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Hopkins SE, Orr E, Boyer BB, Thompson B. Culturally adapting an evidence-based intervention to promote a healthy diet and lifestyle for Yup'ik Alaska native communities. Int J Circumpolar Health 2023; 82:2159888. [PMID: 36544274 PMCID: PMC9788688 DOI: 10.1080/22423982.2022.2159888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Underserved populations are at increased risk for obesity and related cardiovascular disease, type 2 diabetes, and other chronic diseases. Lack of access to healthy foods, sedentary behaviour, and other social environmental factors contribute to disease risk. Yup'ik Alaska Native communities are experiencing lifestyle changes that are likely to affect their cardiometabolic risks. Barrera & Castro's Cultural Adaptation Framework was used to adapt an evidence-based intervention (EBI) originally designed for Latino communities for use in Yup'ik communities. Focus groups and key informant interviews were held in two Yup'ik communities. Major themes included causes of obesity, barriers and facilitators to healthy foods and physical activity, and intervention ideas. The adaptation process was guided by a Community Planning Group of Yup'ik women and included information gathering, preliminary adaptation design, preliminary adaptation tests, and adaptation refinement. Two of the adapted educational modules were pilot tested. Involving community members as co-researchers in cultural adaptation is vital for an EBI to be effective in another population. Small group gatherings led by local lay health workers are culturally appropriate and may be an effective health promotion model in Yup'ik communities. Social environmental factors affecting healthy food availability and physical activity need further exploration.
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Affiliation(s)
- Scarlett E. Hopkins
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Eliza Orr
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Bert B. Boyer
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Beti Thompson
- Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Ohle KA, Koller KR, Walch AK, Lee FR, Palmer L, Nu J, Thomas TK. Alaska Native Parents' Decision-Making About Food, Beverages, and Screen Time for Young Children: Formative Insights From the "Got Neqpiaq?" Project. FAMILY & COMMUNITY HEALTH 2023; 46:250-258. [PMID: 37703513 PMCID: PMC10502956 DOI: 10.1097/fch.0000000000000370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
With rising childhood obesity rates, ensuring children adopt healthy habits early is imperative. Given the unique context for Alaska Native families living in rural remote communities, who are concurrently experiencing changes in traditional practices, we investigated what impacts parents' decisions as they relate to daily living before revising a preschool curriculum focused on healthy habits. The objective of this study was to explore factors influencing parents' decisions about their children's foods, beverages, and activities. In focus group discussions with AN parents of young children across 12 communities, we asked about meals, traditional foods, beverages, physical activity, and screen time. All sessions were recorded, transcribed, and analyzed using open and selective coding to allow the most important themes to emerge. As parents discussed how they make decisions, several trends emerged related to adults' and children's food and beverage preferences; the impact of adult modeling on children; and how convenience, seasonality, access, and a reluctance to engage in conflict all impact decision-making. Parents and other community members shared important perspectives on exposing children to traditional subsistence foods and activities and passing important traditional knowledge to them at an early age. These perspectives will form the basis for preschool curricula in these communities.
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Affiliation(s)
- Kathryn A Ohle
- Early Childhood Education, Grand Valley State University, Grand Rapids, Michigan (Dr Ohle); Alaska Native Tribal Health Consortium, Research Services, Anchorage, Alaska (Drs Koller and Thomas and Ms Lee); Dietetics & Nutrition, University of Alaska Anchorage (Dr Walch); RurAL Cap Head Start, Anchorage, Alaska (Ms Palmer); and Center for Alaska Native Health Research, University of Alaska Fairbanks (Ms Nu)
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Risk perception, adaptation, and resilience during the COVID-19 pandemic in Southeast Alaska Natives. Soc Sci Med 2023; 317:115609. [PMID: 36525784 PMCID: PMC9734070 DOI: 10.1016/j.socscimed.2022.115609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/03/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022]
Abstract
Indigenous communities worldwide are at higher risk of negative pandemic outcomes, and communities Indigenous to the Arctic are disproportionately affected compared to national majorities. Despite this, their experiences have scarcely been investigated qualitatively and from their own perspectives. We collected and analyzed 22 structured interviews in three Southeast Alaska island communities (Sitka, Hoonah, and Kake) to learn about their perceptions of and experiences with the COVID-19 pandemic. Interviews were analyzed with thematic qualitative analysis in Dedoose. Four primary categories were identified within which to discuss risk and resilience in Southeast Alaska: (1) risk perception, (2) socioeconomic impacts, (3) reactions to public health guidelines, and (4) coping. Primary findings indicate that Southeast Alaska Native communities display considerable resilience and adaptive flexibility despite the significant adversity imposed by the COVID-19 pandemic. Southeast Alaska Native people use historical and traditional knowledge to culturally ground adaptive behaviors to cope with the threat of COVID-19. Interviewees expressed that adaptive, community-centered, and non-individualistic behaviors strongly tied to Native culture minimized the negative epidemiological impacts of the pandemic. Future research can more deeply explore the root causes of the need for adaptiveness and resilience, such as histories of colonialism and marginalization, to emergency situations in Indigenous communities.
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Nash SH, Zimpelman GL, Miller KN, Clark JH, Britton CL. The Alaska Native Tumour Registry: fifty years of cancer surveillance data for Alaska Native people. Int J Circumpolar Health 2022; 81:2013403. [PMID: 34918619 PMCID: PMC8725679 DOI: 10.1080/22423982.2021.2013403] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/22/2021] [Accepted: 11/29/2021] [Indexed: 12/02/2022] Open
Abstract
Like other Indigenous Circumpolar populations, Alaska Native (AN) people experience different patterns of cancer than their non-Indigenous counterparts. Every 5 years, the Alaska Native Tumour Registry releases a comprehensive report on cancer among AN people; this study provides 50 years of cancer surveillance data. Five-year annual-average age-adjusted incidence rates were calculated for time-periods ranging 1969-2018. AN data were compared with data for US whites (SEER 9). Mortality rates were calculated for 1994-2018 using data from the National Center for Health Statistics. During 2014-2018, there were 2,401 cases of invasive cancer among AN people. Among these, the most commonly diagnosed cancers were colorectal (405 cases, 17% of all cancers), lung and bronchus (373 cases, 16% of all cancers), and female breast (340 cases, 14% of all cancers). Lung cancer was the leading cause of cancer death, followed by colorectal and female breast cancers. These leading cancers are screenable, and preventable through lifestyle modifications including tobacco cessation, healthy eating and engaging in physical activity. These data provide important information to support cancer prevention and control among AN people. Cancer surveillance has been a valuable tool throughout the Circumpolar North to support reducing the burden of cancer among Indigenous populations.Abbreviations: ANAI: Alaska Native/American Indian; AN: Alaska Native; USW: U.S. White(s); ANMC: Alaska Native Medical Center; ANTR: Alaska Native Tumour Registry; IR: Incidence Rate; CI: Confidence Interval; RR: Rate Ratio; ICD-O-3: International Classification of Diseases for Oncology - Third Edition; SEER: Surveillance, Epidemiology and End Results.
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Affiliation(s)
- Sarah H Nash
- Alaska Native Epidemiology Center, Community Health Services, Anchorage, AK, USA
| | - Garrett L Zimpelman
- Alaska Native Epidemiology Center, Community Health Services, Anchorage, AK, USA
| | - Keri N Miller
- Alaska Native Epidemiology Center, Community Health Services, Anchorage, AK, USA
| | - James H Clark
- Alaska Native Epidemiology Center, Community Health Services, Anchorage, AK, USA
| | - Carla L Britton
- Alaska Native Epidemiology Center, Community Health Services, Anchorage, AK, USA
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Sanders MA, Oppezzo M, Skan J, Benowitz NL, Schnellbaecher M, Prochaska JJ. Demographic and cultural correlates of traditional eating among Alaska Native adults at risk for cardiovascular disease. PLoS One 2022; 17:e0275445. [PMID: 36178914 PMCID: PMC9524684 DOI: 10.1371/journal.pone.0275445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 09/15/2022] [Indexed: 11/18/2022] Open
Abstract
This cross-sectional study assessed how traditional eating relates to cultural and community factors. Alaska Native adults from the Norton Sound region were recruited and surveyed between 2015-2018 for a randomized clinical trial of multiple risk behavior change interventions for cardiovascular disease prevention. Participants (n = 291) were 49% female with a mean age of 47 years (SD = 14). A 34-item food frequency questionnaire assessed consumption of foods traditional and nontraditional to the regional Alaska Native diet. A novel measure, termed the "traditional foods index", was computed as weekly servings of culturally traditional food consumption divided by total foods reported. Overall, the sample's traditional foods index averaged 21%±16%, with higher values reported by participants assessed in summer (23%±17%) than winter (19%±15%, p<0.05); by women (22%±16%) than men (19%±16%, p < .05); and by residents of smaller communities (22%±17%) than the comparatively larger community of Nome (17%±14%, p<0.05). The traditional foods index was correlated with age (r = .26, p < .01), as well as the cultural variables of community connectedness (r = .19, p < .01), community standing (r = .15, p < .01), and traditional language comprehension (r = .19, p < .01). In a multivariate regression model, age, community connectedness, and community standing remained significantly associated with traditional diet. These findings may inform the design and evaluation of community-based, culturally-relevant dietary initiatives for heart health.
