Dataset Information

Diabetes and Obesity Associated with Poor Food Environments in American Indian Communities: the Tribal Health and Resilience in Vulnerable Environments (THRIVE) Study.

ABSTRACT:

Background

American Indians (AIs) have significantly higher rates of diet-related chronic diseases than other racial/ethnic groups, and many live in environments with limited access to healthy food.

Objective

As part of the Tribal Resilience in Vulnerable Environments (THRIVE) study, we examined the relations between the perceived food environment, utilization of food retailers, fruit and vegetable intake, and chronic diseases, including obesity, hypertension, and type 2 diabetes among AI adults.

Methods

Through a community-based participatory research partnership, we surveyed a cross-sectional sample of 513 AIs living within the Chickasaw Nation and the Choctaw Nation of Oklahoma.

Results

Only 57% of participants reported that it was easy to purchase fruits and vegetables in their town, and fewer (35%) reported that available fruits and vegetables were of high quality. Additionally, over half (56%) reported traveling ?20 miles round trip to shop for food. Few participants met the recommended daily intake for fruit (44%) or vegetables (25%). Obesity (55%), hypertension (49%), and diabetes (25%) were commonly reported. Obesity was significantly higher among participants who reported that the price of fruits and vegetables were cost-prohibitive (prevalence proportion ratio (PPR): 1.24; 95% CI: 1.02, 1.50) and those who shopped frequently for food at nontraditional food retailers, such as Dollar Stores (PPR: 1.35; 95% CI: 1.08, 1.69) and small markets (PPR: 1.38; 95% CI: 1.02, 1.86). Diabetes was significantly higher among participants who frequently shopped at convenience stores/gas stations (PPR: 2.26; 95% CI: 1.22, 4.19).

Conclusions

Our study found that the use of nontraditional food retailers, including convenience stores, gas stations, and Dollar Stores, as a regular source of food was associated with obesity and diabetes. These results underscore the importance of interventions to improve rural Tribal food environments. Healthy retail interventions in nontraditional retail settings, such as those implemented through the THRIVE study, may contribute to reducing AI health disparities.

SUBMITTER: Love CV

PROVIDER: S-EPMC6700455 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Publications

Diabetes and Obesity Associated with Poor Food Environments in American Indian Communities: the Tribal Health and Resilience in Vulnerable Environments (THRIVE) Study.

Love Charlotte V CV Taniguchi Tori E TE Williams Mary B MB Noonan Carolyn J CJ Wetherill Marianna S MS Salvatore Alicia L AL Salvatore Alicia L AL Jacob Tvli T Cannady Tamela K TK Standridge Joy J Spiegel Jennifer J Jernigan Valarie Blue Bird VBB

Current developments in nutrition 20181205 Suppl 2

<h4>Background</h4>American Indians (AIs) have significantly higher rates of diet-related chronic diseases than other racial/ethnic groups, and many live in environments with limited access to healthy food.<h4>Objective</h4>As part of the Tribal Resilience in Vulnerable Environments (THRIVE) study, we examined the relations between the perceived food environment, utilization of food retailers, fruit and vegetable intake, and chronic diseases, including obesity, hypertension, and type 2 diabetes ...[more]

PMID: 31453429

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Project description:ObjectiveExplore the relationship between diabetes-related psychosocial outcomes and food stress in American Indian communities.DesignConvergence model of a mixed methods triangulation study.SettingFive American Indian reservation communities in the Midwest.ParticipantsOne-hundred ninety-two participants were randomly selected from tribal health centers using clinic patient records and were surveyed about diabetes distress, empowerment, and food stress across 4 different time points. Seventeen focus group discussions were conducted and transcribed, and a mix of purposive and convenience sampling was used.Phenomenon of interestPsychosocial outcomes associated with (or related to) diabetes and food stress.AnalysisQuantitative: Multiple linear regression was performed to explore relationships between food stress and diabetes distress and empowerment. Qualitative: Open coding of data identified portions of the transcripts related to food followed by a deductive approach on the basis of the components of quantitative food stress.ResultsFood stress in the forms of (1) not having enough money for food and not having enough time for cooking or shopping (P = 0.08) and (2) inadequate food access and being on a special diet (P = 0.032) were associated with increased diabetes distress. Lower diabetes empowerment was associated with not having enough money for food and being on a special diet (P = 0.030). Our qualitative data mirrored quantitative findings that experiencing multiple forms of food stress negatively impacted diabetes psychosocial outcomes and illuminated the cyclical role mental health can play in relationships to food.Conclusions and implicationsOur findings highlight that experiencing food stress negatively affects diabetes empowerment and diabetes distress. These findings emphasize the importance of improving community food environments and addressing individual food access for diabetes management and prevention initiatives in American Indian communities.

