Diet and physical activity patterns of Lakota Indian adults

Change in physical activity, food choices and hemoglobin A1c among American Indians and Alaska Natives with type 2 diabetes

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At baseline, physically active participants with higher healthy food scores had lower HbA1c levels than non-active participants.

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Over the three-year period, women who increased physical activity and/or healthy food consumption had slightly decreased HbA1c.

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Changes in physical activity and HbA1c differed by gender.

The prevalence of diabetes among American Indian and Alaska Native (AI/AN) adults is the highest of all United States racial/ethnic groups. Health behaviors, including regular physical activity and healthy food choices, are important components in the management of diabetes. We estimated the cross-sectional association between physical activity and healthy food scores, separately, and combined (PAHF) with hemoglobin A1c (HbA1c) over three years of the Special Diabetes Program for Indians-Healthy Heart demonstration project (SDPI-HH) intervention. The relationship between physical activity and food choices was also examined. Among 3,039 SDPI-HH participants at baseline, those reporting being physically active and having high healthy food scores had statistically significant lower HbA1c (mean = 7.67 ± 2.01) compared to inactive participants with low healthy food scores (7.90 ± 1.92). Among the 1,150 SDPI-HH participants who attended the three-year follow-up visit, participants who increased physical activity, consumption of healthy foods, or both had a larger decrease in HbA1c (β = -0.29, P = 0.03) over the study period compared to participants with no improvement in physical activity or increase in consuming healthy foods. This association was statistically significant among women (β = -0.35, P = 0.04) but not among men (β = -0.08, P = 0.70). Our findings indicated that an increase in healthier behaviors, including physical activity and healthy food choices, was associated with a small improvement in HbA1c in the subset of women who participated in the SDPI-HH through the three-year follow up. Although the decrease in HbA1c was small, physical activity and healthy food choices are important behaviors to incorporate into everyday life among AI/AN adults, particularly those with diabetes.

Barriers and facilitators to being physically active on a rural U.S. Northern Plains American Indian reservation

The objective of the present study was to identify barriers to and facilitators of physical activity among American Indian adults living on a rural, U.S. Northern Plains reservation using the nominal group technique (NGT). NGT is a method of data generation and interpretation that combines aspects of qualitative (free generation of responses) and quantitative (systematic ranking of responses) methodologies. Adults participated in one of two NGT sessions asking about either barriers to (n = 6), or facilitators of (n = 5), being physically active. Participants nominated and ranked 21 barriers and 18 facilitators. Barriers indicated lack of knowledge of how to fit physical activity into a daily schedule, work, caring for family members, and prioritizing sedentary pursuits. Other responses included environmental barriers such as lack of access and transportation to a gym, unsafe walking conditions, and inclement weather. Facilitators to following recommendations included knowledge of health benefits of physical activity and the perception of physical activity as enjoyable, including feeling good when working out. Environmental facilitators included being outdoors walking and biking as well as parks and exercise facilities. Responses provided direction for locally designed community-based programs to promote facilitators and decrease barriers to individual's engagement in physical activity.

Modifiable cardiovascular disease risk factors among indigenous populations

Objective. To identify modifiable cardio-metabolic and lifestyle risk factors among indigenous populations from Australia (Aboriginal Australians/Torres Strait Islanders), New Zealand (Māori), and the United States (American Indians and Alaska Natives) that contribute to cardiovascular disease (CVD). Methods. National health surveys were identified where available. Electronic databases identified sources for filling missing data. The most relevant data were identified, organized, and synthesized. Results. Compared to their non-indigenous counterparts, indigenous populations exhibit lower life expectancies and a greater prevalence of CVD. All indigenous populations have higher rates of obesity and diabetes, hypertension is greater for Māori and Aboriginal Australians, and high cholesterol is greater only among American Indians/Alaska Natives. In turn, all indigenous groups exhibit higher rates of smoking and dangerous alcohol behaviour as well as consuming less fruits and vegetables. Aboriginal Australians and American Indians/Alaska Natives also exhibit greater rates of sedentary behaviour. Conclusion. Indigenous groups from Australia, New Zealand, and the United States have a lower life expectancy then their respective non-indigenous counterparts. A higher prevalence of CVD is a major driving force behind this discrepancy. A cluster of modifiable cardio-metabolic risk factors precede CVD, which, in turn, is linked to modifiable lifestyle risk factors.

