项目成果

Relationship between food insecurity and a gestational diabetes risk reduction intervention: outcomes among American Indian and Alaska Native adolescent and young adult females.

• DOI: 10.1093/tbm/ibad029
• 发表时间: 2023-09-12
• 期刊: TRANSLATIONAL BEHAVIORAL MEDICINE
• 影响因子: 3.6
• 作者: Stotz, Sarah A.;Hebert, Luciana E.;Charron-Prochownik, Denise;Scarton, Lisa;Moore, Kelly R.;Sereika, Susan M.
• 通讯作者: Sereika, Susan M.