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Affiliation(s)
- Mark A. Sanders
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, United States of America
| | - Marily Oppezzo
- Department of Medicine, Stanford Prevention Research Center, Stanford University, Stanford, California, United States of America
| | - Jordan Skan
- Cardiology Department, Alaska Native Tribal Health Consortium, Anchorage, Alaska, United States of America
| | - Neal L. Benowitz
- Department of Medicine, Division of Cardiology, Program in Clinical Pharmacology, and the Center for Tobacco Control Research and Education, UCSF, San Francisco, California, United States of America
| | - Matthew Schnellbaecher
- Cardiology Department, Alaska Native Tribal Health Consortium, Anchorage, Alaska, United States of America
| | - Judith J. Prochaska
- Department of Medicine, Stanford Prevention Research Center, Stanford University, Stanford, California, United States of America
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Oppezzo M, Knox M, Skan J, Chieng A, Crouch M, Aikens RC, Benowitz NL, Schnellbaecher M, Prochaska JJ. Traditional Heart-Healthy Diet and Medication Adherence in the Norton Sound Region: An 18-Month Telehealth Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9885. [PMID: 36011519 PMCID: PMC9408057 DOI: 10.3390/ijerph19169885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/05/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Innovations are needed for preventing cardiovascular disease (CVD) and for reaching diverse communities in remote regions. The current study reports on a telemedicine-delivered intervention promoting a traditional heart-healthy diet and medication adherence with Alaska Native men and women residing in the Norton Sound region of Alaska. METHODS Participants were 299 men and women with high blood pressure or high cholesterol smoking daily who were randomized to receive telemedicine-delivered counseling and printed materials on diet and medication adherence or on smoking and physical activity. Intervention contacts were at baseline and 3-, 6-, and 12-months follow-up, with a final assessment at 18 months. Nutrition outcomes were the ratio of heart-healthy foods and traditional heart-healthy foods relative to all foods reported on a 34-item food frequency questionnaire. Recent and typical adherence for heart medications were self-reported. RESULTS Intervention effects were significant for the heart-healthy foods ratio at 6 months only (p = 0.014) and significant for the traditional heart-healthy foods ratio at 6 months only for those aged 47+ (p = 0.031). For recent and typical medication adherence, there were no significant group differences by time. DISCUSSION In a remote region of Alaska, telemedicine proved feasible and acceptable for engaging Alaska Native men and women in counseling on CVD risk behaviors. The findings indicate that more touchpoints may be necessary to impart comprehensive lasting change in heart-healthy eating patterns. Medication adherence group differences were not significant; however, medication adherence was high overall.
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Affiliation(s)
- Marily Oppezzo
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Palo Alto, CA 94304, USA
| | - Mariah Knox
- Cardiology Department, Alaska Native Tribal Health Consortium, Anchorage, AK 99508, USA
| | - Jordan Skan
- Cardiology Department, Alaska Native Tribal Health Consortium, Anchorage, AK 99508, USA
| | - Amy Chieng
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Palo Alto, CA 94304, USA
| | - Maria Crouch
- Cardiology Department, Alaska Native Tribal Health Consortium, Anchorage, AK 99508, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
| | - Rachael C. Aikens
- Biomedical Informatics, Stanford University, Stanford, CA 94305, USA
| | - Neal L. Benowitz
- Division of Cardiology, Department of Medicine, University of California, San Francisco, CA 94158, USA
| | | | - Judith J. Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Palo Alto, CA 94304, USA
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Marshall KE, Kim M, Kosma M, Frusher S. Physical activity facilitators, barriers, and life challenges among Native American freshmen. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:1040-1046. [PMID: 32705960 DOI: 10.1080/07448481.2020.1784905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 04/28/2020] [Accepted: 06/12/2020] [Indexed: 06/11/2023]
Abstract
ObjectiveThe purpose of this phronetic, qualitative study was to examine exercise facilitators and barriers among Native American freshmen in relation to life challenges during their transition from high school to college. Participants: Seven Native American freshmen college students (females = 2, males = 5) were recruited. Methods: A focus group and individual interviews on exercise values and life challenges were conducted. Results: Based on the thematic analysis, three themes emerged, including several sub-themes. Factors affecting transition to college (theme 1) included: a) being independent and responsible and b) supportive environment. Exercise barriers (theme 2) included: a) lack of time, b) exercise options and level of competition, and c) limited equipment and exercise partners. Exercise facilitators (theme 3) included: a) Native American traditional activities and b) social multi-cultural opportunities. Conclusion: Exercise promoters should take into consideration the Native American culture and networks for Native American freshmen.
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Affiliation(s)
- Kristian E Marshall
- School of Kinesiology, Applied Health and Recreation, College of Education, Health and Aviation, Oklahoma State University, Stillwater, OK
| | - MooSong Kim
- Department of Health and Kinesiology, College of Education, Northeastern State University, Tahlequah, OK
| | - Maria Kosma
- School of Kinesiology, Louisiana State University, Baton Rouge, LA
| | - Susan Frusher
- Department of Educational Leadership, College of Education, Northeastern State University, Tahlequah, OK
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Treuth MS, Poirier L, Pardilla M, Redmond L, Gittelsohn J. Physical Activity Levels in Six Native American Communities Using the FITT-VP Approach. TRANSLATIONAL JOURNAL OF THE AMERICAN COLLEGE OF SPORTS MEDICINE 2022. [DOI: 10.1249/tjx.0000000000000135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Koller KR, Wilson A, Normolle DP, Nicholson JK, Li JV, Kinross J, Lee FR, Flanagan CA, Merculieff ZT, Iyer P, Lammers DL, Thomas TK, O'Keefe SJD. Dietary fibre to reduce colon cancer risk in Alaska Native people: the Alaska FIRST randomised clinical trial protocol. BMJ Open 2021; 11:e047162. [PMID: 34452959 PMCID: PMC8404459 DOI: 10.1136/bmjopen-2020-047162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 08/09/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Diet, shown to impact colorectal cancer (CRC) risk, is a modifiable environmental factor. Fibre foods fermented by gut microbiota produce metabolites that not only provide food for the colonic epithelium but also exert regulatory effects on colonic mucosal inflammation and proliferation. We describe methods used in a double-blinded, randomised, controlled trial with Alaska Native (AN) people to determine if dietary fibre supplementation can substantially reduce CRC risk among people with the highest reported CRC incidence worldwide. METHODS AND ANALYSES Eligible patients undergoing routine screening colonoscopy consent to baseline assessments and specimen/data collection (blood, urine, stool, saliva, breath and colon mucosal biopsies) at the time of colonoscopy. Following an 8-week stabilisation period to re-establish normal gut microbiota post colonoscopy, study personnel randomise participants to either a high fibre supplement (resistant starch, n=30) or placebo (digestible starch, n=30) condition, repeating stool sample collection. During the 28-day supplement trial, each participant consumes their usual diet plus their supplement under direct observation. On day 29, participants undergo a flexible sigmoidoscopy to obtain mucosal biopsy samples to measure the effect of the supplement on inflammatory and proliferative biomarkers of cancer risk, with follow-up assessments and data/specimen collection similar to baseline. Secondary outcome measures include the impact of a high fibre supplement on the oral and colonic microbiome and biofluid metabolome. ETHICS AND DISSEMINATION Approvals were obtained from the Alaska Area and University of Pittsburgh Institutional Review Boards and Alaska Native Tribal Health Consortium and Southcentral Foundation research review bodies. A data safety monitoring board, material transfer agreements and weekly study team meetings provide regular oversight throughout the study. Study findings will first be shared with AN tribal leaders, health administrators, providers and community members. Peer-reviewed journal articles and conference presentations will be forthcoming once approved by tribal review bodies. TRIAL REGISTRATION NUMBER NCT03028831.