Associations between body mass index, cardiorespiratory fitness, metabolic syndrome, and impaired fasting glucose in young, urban native american women

BACKGROUND

To investigate the baseline associations between body composition, cardiorespiratory fitness, physical activity, family history of type 2 diabetes, metabolic syndrome and impaired fasting glucose (IFG) among 200 asymptomatic urban Native American women aged 18-40 years participating in a diabetes prevention intervention.

METHODS

Participants without diabetes who self-identified as Native American were recruited from the general urban community into a randomized controlled trial. Inclusion criteria included not being pregnant and willingness to stay in the urban area for 2 years. From June 2002 to June 2004, baseline measures were taken and included fasting serum glucose, insulin, and lipids, body mass index (BMI), waist circumference, percent body fat, submaximal predicted cardiorespiratory fitness, and self-reported leisure physical activity and family history of type 2 diabetes.

RESULTS

Most participants were overweight or obese (mean BMI = 29.4 +/- 6.3 kg/m(2); mean percent body fat = 41.2% +/- 6.2%). Fifty-five (27.5%) had metabolic syndrome and 42 (21%) had IFG. Stepwise logistic regression indicated that BMI (odd ratio [OR] = 1.24; p < 0.001) and a family history of type 2 diabetes (OR = 4.96; p = 0.008) were significantly associated with metabolic syndrome. BMI (OR = 1.13; p = 0.003) was strongly positively associated with IFG. After adjusting for BMI, age (OR = 1.08; p = 0.021) was positively, and high-density lipoprotein cholesterol (HDL-C; OR = 0.93; p = 0.008) and cardiorespiratory fitness (OR = 0.36; p = 0.046) were inversely significantly associated with IFG.

CONCLUSIONS

BMI, cardiorespiratory fitness, and physical activity levels are important variables to modify when attempting to reduce the prevalence of metabolic syndrome and IFG among young, asymptomatic Native American women. This information can be used to design effective diabetes prevention interventions.

Changes in the acquisition and consumption of food plants and their relationship with indigenous perceptions of health in a Guarani village, São Paulo, Brazil

Objective

The present study investigated Guarani village interviewees’ diet changes over time, their perceptions about the changes and the effects of these changes on their health.

Design

The study employed qualitative methods with a sample of Guarani Indians selected by snowball sampling. Ethnographic methods and techniques included field diaries, informal and unstructured interviews and participant observation.

Setting

The Tenondé Porã Guarani village is located in the district of Parelheiros, São Paulo, Brazil. Interviews were conducted from July 2008 to December 2009.

Subjects

Fifteen Guarani Indians, males and females in age categories ranging from youths to elders, took part in the study.

Results

The interviewees reported changes in how food was obtained, the occurrence of food substitutions and food species abandonment, recipe changes and the introduction of new foods. Some ritual use of plants was maintained. Disease frequency was found to increase because of this change and a lack of obedience to Nhanderu (the Guarani God). A lack of space for daily traditional activities (e.g. farming, hunting) was found to result in sedentary lifestyles.

Conclusions

The village location was a key factor in the Guarani diet change, although some rituals related to available plants were preserved.

Urban inequities; urban rights: a conceptual analysis and review of impacts on children, and policies to address them

This paper explores current conceptual understanding of urban social, environmental, and health inequality and inequity, and looks at the impact of these processes on urban children and young people in the 21st century. This conceptual analysis was commissioned for a discussion paper for UNICEF's flagship publication: State of the World's Children 2012: Children in an Urban World. The aim of the paper is to examine evidence on the meaning of urban inequality and inequity for urban children and young people. It further looks at the controversial policies of targeting "vulnerable" young people, and policies to achieve the urban MDGs. Finally, the paper looks briefly at the potential of concepts such as environment justice and rights to change our understanding of urban inequality and inequity.