Project description:BackgroundMost studies on the local food environment have used secondary sources to describe the food environment, such as government food registries or commercial listings (e.g., Reference USA). Most of the studies exploring evidence for validity of secondary retail food data have used on-site verification and have not conducted analysis by data source (e.g., sensitivity of Reference USA) or by food outlet type (e.g., sensitivity of Reference USA for convenience stores). Few studies have explored the food environment in American Indian communities. To advance the science on measuring the food environment, we conducted direct, on-site observations of a wide range of food outlets in multiple American Indian communities, without a list guiding the field observations, and then compared our findings to several types of secondary data.MethodsFood outlets located within seven State Designated Tribal Statistical Areas in North Carolina (NC) were gathered from online Yellow Pages, Reference USA, Dun & Bradstreet, local health departments, and the NC Department of Agriculture and Consumer Services. All TIGER/Line 2009 roads (>1,500 miles) were driven in six of the more rural tribal areas and, for the largest tribe, all roads in two of its cities were driven. Sensitivity, positive predictive value, concordance, and kappa statistics were calculated to compare secondary data sources to primary data.Results699 food outlets were identified during primary data collection. Match rate for primary data and secondary data differed by type of food outlet observed, with the highest match rates found for grocery stores (97%), general merchandise stores (96%), and restaurants (91%). Reference USA exhibited almost perfect sensitivity (0.89). Local health department data had substantial sensitivity (0.66) and was almost perfect when focusing only on restaurants (0.91). Positive predictive value was substantial for Reference USA (0.67) and moderate for local health department data (0.49). Evidence for validity was comparatively lower for Dun & Bradstreet, online Yellow Pages, and the NC Department of Agriculture.ConclusionsSecondary data sources both over- and under-represented the food environment; they were particularly problematic for identifying convenience stores and specialty markets. More attention is needed to improve the validity of existing data sources, especially for rural local food environments.

Project description:Rationale: Exposure to inorganic arsenic, through drinking naturally-contaminated water, is an established cause of lung cancer. Evidence on the impact of arsenic exposure on lung function, however, is less conclusive. The evidence available, mostly from populations exposed to water arsenic levels >100 ?g/L, suggests that arsenic exposure is associated with lower lung function. Prospective studies and studies examining low-to-moderate levels of water arsenic exposure (<50 ?g/L) the level relevant for U.S. populations, are very limited. Objectives: We evaluated the association between chronic low-to-moderate arsenic exposure with lung function and disease in an American Indian population. Methods: The Strong Heart Study is a multicenter prospective study of cardiovascular disease and its risk factors among American Indian adults. The present analysis, in 2,166 adults, used urinary arsenic measurements at baseline (1989–1991) and lung symptoms and function assessment by standardized spirometry at the second examination (1993–1995). We evaluated associations between arsenic exposure and airflow obstruction, defined as ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) of less than 0.70, and restrictive pattern, defined as FEV1/FVC ratio greater than 0.70 and FVC less than 80% predicted; respiratory symptoms; and self-reported physician diagnosis of nonmalignant respiratory disease. Results: The prevalence of airflow obstruction between 1993 and 1995 was 21.4% (463/2,166); restrictive pattern was 14.5% (314/2,166). Median urinary arsenic concentrations were higher in participants with airflow obstruction (11.0 ?g/g creatinine) compared to those without obstruction (9.8 ?g/g creatinine), and higher in those with restrictive pattern (12.0 ?g/g) compared to those without restrictive pattern (9.4 ?g/g). The odds ratio (95% confidence interval) for obstructive and restrictive patterns comparing the 75th to 25th percentile of arsenic was 1.13 (0.96–1.32) and 1.27 (1.01–1.60), respectively, after adjustment for age, sex, education, study site, smoking status, smoking pack-year, estimated glomerular filtration rate, tuberculosis, and body mass index. Emphysema, cough 4–6 times a day, phlegm, and stopping for breath were also positively associated with arsenic. Conclusions: In this American Indian population, exposure to low-to-moderate levels of inorganic arsenic, as measured in urine, was positively associated with restrictive pattern as measured by spirometry, self-reported emphysema diagnosis, self-reported shortness of breath, and more frequent cough and phlegm among those with cough, independent of smoking status. These findings suggest that low-to-moderate arsenic exposure can contribute to nonmalignant lung disease, and may be associated with restrictive lung disease.

Dataset Information

Diabetes and Obesity Associated with Poor Food Environments in American Indian Communities: the Tribal Health and Resilience in Vulnerable Environments (THRIVE) Study.

Background

Objective

Methods

Results

Conclusions

Publications

Diabetes and Obesity Associated with Poor Food Environments in American Indian Communities: the Tribal Health and Resilience in Vulnerable Environments (THRIVE) Study.

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