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Affiliation(s)
- Kathryn R Koller
- Research Services, Alaska Native Tribal Health Consortium, Anchorage, Alaska, USA
| | - Annette Wilson
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Daniel P Normolle
- Hillman Cancer Center Biostatistics Facility, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jeremy K Nicholson
- Australian National Phenome Center, Murdoch University, Perth, Western Australia, Australia
| | - Jia V Li
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - James Kinross
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Flora R Lee
- Research Services, Alaska Native Tribal Health Consortium, Anchorage, Alaska, USA
| | - Christie A Flanagan
- Alaska Native Epidemiology Center, Alaska Native Tribal Health Consortium, Anchorage, Alaska, USA
| | - Zoe T Merculieff
- Wellness and Prevention, Alaska Native Tribal Health Consortium, Anchorage, Alaska, USA
| | - Priya Iyer
- Hillman Cancer Center Biostatistics Facility, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Daniela L Lammers
- Research Services, Alaska Native Tribal Health Consortium, Anchorage, Alaska, USA
| | - Timothy K Thomas
- Research Services, Alaska Native Tribal Health Consortium, Anchorage, Alaska, USA
| | - Stephen J D O'Keefe
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Moriarity RJ, Zuk AM, Liberda EN, Tsuji LJS. Health measures of Eeyouch (Cree) who are eligible to participate in the on-the-land Income Security Program in Eeyou Istchee (northern Quebec, Canada). BMC Public Health 2021; 21:628. [PMID: 33789644 PMCID: PMC8011104 DOI: 10.1186/s12889-021-10654-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/18/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Participation in on-the-land programs that encourage traditional cultural activities may improve health and well-being. The Income Security Program (ISP) - a financial incentive-based on-the-land program - for Eeyouch (Cree) hunters and trappers in Eeyou Istchee was created as a result of the 1975 James Bay and Northern Quebec Agreement to help mitigate the effects of hydroelectric development on the Cree people of northern Quebec, Canada. Beyond the ISP's financial incentives, little is known about the health measures of those who are eligible to participate in the ISP (i.e. spent ≥120 days on-the-land during the previous year). Therefore, this paper's objective was to assess the health measures of northern Quebec Cree, who were eligible for participation in the ISP. METHODS Using participant data (n = 545) compiled from the Nituuchischaayihtitaau Aschii Multi-Community Environment-and-Health Study, we assessed 13 different health measures in generalized linear models with the independent variable being the eligibility to participate in the ISP. RESULTS Participants in the present study who were eligible for the ISP had significantly higher levels of vigorous and moderate activity per week, and higher concentrations of omega-3 polyunsaturated fatty acids in the blood compared to those ineligible for the ISP (i.e. spent ≤119 days on-the-land during the previous year). Encouragingly, following model adjustment for age and sex, participants eligible for the ISP did not have higher blood concentrations of mercury than those who were not eligible for the ISP. CONCLUSIONS Our results suggest that the participants eligible for participation in the ISP are likely to be healthier than those who are ineligible to participate - and are promising for on-the-land programs for Indigenous peoples beyond a financial incentive - with no apparent higher risk of increasing contaminant body burden through traditional on-the-land-activities (e.g. fish consumption).
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Affiliation(s)
- Robert J Moriarity
- Department of Physical and Environmental Sciences, SW151 University of Toronto, Toronto, ON, M1C 1A4, Canada.
| | - Aleksandra M Zuk
- Department of Physical and Environmental Sciences, SW151 University of Toronto, Toronto, ON, M1C 1A4, Canada.,School of Nursing, Queen's University, Kingston, ON, Canada
| | - Eric N Liberda
- School of Occupational and Public Health, Ryerson University, Toronto, ON, Canada
| | - Leonard J S Tsuji
- Department of Physical and Environmental Sciences, SW151 University of Toronto, Toronto, ON, M1C 1A4, Canada
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Nash SH, Day G, Hiratsuka VY, Beans J, Redwood D, Holck P, Howard BV, Umans J, Koller KR. Ten-year weight gain is not associated with multiple cardiometabolic measures in Alaska EARTH study participants. Nutr Metab Cardiovasc Dis 2021; 31:403-410. [PMID: 33127251 PMCID: PMC7887000 DOI: 10.1016/j.numecd.2020.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 09/01/2020] [Accepted: 09/17/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIMS Alaska Native (AN) traditional lifestyle may be protective against chronic disease risk. Weight gain in adulthood has been linked to increases in chronic disease risk among other populations; yet, its impact among Alaska Native people has never been evaluated. We aimed to evaluate changes in obesity-related metrics over time, and determine associations of changes with cardiometabolic markers of chronic disease risk among AN people. METHODS AND RESULTS Study participants enrolled in the southcentral Alaska Education and Research Towards Health Study in 2004-2006 were invited to participate in a follow-up study conducted 2015-2017. Of the original 1320 participants, 388 completed follow-up health assessments consisting of multiple health surveys, anthropometric measurements, and cardiometabolic measures including blood sugars, blood lipids, and blood pressure. Differences in measurements between visits were determined and associations of weight change with cardiometabolic measures evaluated. Body mass index increased by 3.7 kg/m2 among men and 4.8 kg/m2 among women. Hip circumference (1.1 cm, p < 0.01) and waist circumference (0.7 cm, p < 0.01) increased among women; only waist circumference increased among men (1.6 cm, p < 0.01). Among men, there were no associations of weight change with cardiometabolic measures. Among women, there was an inverse association between weight gain and high-density lipoprotein cholesterol only (0.17 mg/dL (CI: -3.1, -0.03), p = 0.02). CONCLUSIONS While weight increase over a 10-year period was not associated with substantive changes in cardiometabolic measures among AN men, there was a decrease in high density lipid cholesterol associated with weight gain among AN women.
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Affiliation(s)
- Sarah H Nash
- Alaska Native Epidemiology Center, Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA.
| | - Gretchen Day
- Clinical and Research Services, Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | | | - Julie Beans
- Clinical and Research Services, Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Diana Redwood
- Alaska Native Epidemiology Center, Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Peter Holck
- Clinical and Research Services, Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Barbara V Howard
- Medstar Health Research Institute, Hyattsville, MD, USA; Georgetown/Howard Universities Center for Clinical and Translational Research, Washington, DC, USA
| | - Jason Umans
- Medstar Health Research Institute, Hyattsville, MD, USA; Georgetown/Howard Universities Center for Clinical and Translational Research, Washington, DC, USA
| | - Kathryn R Koller
- Clinical and Research Services, Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
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Goins RT, Jones J, Schure M, Winchester B, Bradley V. Type 2 diabetes management among older American Indians: beliefs, attitudes, and practices. ETHNICITY & HEALTH 2020; 25:1055-1071. [PMID: 29968494 PMCID: PMC6408982 DOI: 10.1080/13557858.2018.1493092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 06/11/2018] [Indexed: 06/08/2023]
Abstract
Objective: The purpose of this study was to examine beliefs, attitudes, and practices of older American Indians regarding their type 2 diabetes mellitus (T2DM) management. T2DM is one of the leading causes of morbidity and mortality among American Indians. American Indians are more than twice as likely to have T2DM and have over three times a T2DM mortality rate as Whites. Design: Study participants were older members of a federally recognized tribe who had T2DM. A low-inference qualitative descriptive design was used. Data were collected through semi-structured in-depth qualitative interviews with a mixed inductive, deductive, and reflexive analytic team process. Results: Our study sample included 28 participants with a mean age of 73.0 ± 6.4 years of whom 16 (57%) were women. Participants' mean self-confidence score of successful T2DM management was 8.0 ± 1.7 on a scale from 1 to 10 with 10 representing the greatest amount of confidence. Participants' mean HbA1c was 7.3% ± 1.5%. Overall, participants discussed T2DM management within five themes: 1) sociocultural factors, 2) causes and consequences, 3) cognitive and affective assessment, 4) diet and exercise, and 5) medical management. Conclusions: It is important to be aware of the beliefs and attitudes of patients. Lay understandings can help identify factors underlying health and illness behaviors including motivations to maintain healthy behaviors or to change unhealthy behaviors. Such information can be helpful for health educators and health promotion program staff to ensure their efforts are effective and in alignment with patients' realities.