Physical activity and fruit and vegetable intake among American Indians

The American Indian population has among the highest rates of obesity in the United States. Thus, it is critical to understand factors related to this epidemic (e.g., physical activity, nutrition) among this ethnic minority population. The current study examined factors related to engaging in at least 4 days of physical activity (PA) per week and factors related to consuming at least 5 fruits and vegetables (FV) per day among a sample of American Indians in the Midwest. We used multiple methods to recruit participants for this study, including recruitment at pow wows, focus groups, health fairs, new student orientation for American Indian students, and other venues. A total of 998 American Indians (76% participation rate) completed a survey assessing sociodemographics, physical activity level, fruit and vegetable intake, and perceptions regarding the recommendations for physical activity and fruit and vegetable intake. Factors associated with exercising ≥4 days in the past week (44.77% of the sample) include being younger (P = .002), being male (P < .001), having at least some college education (P = .048), eating ≥5 FV per day, and higher perceived number of days of PA recommended (P < .001). Factors associated with eating ≥5 servings of FV per day (37.01% of the sample) included exercising ≥4 days in the past week (P < .001) and higher perceived number of servings of FV recommended (P < .001). These findings highlight the importance of education in enhancing engagement in positive weight control behaviors and the importance of addressing both physical activity and nutrition among the American Indian population.

Food-related environmental, behavioral, and personal factors associated with body mass index among urban, low-income African-American, American Indian, and Caucasian women

PURPOSE

To examine racial/ethnic differences in relationships between food-related environmental, behavioral and personal factors and low-income women's weight status using Social Cognitive Theory (SCT) as a framework.

DESIGN

Cross-sectional survey.

SETTING

Community sites and low-income housing developments in the Twin Cities metropolitan area.

SUBJECTS

Low-income African-American, American Indian, and Caucasian women ≥18 years old (n  =  367).

MEASURES

Participants completed a survey including demographic, food security, and theoretically based questions. Heights and weights were measured to determine body mass index (BMI).

ANALYSIS

Data were split by race/ethnicity and reduced by examining Pearson coefficients for SCT survey questions significantly correlated with BMI (p < .05). Separate environmental, behavioral, and personal multiple linear regression models for each racial/ethnic group were run to explore the proportion of variance in BMI explained by each SCT construct and which questions were significant predictors.

RESULTS

All regression models were statistically significant, although the personal regression models predicted the greatest proportion of the variance in BMI for African-American (15% of the variance), American Indian (22% of the variance), and Caucasian women (37% of the variance).

CONCLUSION

Effective nutrition education and intervention efforts to control the obesity epidemic among urban, low-income women may call for a tailored approach with noted consideration of their racial/ethnic identity. Although broader changes to the food environment are necessary, the importance of addressing personal factors such as nutrition knowledge, self-efficacy, and emotional coping responses to stress, in the context of income constraints, food insecurity, and health beliefs, is also implicated.

Assessing health status, behavioral risks, and health disparities in American Indians living on the northern plains of the U.S

OBJECTIVE

We assessed health status and behavioral risks in American Indians (AIs) from rural, northern plains reservation communities.

METHODS

AI interviewers from the communities administered the core and optional modules of the Behavioral Risk Factor Surveillance System (BRFSS) to 404 AI adults randomly selected from housing lists from four AI tribal communities located on the northern plains of the U.S. The BRFSS interview assessed several health functioning areas including medical conditions, preventive screenings, and behavioral risks. We measured health disparities by comparing the AI sample data with a northern plains statewide (North Dakota) sample and a U.S. national sample. We compared outcomes with BRFSS statewide (North Dakota) and U.S. national data from telephone-based interviews.

RESULTS

AI participants showed a significantly greater prevalence of diabetes, coronary heart disease, myocardial infarction, smoking, obesity, and heavy alcohol use than either the regional or national samples. They also reported being less likely to engage in leisure-time physical activity and to have had age-appropriate preventive screenings for several diseases including colorectal cancer, prostate cancer, breast cancer, and cardiovascular disease.

CONCLUSIONS

Face-to-face interviews conducted by AI community members are an effective means of gathering health information about AIs living in rural, reservation communities. AIs living in these communities on the northern plains have a much higher prevalence of many health-risk behaviors and some medical conditions than are found in the general population. Improved health-care access, better preventive screenings, and culturally appropriate community-based health promotion programs and policies should be examined as possible ways to reduce health disparities.

The medicine wheel nutrition intervention: a diabetes education study with the Cheyenne River Sioux Tribe

OBJECTIVE

The Northern Plains Indians of the Cheyenne River Sioux Tribe have experienced significant lifestyle and dietary changes over the past seven generations that have resulted in increased rates of diabetes and obesity. The objective of this study was to determine if Northern Plains Indians with type 2 diabetes mellitus who are randomized to receive culturally adapted educational lessons based on the Medicine Wheel Model for Nutrition in addition to their usual dietary education will have better control of their type 2 diabetes than a nonintervention, usual care group who received only the usual dietary education from their personal providers.

DESIGN

A 6-month, randomized, controlled trial was conducted January 2005 through December 2005, with participants randomized to the education intervention or usual care control group. The education group received six nutrition lessons based on the Medicine Wheel Model for Nutrition. The usual care group received the usual dietary education from their personal providers.

PARTICIPANTS

One hundred fourteen Northern Plains Indians from Cheyenne River Sioux Tribe aged 18 to 65 years, with type 2 diabetes.

METHODS

Weight, body mass index (BMI), hemoglobin A1c, fasting serum glucose and lipid parameters, circulating insulin, and blood pressure were measured at the beginning and completion. Diet histories, physical activity, and dietary satiety surveys were measured at baseline and monthly through completion. Differences were determined using Student t tests, chi(2) tests, and analysis of variance.

RESULTS

The education group had a significant weight loss (1.4+/-0.4 kg, P<or=0.05) and decrease in BMI (1.0+/-0.1, P<or=0.05) from baseline to completion. The usual care group had no change in weight (0.5+/-0.5 kg) or BMI (0.5+/-0.2). There were no between group differences due to intervention in energy, carbohydrate, protein, and fat intake and physical activity.

CONCLUSIONS

The culturally based nutrition intervention promoted small but positive changes in weight. Greater frequency and longer duration of educational support may be needed to influence blood glucose and lipid parameters.

Physical activity patterns of American Indian and Alaskan Native people living in Alaska and the Southwestern United States

PURPOSE

Assessment of self-reported physical activity (PA) and effects on health measures.

DESIGN

Cross-sectional analysis of baseline data from a cohort study.

SETTING

Education and Research Towards Health study participants from Alaska and the Southwestern United States enrolled from 2004 to 2007.

SUBJECTS

Total of 10,372 American Indian and Alaskan Native people (AI/AN) of at least 18 years.

MEASURES

Participants completed computer-assisted, self-administered questionnaires, and anthropometric and health measurements were taken of each participant.

ANALYSIS

Analysis of variance, chi2 tests, and multiple linear regressions were used.

RESULTS

Almost 23% of participants reported less than 30 minutes per week of moderate or vigorous activities. Half (49%) reported no vigorous activities. Characteristics associated with more time spent performing vigorous activity were male gender, age less than 40 years, higher income and education levels, and living in a rural area. Almost 70% of Alaskan participants and 36% of Southwest participants engaged in wild food-harvesting activities. Participants with higher levels of activity had significantly better clinical characteristics (high-density lipoprotein cholesterol, triglycerides, body mass index, and waist circumference).

CONCLUSION

AI/AN people engage in many different physical activities, including traditional harvesting activities. Women had lower levels of PA than men, and participation in vigorous PA was associated with better clinical characteristics. These data can be used to guide health promotion efforts in AI/AN populations.

[Physical activity among aboriginals in Canada]

This paper summarizes available information on patterns of physical activity, their determinants and consequences, and the results of various interventions designed to increase the physical activity of Aboriginal peoples in Canada and the United States. There is a paucity of national data on this issue for Aboriginal peoples. The most recent data, from the First Nations Regional Longitudinal Health Survey of 2002-2003, indicate that 21% of adults (27% of men, 15% of women) were engaging in at least 30 min of moderate to vigorous physical activity on 4 d/week or more. The present paper highlights the unique challenges this group faces, underlining the need to integrate collective knowledge regarding how much physical activity is required for Aboriginal Canadians, and how this activity should be accomplished, to promote and maintain health. Efforts are currently underway to tailor Canada's physical activity guide for First Nations, Inuit, and Métis. Future research among Aboriginal groups should examine the minimal and optimal levels of physical activity required to achieve health benefits.

The metabolic syndrome in American Indians: the strong heart study

Although the underlying cause of the metabolic syndrome (MS) is not entirely clear, it is thought that MS results from central obesity and insulin resistance (IR). IR has long been known to be a predictor of type 2 diabetes in many populations, including American Indians, the group with a rising prevalence of obesity and the highest rate of diabetes in the United States. In addition to being a predictor of diabetes, MS has now been shown to be associated with higher risk of cardiovascular disease, independent of diabetes, in American Indians as well as in other ethnic groups. Furthermore, MS may carry a risk beyond that of single risk factors. Identifying MS in American Indians and treating the factors that comprise it may reduce risk of both diabetes and cardiovascular disease in this population.