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Affiliation(s)
- R. Turner Goins
- College of Health and Human Sciences, Western Carolina University, Cullowhee, NC, USA
| | - Jacqueline Jones
- College of Nursing, University of Colorado Denver, Aurora, CO, USA
| | - Mark Schure
- Community Health, Montana State University, Bozeman, MT, USA
| | | | - Vickie Bradley
- Public Health and Human Services, Eastern Band of Cherokee Indians, Cherokee, NC, USA
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Nash SH, Peters U, Redwood D. Developing an Epidemiologic Study to Investigate Risk Factors for Colorectal Cancer Among Alaska Native People. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 25 Suppl 5, Tribal Epidemiology Centers: Advancing Public Health in Indian Country for Over 20 Years:S54-S60. [PMID: 31348191 DOI: 10.1097/phh.0000000000000994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Alaska Native (AN) people have among the highest rates of colorectal cancer (CRC) recorded globally. Preventing CRC is an important health priority of AN tribal health leaders and communities. Lifestyle and genetic risk and protective factors for CRC among AN people remain understudied. We have been working to establish a tribally led, community-based, comprehensive investigation of lifestyle and genetic risk and protective factors for CRC among AN people. We describe the process of initiating this research study, including conversations with key tribal health system staff. We discuss themes that arose during these conversations and literature review and describe how those themes were used during the study design and protocol development phase. This description is intended to provide guidance to other researchers working to establish community-based studies of cancer risk, particularly among tribal communities.
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Affiliation(s)
- Sarah H Nash
- Alaska Native Epidemiology Center, Alaska Native Tribal Health Consortium, Anchorage, Alaska (Drs Nash and Redwood); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington (Dr Peters); and School of Public Health, University of Washington, Seattle, Washington (Dr Peters)
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Walch A, Bersamin A. Traditional Food Intake Is Positively Associated with Diet Quality among Low-Income, Urban Alaska Native Women. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2020; 15:264-272. [DOI: 10.1080/19320248.2019.1619648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Amanda Walch
- Dietetics and Nutrition Department, University of Alaska Anchorage, Anchorage, AK, USA
| | - Andrea Bersamin
- Center for Alaska Native Health Research, Institute of Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK, USA
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Redwood DG, Day GM, Beans JA, Hiratsuka VY, Nash SH, Howard BV, Umans JG, Koller KR. Alaska Native Traditional Food and Harvesting Activity Patterns over 10 Years of Follow-Up. Curr Dev Nutr 2019; 3:nzz114. [PMID: 31723724 PMCID: PMC6834783 DOI: 10.1093/cdn/nzz114] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 09/20/2019] [Accepted: 10/07/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Alaska Native (AN) traditional foods and associated harvesting activities are beneficial to human health. OBJECTIVE This study assessed longitudinal self-reported traditional food use and harvesting activities among Alaska Native and American Indian (AN/AI) participants in the Alaska Education and Research Towards Health (EARTH) study. METHODS In 2004-2006, southcentral Alaska EARTH study participants (n = 1320) completed diet and activity questionnaires which were repeated in 2015-2017; results were compared between participants who completed both questionnaires (n = 388). RESULTS In the follow-up questionnaire, >93% of participants reported eating ≥1 traditional food in the past year. The top 3 traditional foods were fish (75%), moose (42%), and shellfish (41%). Women were more likely than men to consume traditional foods, especially fish, gathered berries, shellfish, and seal oil (P < 0.05). Participants aged ≥60 y in the original cohort were significantly more likely to consume fish and shellfish at follow-up, whereas those aged 40-59 y were the most likely of the 3 age groups to consume seal oil (P < 0.05). Between the original cohort and follow-up, there was a significant decline in the mean number of traditional foods eaten from 6.3 to 5.5, as well as reduced consumption of multiple traditional foods (P < 0.001). Over 59% of participants reported ≥1 traditional harvesting activity in the past year; this proportion did not significantly change between baseline and follow-up. Picking berries/greens (44%), cutting/smoking fish or meat (33%), and fishing (30%) were the most common activities. Participation in traditional harvesting activities was greater among women than men (P < 0.05), but did not differ by age. CONCLUSIONS Longitudinal follow-up demonstrated that AN/AI people maintained participation in traditional harvesting activities, but the variety of traditional foods declined significantly among both men and women. Promotion of traditional foods and harvesting activities that serve as protective factors against chronic diseases may benefit this population.
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Affiliation(s)
| | - Gretchen M Day
- Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | | | | | - Sarah H Nash
- Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | | | - Jason G Umans
- Medstar Health Research Institute, Hyattsville, MD, USA
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Beans JA, Hiratsuka VY, Shane AL, Day GE, Redwood DG, Flanagan CA, Wilson AS, Howard BV, Umans JG, Koller KR. Follow-up Study Methods for a Longitudinal Cohort of Alaska Native and American Indian People Living within Urban South Central Alaska: The EARTH Study. J Community Health 2019; 44:903-911. [PMID: 30798425 PMCID: PMC6707895 DOI: 10.1007/s10900-019-00630-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Longitudinal data are needed to investigate chronic disease causation and improve prevention efforts for Alaska Native and American Indian (ANAI) people. This paper describes the methods used to conduct follow-up data collection of a longitudinal cohort that enrolled ANAI adults between 2004 and 2006 in south central Alaska. The follow-up study re-examined ANAI participants in a large, urban centre in south central Alaska between 2015 and 2017. Computerized surveys were used to collect self-reported health, lifestyle, physical activity, and diet data. Clinical measurements included blood pressure, fasting blood glucose and lipid panel, urine albumin/creatinine, height, weight, and waist and hip circumference. Participants were provided individual results at the conclusion of their visit. A total of 1320 south central Alaska study participants completed the baseline visit. Study staff attempted to contact all living cohort members for inclusion in the follow-up study. More than 11,000 attempted contacts were made. Of the 637 available for participation, 388 completed the follow-up visit. The proportion of women increased from baseline to follow-up examinations (67 vs. 72%, p < 0.01). Self-reported health status of being married or living as married (46% vs. 39%, p < 0.01), and those reporting being employed or self-employed (55% vs. 47%, p < 0.01) were higher at follow-up when compared to baseline. Almost all participants at follow-up (97%) agreed to long-term storage of biological specimens for future study. Despite demographic differences between the follow-up and baseline cohorts, longitudinal data collected will provide novel insight on chronic disease development and prevention for ANAI people as well as other populations.
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Affiliation(s)
- Julie A Beans
- Research Department, Southcentral Foundation, 4085 Tudor Centre Drive, Anchorage, AK, 99508, USA.
| | - Vanessa Y Hiratsuka
- Research Department, Southcentral Foundation, 4085 Tudor Centre Drive, Anchorage, AK, 99508, USA
| | - Aliassa L Shane
- Research Department, Southcentral Foundation, 4085 Tudor Centre Drive, Anchorage, AK, 99508, USA
| | - Gretchen E Day
- Alaska Native Tribal Health Consortium, 3900 Ambassador Dr., Ste. 201, Anchorage, AK, 99508, USA
| | - Diana G Redwood
- Alaska Native Tribal Health Consortium, 3900 Ambassador Dr., Ste. 201, Anchorage, AK, 99508, USA
| | - Christie A Flanagan
- Alaska Native Tribal Health Consortium, 3900 Ambassador Dr., Ste. 201, Anchorage, AK, 99508, USA
| | - Amy Swango Wilson
- Alaska Native Tribal Health Consortium, 3900 Ambassador Dr., Ste. 201, Anchorage, AK, 99508, USA
| | - Barbara V Howard
- Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, USA
- MedStar Health Research Institute, Hyattsville, MD, USA
| | - Jason G Umans
- Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, USA
- MedStar Health Research Institute, Hyattsville, MD, USA
| | - Kathryn R Koller
- Alaska Native Tribal Health Consortium, 3900 Ambassador Dr., Ste. 201, Anchorage, AK, 99508, USA
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Nash SH, Day G, Zimpelman G, Hiratsuka VY, Koller KR. Cancer incidence and associations with known risk and protective factors: the Alaska EARTH study. Cancer Causes Control 2019; 30:1067-1074. [PMID: 31428891 DOI: 10.1007/s10552-019-01216-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 08/09/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Cancer is the leading cause of mortality among Alaska Native (AN) people. The Alaska Education and Research Towards Health (EARTH) cohort was established to examine risk and protective factors for chronic diseases, including cancer, among AN people. Here, we describe the cancer experience of the Alaska EARTH cohort in relation to statewide- and region-specific tumor registry data, and assess associations with key cancer risk factors. METHODS AN participants were recruited into the Alaska EARTH cohort during 2004-2006. Data collected included patient demographic, anthropometric, medical and family history, and lifestyle information. This study linked the Alaska EARTH data with cancer diagnoses recorded by the Alaska Native Tumor Registry (ANTR) through 12/31/15. We compared EARTH incidence to ANTR statewide incidence. We examined independent associations of smoking status, diet, BMI, and physical activity with incident all-site cancers using multivariable-adjusted Cox proportional hazards models. RESULTS Between study enrollment and 2015, 171 of 3,712 (4.7%) Alaska EARTH study participants were diagnosed with cancer. The leading cancers among Alaska EARTH participants were female breast, lung, and colorectal cancer, which reflected those observed among AN people statewide. Incidence (95% CI) of cancer (all sites) among Alaska EARTH participants was 629.7 (510.9-748.6) per 100,000 person-years; this was comparable to statewide rates [680.5 (660.0-701.5) per 100,000 population]. We observed lower risk of all-sites cancer incidence among never smokers. CONCLUSIONS Cancer incidence in the Alaska EARTH cohort was similar to incidence observed statewide. Risk and protective factors for leading cancers among AN people mirror those observed among other populations.