Reducing diabetes risk in American Indian women

BACKGROUND

American Indians experience high rates of type 2 diabetes. The impact of low-intensity interventions on diabetes risk among young American Indian women is unknown.

DESIGN

Randomized controlled trial.

SETTING/PARTICIPANTS

Community-based; participants were 200 young urban American Indian women who were block-randomized on fasting blood glucose (FBG) into intervention and control groups. Inclusion criteria included self-reported identity, aged 18-40 years, not pregnant, willingness to stay in urban area for 2 years, and not having type 2 diabetes. Measures were taken at baseline, 6, 12, and 18 months. Data were gathered in 2002-2006 and analyzed in 2006-2007.

INTERVENTION

Five discussion group sessions (one meeting per month for 5 months) were held focusing on healthful eating, physical activity, goal-setting, and social support.

MAIN OUTCOME MEASURES

Primary outcomes included dietary fat and vegetable consumption and self-reported physical activity. Secondary outcomes included cardiorespiratory fitness, insulin sensitivity, blood pressure, lipid profiles, percent body fat, BMI, intake of fruit, total sugar and sweetened beverages, FBG, and television viewing.

RESULTS

Mean vegetable and fruit intake increased significantly more in the intervention group than in the control group over time (group by visit interaction, p=0.02 and p=0.002, respectively). Both groups had significant increases in percent body fat and decreases in waist circumference, insulin sensitivity, blood cholesterol, LDL, television viewing, and total intakes of energy, saturated fat, sugar, and sweetened beverages.

CONCLUSIONS

A culturally influenced, low-intensity lifestyle intervention can improve self-reported intakes of vegetables and fruit over 18 months in young, urban American Indian women.

Physical activity of Aboriginal people in CanadaThis article is part of a supplement entitled Advancing physical activity measurement and guidelines in Canada: a scientific review and evidence-based foundation for the future of Canadian physical activity guidelines co-published by Applied Physiology, Nutrition, and Metabolism and the Canadian Journal of Public Health. It may be cited as Appl. Physiol. Nutr. Metab. 32(Suppl. 2E) or as Can. J. Public Health 98(Suppl. 2)

This paper summarizes available information on patterns of physical activity, their determinants and consequences, and the results of various interventions designed to increase the physical activity of Aboriginal peoples in Canada and the United States. There is a paucity of national data on this issue for Aboriginal peoples. The most recent data, from the First Nations Regional Longitudinal Health Survey of 2002–2003, indicate that 21% of adults (27% of men, 15% of women) were engaging in at least 30 min of moderate to vigorous physical activity on 4 d/week or more. The present paper highlights the unique challenges this group faces, underlining the need to integrate collective knowledge regarding how much physical activity is required for Aboriginal Canadians, and how this activity should be accomplished, to promote and maintain health. Efforts are currently underway to tailor Canada’s physical activity guide for First Nations, Inuit, and Métis. Future research among Aboriginal groups should examine the minimal and optimal levels of physical activity required to achieve health benefits.

Low-income American Indians' perceptions of diabetes

OBJECTIVE

To determine inner city American Indians' perceptions of diabetes; find out how they manage their disease; and identify what health care improvements may be necessary for this population.

DESIGN

Eight focus group discussions conducted with diabetic inner city American Indian adults.

SETTING

Focus group discussions led by moderator using open-ended questions with prompts.

PARTICIPANTS

Eligibility criteria include age (> or = 18 years), a self-reported diagnosis of diabetes, and self-identification as inner city American Indian. Participants were screened by telephone to ensure all criteria were met. Forty inner city American Indian men and women participated in 8 focus groups.

PHENOMENON OF INTEREST

American Indians' perception of diabetes, its treatment, and how they manage the disease.

ANALYSIS

Focus group discussions were tape recorded and transcribed verbatim. Transcripts were analyzed by coding responses and identifying common themes according to content analysis procedures. Quantitative data from self-administered demographic forms were analyzed.