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Affiliation(s)
- Sarah H Nash
- Alaska Native Epidemiology Center, Alaska Native Tumor Registry, Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA.
| | - Gretchen Day
- Clinical and Research Services, Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Garrett Zimpelman
- Alaska Native Epidemiology Center, Alaska Native Tumor Registry, Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | | | - Kathryn R Koller
- Clinical and Research Services, Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
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Setiono FJ, Jock B, Trude A, Wensel CR, Poirier L, Pardilla M, Gittelsohn J. Associations between Food Consumption Patterns and Chronic Diseases and Self-Reported Morbidities in 6 American Indian Communities. Curr Dev Nutr 2019. [DOI: 10.1093/cdn/nzz067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT
Background
American Indian (AI) have the highest rates of diet-related chronic diseases in the country. Yet, the relation between dietary patterns and chronic diseases in this population has not been well explored.
Objective
We aimed to characterize common dietary patterns among adults from 6 AI communities (N = 580) and assess their relation with BMI, percentage body fat, waist-to-hip ratio, hypertension, and self-reported type 2 diabetes and cardiovascular disease.
Methods
We conducted a baseline assessment of an obesity prevention study (N = 580). Dietary intake data were collected using a modified Block FFQ. Exploratory factor analysis was used to characterize dietary patterns. We used multivariate linear and logistic regression analyses to assess associations between dietary patterns and health outcomes, controlling for age, sex, employment status, smoking status, geographic region, and energy intake.
Results
Five dietary patterns, explaining 81.8% of variance in reported food consumption, were identified: “meat and fried foods,” “processed foods,” “fruits and vegetables,” “sugary snacks,” and “meat alternatives and high-protein foods.” “Those with higher consumption of “meat and fried foods” were associated with higher mean waist-to-hip ratio (0.03; 95% CI: 0.01, 0.04), higher mean BMI (2.45 kg/m2; 95% CI: 0.83, 4.07), and increased odds of being overweight or obese (OR: 2.63; 95% CI: 1.10, 6.31) compared to those with lower consumption of “meat and fried foods.” Higher consumption of “processed foods” was associated with increased odds of self-reported type 2 diabetes (OR: 3.41; 95% CI: 1.31, 8.90). No protective effect of consumption of “fruits and vegetables” was observed, although average consumption was below national recommendation levels.
Conclusions
AI dietary patterns corroborate nutritional concerns previously reported among AI populations. Future interventions should discourage overconsumption of meat, fried foods, and processed foods, and promote consumption of fruits and vegetables to reduce chronic disease burden in this population.
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Affiliation(s)
- Felicia J Setiono
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Global Obesity Prevention Center, and Center for Human Nutrition, Baltimore, MD, USA
| | - Brittany Jock
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Global Obesity Prevention Center, and Center for Human Nutrition, Baltimore, MD, USA
| | - Angela Trude
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Global Obesity Prevention Center, and Center for Human Nutrition, Baltimore, MD, USA
| | - Caroline R Wensel
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Global Obesity Prevention Center, and Center for Human Nutrition, Baltimore, MD, USA
| | - Lisa Poirier
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Global Obesity Prevention Center, and Center for Human Nutrition, Baltimore, MD, USA
| | - Marla Pardilla
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Global Obesity Prevention Center, and Center for Human Nutrition, Baltimore, MD, USA
| | - Joel Gittelsohn
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Global Obesity Prevention Center, and Center for Human Nutrition, Baltimore, MD, USA
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Walch A, Loring P, Johnson R, Tholl M, Bersamin A. Traditional Food Practices, Attitudes, and Beliefs in Urban Alaska Native Women Receiving WIC Assistance. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:318-325. [PMID: 30409694 PMCID: PMC8731265 DOI: 10.1016/j.jneb.2018.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 09/07/2018] [Accepted: 09/09/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To identify practices, attitudes, and beliefs associated with intake of traditional foods among Alaska Native women. DESIGN Cross-sectional study that measured traditional food intake; participation in food-sharing networks; presence of a hunter or fisherman in the home; the preference, healthfulness, and economic value of traditional foods; and financial barriers to obtaining these foods. PARTICIPANTS Purposive sample of 71 low-income Alaska Native women receiving Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) assistance in Anchorage, AK. ANALYSIS Bivariate and multivariate regression analyses. RESULTS Traditional foods contributed 4% of total daily calories. Given a choice, 63% of participants indicated that they would prefer half or more of the foods they ate to be traditional (ie, not store-bought). The majority of participants (64%) believed that traditional foods were healthier than store-bought foods. Of all participants, 72% relied on food-sharing networks for traditional foods; only 21% acquired traditional foods themselves. Participants who ate more traditional foods preferred traditional foods (B = .011 P = .02). IMPLICATIONS FOR RESEARCH AND PRACTICE Traditional food intake was low and findings suggested that Alaska Native women living in an urban setting prefer to consume more but are unable to do so. Future research might examine the effect of enhancing social networks and implementing policies that support traditional food intake.
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Affiliation(s)
- Amanda Walch
- Dietetics and Nutrition Department, University of Alaska Anchorage, Anchorage, AK
| | - Philip Loring
- Department of Geography, Environment, and Geomatics, University of Guelph, Ontario, Canada
| | - Rhonda Johnson
- Department of Health Sciences, University of Alaska Anchorage, Anchorage, AK
| | - Melissa Tholl
- Dietetics and Nutrition Department, University of Alaska Anchorage, Anchorage, AK
| | - Andrea Bersamin
- Center for Alaska Native Health Research and Institute of Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK.
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Noreen W, Johnson-Down L, Jean-Claude M, Lucas M, Robinson E, Batal M. Factors associated with the intake of traditional foods in the Eeyou Istchee (Cree) of northern Quebec include age, speaking the Cree language and food sovereignty indicators. Int J Circumpolar Health 2018; 77:1536251. [PMID: 30360700 PMCID: PMC6211274 DOI: 10.1080/22423982.2018.1536251] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 09/25/2018] [Accepted: 09/27/2018] [Indexed: 01/14/2023] Open
Abstract
The Eeyouch are a First Nations (Cree) population that live above 49.6°N latitude in Eeyou Istchee in northern Quebec. Eeyouch rely on traditional foods (TF) hunted, fished or gathered from the land. The overarching aim of this study was to achieve an understanding of the factors associated with TF intake among Eeyouch. Data were from 465 women and 330 men who participated in the Nituuchischaayihtitaau Aschii Multi-Community Environment-and-Health (E&H) study. The relationship between TF consumption and dietary, health, sociodemographic and food sovereignty (i.e. being a hunter or receiving Income Security to hunt, trap or fish) variables was examined using linear and logistic regression. Analyses were stratified by sex because of the male/female discrepancy in being a hunter. Among respondents, almost all (99.7%) consumed TF, 51% were hunters and 10% received Income Security. Higher intake of TF was associated with lower consumption of less nutritious ultra-processed products (UPP). In women, TF intake increased with age, hunting and receiving Income Security, but decreased with high school education. In men, TF intake increased with age and speaking only Cree at home. The findings suggest that increased food sovereignty would result in improved diet quality among Eeyouch through increased TF intake and decreased UPP intake.
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Affiliation(s)
- Willows Noreen
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Louise Johnson-Down
- Département de nutrition, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Moubarac Jean-Claude
- Département de nutrition, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Michel Lucas
- Axe Santé publique et pratiques optimales en santé, Centre de recherche du Centre Hospitalier Universitaire (CHU) de Québec, Québec, QC, Canada
- Department of Social and Preventive Medicine, Université Laval, Québec, QC, Canada
| | - Elizabeth Robinson
- Cree Board of health and Social Services of James Bay, Montreal, QC, Canada
| | - Malek Batal
- Département de nutrition, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
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Walch A, Bersamin A, Loring P, Johnson R, Tholl M. A scoping review of traditional food security in Alaska. Int J Circumpolar Health 2018; 77:1419678. [PMID: 29292675 PMCID: PMC5757232 DOI: 10.1080/22423982.2017.1419678] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 11/22/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Food insecurity is a public health concern. The pillars of food security include food access, availability and utilisation. For some indigenous peoples, the pillars may focus on traditional foods. OBJECTIVE To conduct a scoping review on traditional foods and food security in Alaska. DESIGN Google Scholar and the High North Research Documents were used to search for relevant primary research using the following terms: “traditional foods”, “food security”, “access”, “availability”, “utilisation”, “Alaska”, “Alaska Native” and “indigenous”. RESULTS Twenty four articles from Google Scholar and four articles from the High North Research Documents met the inclusion criteria. The articles revealed three types of research approaches, those that quantified traditional food intake (n=18), those that quantified food security (n=2), and qualitative articles that addressed at least one pillar of food security (n=8). CONCLUSIONS Studies that estimate the prevalence of traditional food insecurity in Alaska are virtually absent from the literature. Instead most studies provide a review of factors related to food security. Research investigating dietary intake of traditional foods is more prevalent. Future research should include direct measurements of traditional food intake and food security to provide a more complete picture of traditional food security in Alaska.
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Affiliation(s)
- Amanda Walch
- Department of Biology & Wildlife, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Andrea Bersamin
- Department of Biology & Wildlife, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Philip Loring
- School of Environment and Sustainability, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Rhonda Johnson
- Department of Health Sciences, University of Alaska Anchorage, Anchorage, AK, USA
| | - Melissa Tholl
- Department of Dietetics & Nutrition, University of Alaska Anchorage, Anchorage, AK, USA
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Laberge Gaudin V, Receveur O, Girard F, Potvin L. Facilitators and Barriers to Traditional Food Consumption in the Cree Community of Mistissini, Northern Quebec. Ecol Food Nutr 2016; 54:663-92. [PMID: 26517308 DOI: 10.1080/03670244.2015.1072815] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
To identify barriers to traditional food consumption and factors that facilitate it among the Cree community of Mistissini, a series of four focus groups was conducted with a total of twenty-three people. Two ecological models were created, one for facilitating factors and a second for obstacles, illustrating the role of numerous interconnected influences of traditional food consumption. Environmental impact project, laws and regulation, local businesses, traditional knowledge, youth influence, employment status, and nonconvenience of traditional food were named among numerous factors influencing traditional food consumption. The findings of this study can be used by political and public health organizations to promote traditional food where more emphasis should be invested in community and environmental strategies.
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Affiliation(s)
- Véronique Laberge Gaudin
- a Department of Public Health , Cree Board of Health and Social Services of James Bay , Mistissini , Canada
| | - Olivier Receveur
- b Department of Nutrition , Université de Montréal , Montreal , Canada
| | - Félix Girard
- c Department of Oral Health , Université de Montréal , Montreal , Canada
| | - Louise Potvin
- d School of Public Health , Université de Montréal , Montreal , Canada
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Fleischhacker S. Emerging Opportunities for Registered Dietitian Nutritionists to Help Raise a Healthier Generation of Native American Youth. J Acad Nutr Diet 2016; 116:219-225. [PMID: 26680608 PMCID: PMC4733391 DOI: 10.1016/j.jand.2015.10.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Sheila Fleischhacker
- Corresponding Author and Reprint Contact, Sheila Fleischhacker, PhD, JD, Senior Public Health & Science Policy Advisor, Office of Nutrition Research, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Department of Health and Human Services, Two Democracy Plaza, Room 635, 6707 Democracy Boulevard MSC 5461, Bethesda, Maryland 20892-5461, voice – 301-594-7440, blackberry – 301-640-1396, fax – 301-480-3768,
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Hupp J, Brubaker M, Wilkinson K, Williamson J. How are your berries? Perspectives of Alaska's environmental managers on trends in wild berry abundance. Int J Circumpolar Health 2015; 74:28704. [PMID: 26380964 PMCID: PMC4574151 DOI: 10.3402/ijch.v74.28704] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/24/2015] [Accepted: 08/25/2015] [Indexed: 12/05/2022] Open
Abstract
Background Wild berries are a valued traditional food in Alaska. Phytochemicals in wild berries may contribute to the prevention of vascular disease, cancer and cognitive decline, making berry consumption important to community health in rural areas. Little was known regarding which species of berries were important to Alaskan communities, the number of species typically picked in communities and whether recent environmental change has affected berry abundance or quality. Objective To identify species of wild berries that were consumed by people in different ecological regions of Alaska and to determine if perceived berry abundance was changing for some species or in some regions. Design We asked tribal environmental managers throughout Alaska for their views on which among 12 types of wild berries were important to their communities and whether berry harvests over the past decade were different than in previous years. We received responses from 96 individuals in 73 communities. Results Berries that were considered very important to communities differed among ecological regions of Alaska. Low-bush blueberry (Vaccinium uliginosum and V. caespitosum), cloudberry (Rubus chamaemorus) and salmonberry (Rubus spectabilis) were most frequently identified as very important berries for communities in the boreal, polar and maritime ecoregions, respectively. For 7 of the 12 berries on the survey, a majority of respondents indicated that in the past decade abundance had either declined or become more variable. Conclusions Our study is an example of how environmental managers and participants in local observer networks can report on the status of wild resources in rural Alaska. Their observations suggest that there have been changes in the productivity of some wild berries in the past decade, resulting in greater uncertainty among communities regarding the security of berry harvests. Monitoring and experimental studies are needed to determine how environmental change may affect berry abundance.
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Affiliation(s)
- Jerry Hupp
- U.S. Geological Survey, Alaska Science Center, Anchorage, AK, USA;
| | | | - Kira Wilkinson
- Alaska Native Science and Engineering Program, University of Alaska Anchorage, Anchorage, AK, USA
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25
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Tvermosegaard M, Dahl-Petersen IK, Nielsen NO, Bjerregaard P, Jørgensen ME. Cardiovascular Disease Susceptibility and Resistance in Circumpolar Inuit Populations. Can J Cardiol 2015; 31:1116-23. [PMID: 26239003 DOI: 10.1016/j.cjca.2015.06.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 06/05/2015] [Accepted: 06/05/2015] [Indexed: 11/26/2022] Open
Abstract
Cardiovascular disease (CVD) is a major public health issue in indigenous populations in the Arctic. These diseases have emerged concomitantly with profound social changes over the past 60 years. The aim of this study was to summarize the literature on CVD risk among Arctic Inuit. Literature on prevalence, incidence, and time trends for CVD and its risk factors in Arctic Inuit populations was reviewed. Most evidence supports a similar incidence of coronary heart disease and a higher incidence of cerebrovascular disease among Arctic Inuit than seen in western populations. Factors that may increase CVD risk include aging of the population, genetic susceptibility, and a rapid increase in obesity, diabetes, and hypertension in parallel with decreasing physical activity and deterioration of the lipid profile. In contrast, and of great importance, there has been a decrease in smoking and alcohol intake (at least documented in Greenland), and contaminant levels are declining. Although there have been marked socioeconomic and dietary changes, it remains unsolved and to some extent controversial how this may have influenced cardiovascular risk among Arctic Inuit. The increase in life expectancy, in combination with improved prognosis for patients with manifest CVD, will inevitably lead to a large increase in absolute numbers of individuals affected by CVD in Arctic Inuit populations, exacerbated by the rise in most CVD risk factors over the past decades. For preventive purposes and for health care planning, it is crucial to carefully monitor disease incidence and trends in risk factors in these vulnerable Arctic populations.
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Affiliation(s)
- Maria Tvermosegaard
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; Steno Diabetes Center, Gentofte, Denmark
| | - Inger K Dahl-Petersen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Nina Odgaard Nielsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Peter Bjerregaard
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; Greenland Centre for Health Research, University of Greenland, Nuuk, Greenland
| | - Marit Eika Jørgensen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; Steno Diabetes Center, Gentofte, Denmark.