RESULTS

Participants could verbalize information regarding treatment and management of diabetes, but few could apply this information to their own lives. Some participants were homeless or without insurance, which makes successful disease management difficult. Perceptions of the health care system varied; a majority felt the system was meeting their needs, whereas others said it was not adequate.

IMPLICATIONS FOR RESEARCH AND PRACTICE

The study identified the need for health care workers to develop a better understanding of how this population lives; doing so could improve patient compliance to treatment. The results may provide direction for the development of culturally specific diabetes education appropriate for low-income patients focusing on the diabetic diet and exercise, and suggesting ways that the patient can move from knowing the information to implementing behavior change.

Physical activity and Native Americans: a review

The physical activity behaviors of Native-American populations in the United States and Canada have received little attention in the health literature. The purpose of this review was to unite the literature regarding the physical activity behaviors of Native Americans. A majority of the literature was obtained using online databases. Reference lists were also reviewed to gain further access to the literature. Key-word searches included various combinations of Aboriginal, Native Indian, American Indian, Native American, First Nation, Métis, or Alaska Native with physical activity, exercise, and health behavior. Articles included were those published in English-language, peer-reviewed journals from 1990 until November 2005 that focused on participants aged 18 years and older. This review is organized according to ecologic models of health behavior, which take into account several correlates to explain human behavior, including demographic, personal health, environmental, and psychosocial. Correlates were included if they appeared at least three times in the literature. As a result of these inclusion criteria, the number of reviewed articles includes 28 quantitative, 4 qualitative, and 3 intervention studies. Results indicate that age, gender, and social support are important factors associated with physical activity. The remaining correlates show inconsistent or indeterminate results due in part to the paucity of research. It is suggested that an increase in the number of studies, especially those using longitudinal designs, is needed. Further, the application of psychosocial models to understand physical activity motivations as well as culturally appropriate and validated measurement tools are largely absent in the Native-American physical activity literature.

Fitness, dietary intake, and body mass index in urban Native American youth

This study investigated correlations among physical fitness, dietary intakes, activity levels, and body mass index (BMI) for 155 urban Native American youth, ages 5 to 18 years. Heights, weights, skinfold measurements, activity level, balance times, and dietary intakes were assessed. Presidential Physical Fitness (PPF) testing was completed with 82 youth. Age groups were examined for differences in energy and macronutrient intake, sedentary activities, activity level, and PPF achievement. Pearson and Spearman rho correlations were examined among dietary intakes, fitness, balance, and activity levels. The majority of youth (63%) were at risk for overweight or already overweight, and 59% were sedentary. BMI was correlated with age and PPF achievement for all youth, and with physical activity and frequency of television viewing for youth ages 9 to 18 years. No correlation was found between dietary intake and activity level. Culturally appropriate interventions for obesity should start early, focusing on decreasing sedentary activity and increasing opportunities for fitness.

Environmental, policy, and cultural factors related to physical activity in sedentary American Indian women

Focus group interviews were conducted to explore sociocultural, environmental, and policy-related determinants of physical activity among sedentary American Indian women. Thirty women aged 20 to 50 years (mean = 37.4 +/- 10.6 years) participated. Three sessions were conducted with women aged 20 to 34 years and three with women aged 35 to 50 to evaluate response differences by age. Because no obvious age differences were observed, data were pooled. Barriers to physical activity included inadequate support for household and child care responsibilities and difficulties balancing home-related and societal expectations with physical activity. In addition, women reported little support from their communities and work sites to be physically active. Environmental barriers included lack of safe outdoor areas and accessible walking trails. Weather and stray dogs were also commonly mentioned. Sociocultural barriers included giving family obligations priority above all other things, being expected to eat large portions of high-fat foods, and failing to follow a traditionally active lifestyle. Enablers of physical activity included support from family and coworkers and participation in traditional community events. Suggested intervention approaches included accessible and affordable programs and facilities, community emphasis on physical activity, and programs that incorporated the needs of larger women and of families. Participants emphasized a preference for programs that were compatible with the role expectations of their families and communities, and they expressed the desire for acceptance and encouragement to be physically active from the family, the community, the worksite, and their tribal leaders.