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Koller KR, Metzger JS, Jolly SE, Umans JG, Hopkins SE, Kaufmann C, Wilson AS, Ebbesson SOE, Raymer TW, Austin MA, Howard BV, Boyer BB. Cardiometabolic correlates of low type 2 diabetes incidence in western Alaska Native people - The WATCH study. Diabetes Res Clin Pract 2015; 108:423-31. [PMID: 25805711 PMCID: PMC4442716 DOI: 10.1016/j.diabres.2015.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 02/23/2015] [Accepted: 03/02/2015] [Indexed: 01/22/2023]
Abstract
AIMS Previously rare among Alaska Native (AN) people, type 2 diabetes (DM2) prevalence as indicated by registry data has increased by as much as 300% in some western Alaska regions. We sought to determine prevalence and incidence of DM2 and analyze associated cardiometabolic risk factors in western AN people. METHODS DM2 and prediabetes prevalence and incidence were determined by the Western Alaska Tribal Collaborative for Health using consolidated data from cohort studies conducted during 2000-2010. Crude and age-adjusted incidence for DM2 and prediabetes were calculated using 2010 American Diabetes Association criteria. Effects of covariates on DM2 and prediabetes were determined using univariate and multivariate Cox proportional hazards analyses, adjusted for age and sex. RESULTS Excluding baseline diabetes (n=124, 4.5%), 53 cases of new DM2 were identified among 2630 participants. Age- and sex-adjusted DM2 incidence was 4.3/1000 (95% CI 2.9, 5.0) person-years over an average 5.9-year follow up. After excluding baseline prediabetes, 387 new cases of prediabetes were identified among 1841 participants; adjusted prediabetes incidence was 44.5/1000 (95% CI 39.5, 49.5) person years. Independent predictors for DM2 included age, impaired fasting glucose, and metabolic syndrome; family history of diabetes and obesity were additional independent predictors for prediabetes. CONCLUSIONS DM2 incidence in western AN people is substantially lower than that for U.S. whites; however, incidence of prediabetes is more than 10-fold higher than western AN DM2 incidence and more closely aligned with U.S. rates. Interventions aimed at achieving healthy lifestyles are needed to minimize risk factors and maximize protective factors for DM2 in this population.
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Affiliation(s)
- Kathryn R Koller
- Alaska Native Tribal Health Consortium, Division of Community Health Services, Anchorage, AK, United States.
| | - Jesse S Metzger
- University of Alaska Anchorage, Anchorage, AK, United States
| | - Stacey E Jolly
- Cleveland Clinic Medicine Institute, Cleveland, OH, United States
| | - Jason G Umans
- MedStar Health Research Institute, Hyattsville, MD, United States; Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, United States
| | - Scarlett E Hopkins
- University of Alaska Fairbanks, Center for Alaska Native Health Research, Fairbanks, AK, United States
| | - Cristiane Kaufmann
- University of Alaska Fairbanks, Center for Alaska Native Health Research, Fairbanks, AK, United States
| | - Amy S Wilson
- Alaska Native Tribal Health Consortium, Division of Community Health Services, Anchorage, AK, United States
| | | | - Terry W Raymer
- Alaska Native Tribal Health Consortium, Division of Community Health Services, Anchorage, AK, United States
| | | | - Barbara V Howard
- MedStar Health Research Institute, Hyattsville, MD, United States; Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, United States
| | - Bert B Boyer
- University of Alaska Fairbanks, Center for Alaska Native Health Research, Fairbanks, AK, United States
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Sheehy T, Kolahdooz F, Roache C, Sharma S. Traditional food consumption is associated with better diet quality and adequacy among Inuit adults in Nunavut, Canada. Int J Food Sci Nutr 2015; 66:445-51. [DOI: 10.3109/09637486.2015.1035232] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bersamin A, Wolsko C, Luick B, Boyer B, Lardon C, Hopkins S, Stern JS, Zidenberg-Cherr S. Enculturation, perceived stress, and physical activity: implications for metabolic risk among the Yup'ik--the Center for Alaska Native Health Research Study. ETHNICITY & HEALTH 2014; 19:255-69. [PMID: 23297688 PMCID: PMC3644025 DOI: 10.1080/13557858.2012.758691] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVES American Indians and Alaska Natives (ANs) report among the lowest levels of physical activity in the USA, but there is very little systematic research examining the determinants of physical activity patterns in these populations. This study investigated the relationships between enculturation (or cultural traditionality), psychosocial stress, and physical activity in a community-based sample of Yup'ik women and men living in rural AN communities. Associations between these variables and several metabolic risk factors were also examined. DESIGN A sample of 488 Yup'ik participants (284 women and 204 men) from six villages in the Yukon-Kuskokwim Delta region completed a wellness survey and an array of physiological assessments [e.g., body mass index (BMI), blood pressure]. A subset of 179 participants also completed a 3-day pedometer assessment of physical activity. RESULTS Multivariate linear regression models indicated that participants who were more enculturated (i.e., living more of a traditional lifestyle) and who experienced lower levels of psychosocial stress were significantly more physically active. In turn, both lower levels of psychosocial stress and higher levels of physical activity were associated with lower BMI, lower percent body fat, and lower waist circumference. CONCLUSIONS Findings underscore the importance of gaining a culturally specific understanding of physical activity patterns in indigenous groups in order to inform effective health promotion strategies.
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Affiliation(s)
- Andrea Bersamin
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, Alaska
| | | | - Bret Luick
- Natural Resource Management, University of Alaska Fairbanks, Fairbanks, Alaska
| | - Bert Boyer
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, Alaska
| | - Cecile Lardon
- Psychology Department, University of Alaska Fairbanks, Fairbanks, Alaska
| | - Scarlett Hopkins
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, Alaska
| | - Judith S. Stern
- Department of Nutrition, University of California, Davis, Davis, California
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Sheehy T, Kolahdooz F, Schaefer SE, Douglas DN, Corriveau A, Sharma S. Traditional food patterns are associated with better diet quality and improved dietary adequacy in Aboriginal peoples in the Northwest Territories, Canada. J Hum Nutr Diet 2014; 28:262-71. [PMID: 24852202 DOI: 10.1111/jhn.12243] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Traditionally, the Arctic diet has been derived entirely from locally harvested animal and plant species; however, in recent decades, imported foods purchased from grocery stores have become widely available. The present study aimed to examine Inuvialuit, traditional or nontraditional dietary patterns; nutrient density of the diet; dietary adequacy; and main food sources of energy and selected nutrient intakes. METHODS This cross-sectional study used a culturally appropriate quantitative food frequency questionnaire to assess diet. Traditional and nontraditional eaters were classified as those consuming more or less than 300 g of traditional food daily. Nutrient densities per 4184 kJ (1000 kcal) were determined. Dietary adequacy was determined by comparing participants' nutrient intakes with the Dietary Reference Intakes. RESULTS The diet of nontraditional eaters contained, on average, a lower density of protein, niacin, vitamin B12 , iron, selenium, zinc, omega-3 fatty acids (P ≤ 0.0001), vitamin B6 , potassium, thiamin, pantothenic acid (P ≤ 0.001), riboflavin and magnesium (P ≤ 0.05). Inadequate nutrient intake was more common among nontraditional eaters for calcium, folate, vitamin C, zinc, thiamin, pantothenic acid, vitamin K, magnesium, potassium and sodium. Non-nutrient-dense foods (i.e. high fat and high sugar foods) contributed to energy intake in both groups, more so among nontraditional eaters (45% versus 33%). Traditional foods accounted for 3.3% and 20.7% of total energy intake among nontraditional and traditional eaters, respectively. CONCLUSIONS Diet quality and dietary adequacy were better among Inuvialuit who consumed more traditional foods. The promotion of traditional foods should be incorporated in dietary interventions for this population.
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Affiliation(s)
- T Sheehy
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - F Kolahdooz
- Aboriginal and Global Health Research Group, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - S E Schaefer
- Aboriginal and Global Health Research Group, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - D N Douglas
- Aboriginal and Global Health Research Group, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - A Corriveau
- Office of the Chief Public Health Officer, Department of Health and Social Services, Government of the Northwest Territories, Yellowknife, NT, Canada
| | - S Sharma
- Aboriginal and Global Health Research Group, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Redwood D, Provost E, Asay E, Roberts D, Haverkamp D, Perdue D, Bruce MG, Sacco F, Espey D. Comparison of fecal occult blood tests for colorectal cancer screening in an Alaska Native population with high prevalence of Helicobacter pylori infection, 2008-2012. Prev Chronic Dis 2014; 11:E56. [PMID: 24721216 PMCID: PMC3984942 DOI: 10.5888/pcd11.130281] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction Alaska Native colorectal cancer (CRC) incidence and mortality rates are the highest of any ethnic/racial group in the United States. CRC screening using guaiac-based fecal occult blood tests (gFOBT) are not recommended for Alaska Native people because of false-positive results associated with a high prevalence of Helicobacter pylori-associated hemorrhagic gastritis. This study evaluated whether the newer immunochemical FOBT (iFOBT) resulted in a lower false-positive rate and higher specificity for detecting advanced colorectal neoplasia than gFOBT in a population with elevated prevalence of H. pylori infection. Methods We used a population-based sample of 304 asymptomatic Alaska Native adults aged 40 years or older undergoing screening or surveillance colonoscopy (April 2008–January 2012). Results Specificity differed significantly (P < .001) between gFOBT (76%; 95% CI, 71%–81%) and iFOBT (92%; 95% CI, 89%–96%). Among H. pylori-positive participants (54%), specificity of iFOBT was even higher (93% vs 69%). Overall, sensitivity did not differ significantly (P = .73) between gFOBT (29%) and iFOBT (36%). Positive predictive value was 11% for gFOBT and 32% for iFOBT. Conclusion The iFOBT had a significantly higher specificity than gFOBT, especially in participants with current H. pylori infection. The iFOBT represents a potential strategy for expanding CRC screening among Alaska Native and other populations with elevated prevalence of H. pylori, especially where access to screening endoscopy is limited.