Obesity correlates with increased blood pressures in urban Native American youth

Although obesity is a growing problem with Native American youth living on reservations, little research has been conducted examining the prevalence of obesity and correlations between age, body composition, dietary intake, and blood pressures (BP) for urban Native youth. The purpose of this study was to investigate the relationship of these variables in urban Native American youth. Height and weight were measured for 155 Native American youth, age 5-18 years, and the body mass index (BMI) was calculated and classified into percentile categories. Skinfold thicknesses at the biceps, triceps, suprailiac, and subscapular sites, arm and waist circumferences, and systolic (SBP) and diastolic (DBP) blood pressures were also measured. There was a high proportion of obesity (>95 percentile) for youth in all age groups. The prevalence was 38% for the 5-10-year-olds and 45% for the 11-18-year-olds youth. There were no significant correlations between SBP and DBP and dietary variables. Mean SBP and DBP increased with increasing BMI percentiles. Stepwise regression analyses showed that waist circumference, age, and BMI were strong predictors for SBP, while waist circumference and age were predictors for DBP in the total sample. The findings suggest that overweight/obesity is very prevalent among urban Native American youth and the increased adiposity is associated with increased SBP and DBP.

Sociodemographic diversity and behavioral medicine

The broad array of economic and cultural diversity in the U.S. population correlates with and impacts on the study of behavioral aspects of health. The purpose of this article was to provide a selective overview of behavioral medicine research on sociodemographically diverse populations, with a focus on ethnicity, gender, and socioeconomic status. Suggestions are provided with regard to methodological refinement of research and insights into possible future directions in behavioral medicine research on ethnically and economically diverse populations.

Correlates of physical activity among women from diverse racial/ethnic groups

OBJECTIVE

Women have lower rates of participation in leisure time physical activity than men and have been studied to a lesser extent than men. Because physical activity plays a vital role in overall health, it is important to identify factors than can help increase physical activity rates for women.

METHODS

Defining and understanding correlates of physical activity is critical for at-risk populations and for planning effective interventions. This paper reviews research conducted in the past two decades on correlates of physical activity in women. An ecological model with an added physical environment component was used to organize the correlates. Studies conducted among adult white, black, American Indian, Asian, and Hispanic women are included. A total of 91 studies were reviewed. Many studies included white women, fewer studies included black and Hispanic women, and even fewer included American Indian women, and only 3 studies included Asian women.

RESULTS

The correlates most studied are sociodemographic variables, with nonwhite race, lower educational levels, and older age most consistently associated with lower levels of physical activity. Few studies focused on environmental and policy correlates. Social support was an overwhelmingly positive determinant of physical activity for all groups of women.

CONCLUSIONS

Based on these findings, we recommend that future research include more diverse groups of women and evaluate modifiable factors, such as psychological, interpersonal, and environmental correlates. Future research also should include more intervention and longitudinal studies.

Geographic variation in cardiovascular disease risk factors among American Indians and comparisons with the corresponding state populations

OBJECTIVES

(1) To compare the prevalence of self-reported CVD, diabetes, hypertension, fair/poor perceived health status, and current tobacco use from three surveys of American Indians - two in the Southeast (Catawba Diabetes and Health Survey [CDHS] and Lumbee Diabetes and Health Survey [LDHS]) and one in the upper Midwest (Inter-Tribal Heart Project [ITHP]). (2) To compare the prevalence estimates from the CDHS, LDHS, ITHP with those for the corresponding state populations (South Carolina, North Carolina, Minnesota and Wisconsin, respectively) derived from the Behavioral Risk Factor Surveillance System (BRFSS).

METHODS

Pearson's Chi-square analyses were used to detect statistically significant differences in the age-adjusted prevalence estimates across the study populations.

RESULTS

Among these three populations of American Indians, the ITHP participants had the highest prevalence estimates of diabetes (20.1%) and current cigarette smoking (62.8%). The CDHS participants had the highest prevalence estimate of fair/poor perceived health status (32.0%). The LDHS participants had the highest prevalence estimate of chewing tobacco use (14.0%), and the lowest prevalence of CVD. The prevalence estimates of self-reported diabetes were dramatically higher among American Indian participants in the ITHP (20.1%) and CDHS (14.9%) than among participants in the corresponding state BRFSS (5.8% MN and WI and 6.6% SC), as were the estimates for hypertension.

CONCLUSION

The substantial variations in prevalence of CVD and its risk factors among Tribal Nations suggests that distinct cultural norms, historic conditions, and important health issues of each American Indian community must be recognized and incorporated into all health promotion programs and policies.