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Affiliation(s)
- Diana Redwood
- 4000 Ambassador Dr, C-DCHS, Anchorage, AK 99508. Telephone 907-729-3959. E-mail:
| | - Ellen Provost
- Alaska Native Tribal Health Consortium, Anchorage, Alaska
| | - Elvin Asay
- Alaska Native Tribal Health Consortium, Anchorage, Alaska
| | - Diana Roberts
- Centers for Disease Control and Prevention, Albuquerque, New Mexico
| | - Donald Haverkamp
- Centers for Disease Control and Prevention, Albuquerque, New Mexico
| | - David Perdue
- American Indian Cancer Foundation and Minnesota Gastroenterology PA, Minneapolis, Minnesota
| | - Michael G Bruce
- Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Frank Sacco
- Alaska Native Tribal Health Consortium, Anchorage, Alaska
| | - David Espey
- Centers for Disease Control and Prevention, Albuquerque, New Mexico
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Duncan GE, McDougall CL, Dansie E, Garroutte E, Buchwald D, Henderson JA. Association of American Indian cultural identity with physical activity. Ethn Dis 2014; 24:1-7. [PMID: 24620441 PMCID: PMC3970840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE Cultural factors are associated with health behaviors among American Indians. Accordingly, the objective of our study was to investigate whether cultural identity, defined as the primary language spoken at home, is associated with: 1) higher total physical activity levels, and 2) levels of leisure-time physical activity recommended for health benefits in a diverse sample of American Indians. DESIGN Cross-sectional analysis of 5,207 American Indian adults 18 to 82 years. Participants resided on the Oglala Sioux (n=2,025) and Cheyenne River Sioux (n=1,528) reservations in South Dakota, and the Gila River Indian Community (n=1,654) in Arizona. RESULTS Bicultural participants in South Dakota, but not Arizona, reported significantly higher total physical activity compared to the English-only group (P<.05). About 35% of English only speakers, 39% of American Indian/Alaska Native only speakers, and 39% of participants speaking both languages met the 150 minutes/week activity threshold. Odds of being sufficiently active were higher among bicultural respondents in both regions when compared to respondents endorsing only English, controlling for sociodemographic and health-related covariates (P<.05). CONCLUSION Bicultural respondents among tribal members in South Dakota had significantly higher total physical activity, and higher levels of sufficient leisure-time activity in both South Dakota and Arizona, compared to those who spoke either language exclusively. Interventions that encourage American Indians to develop their bicultural efficacy and to draw on resources for healthy living that may be available in all the cultures with which they identify are recommended.
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Zeng W, Eisenberg DTA, Jovel KR, Undurraga EA, Nyberg C, Tanner S, Reyes-García V, Leonard WR, Castaño J, Huanca T, McDade TW, Godoy R. Adult obesity: panel study from native Amazonians. ECONOMICS AND HUMAN BIOLOGY 2013; 11:227-235. [PMID: 22591954 DOI: 10.1016/j.ehb.2012.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 01/29/2012] [Accepted: 01/30/2012] [Indexed: 05/31/2023]
Abstract
This paper examines three morphological indicators measuring obesity among a native Amazonian population of foragers-farmers in Bolivia (Tsimane') and estimates the associations between them and standard covariates of obesity (e.g., socioeconomic status [SES]). We collected annual data from 350 non-pregnant women and 385 men ≥20 years of age from all 311 households in 13 villages during five consecutive years (2002-2006). We used three indicators to measure obesity: body-mass index (BMI), waist circumference (WC), and body fat using bioelectrical impedance analysis (BF-BIA). We ran separate individual random-effect panel multiple regressions for women and men with wealth, acculturation, health, and household food availability as key covariates, and controlled for village and year fixed effects and village×year interaction effects. Although BMI increases by a statistically significant annual growth rate of 0.64% among women and 0.37% among men over the five years, the increase does not yield significant biological meanings. Neither do we find consistent and biologically meaningful covariates associated with adult obesity.
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Affiliation(s)
- Wu Zeng
- Heller School, Brandeis University, Waltham, MA 02454, USA.
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Abstract
Dietary patterns are strongly influenced by cultural background and perspectives. Levels of dietary acculturation need to be considered when talking with immigrants about healthy eating. Lower levels of dietary acculturation are associated with positive health outcomes. Encouraging healthy traditional foods is a positive approach to use with individuals who are at lower levels of dietary acculturation. Questions about languages spoken in different settings and foods most often consumed can help health care practitioners assess levels of dietary acculturation. General intake recommendations of lower saturated fat, more whole grains, more fruits, more vegetables, leaner proteins, and smaller portion sizes (for caloric balance) are general recommendations that can be applied within most cultural food patterns to optimize health outcomes.
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Affiliation(s)
- Sarah E. Colby
- Department of Nutrition, The University of Tennessee, Knoxville, Tennessee
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Changes in the acquisition and consumption of food plants and their relationship with indigenous perceptions of health in a Guarani village, São Paulo, Brazil. Public Health Nutr 2012; 16:1820-6. [DOI: 10.1017/s136898001200434x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveThe present study investigated Guarani village interviewees’ diet changes over time, their perceptions about the changes and the effects of these changes on their health.DesignThe 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.SettingThe Tenondé Porã Guarani village is located in the district of Parelheiros, São Paulo, Brazil. Interviews were conducted from July 2008 to December 2009.SubjectsFifteen Guarani Indians, males and females in age categories ranging from youths to elders, took part in the study.ResultsThe 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.ConclusionsThe village location was a key factor in the Guarani diet change, although some rituals related to available plants were preserved.
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Redwood DG, Lanier AP, Johnston JM, Murphy N, Murtaugh MA. Reproductive cancer risk factors among Alaska Native women: the Alaska Education and Research Towards Health (EARTH) Study. Womens Health Issues 2012; 22:e387-93. [PMID: 22609255 PMCID: PMC3569005 DOI: 10.1016/j.whi.2012.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 04/13/2012] [Accepted: 04/13/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The purpose of this study was to provide estimates for the prevalence of reproductive cancer risk factors among Alaska Native (AN) women who enrolled in the Alaska Education and Research Towards Health (EARTH) Study from 2004 to 2006. METHODS A total of 2,315 AN women 18 years or older completed reproductive health questions as part of a comprehensive health history questionnaire. The reproductive health section included menstrual status (age at menarche and menopause), pregnancy and live birth history, use of hormonal contraception, hormone replacement therapy, and history of hysterectomy and/or oophorectomy. RESULTS A total of 463 (20%) of women experienced menarche before age 12 with a decline in mean age at menarche by age cohort. More than 86% had been pregnant (mean number of pregnancies, 3.8; mean number of live births, 2.9). More than one half of women (58%) had their first live birth between the ages of 18 and 24. Almost 28% of participants had completed menopause, of whom 24% completed menopause after age 52. Fewer than half (43%) reported ever using hormone replacement therapy. Almost two thirds (62%) reported ever using oral contraceptives, and fewer reported ever using birth control shots (30%) or implants (10%). CONCLUSIONS This study is unique in reporting reproductive health factors among a large group of AN women. These data show that AN women have selective protective factors for reproductive cancers, including low nulliparity rates, low use of menopausal estrogens, and common use of contraceptive hormones. However, analysis by age cohorts indicates decreasing age at menarche that might increase the risk for reproductive cancers among AN women in the future.
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Affiliation(s)
- Diana G Redwood
- Alaska Native Tribal Health Consortium, Anchorage, Alaska 99508, USA.
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Fialkowski MK, Okoror TA, Boushey CJ. The relevancy of community-based methods: using diet within Native American and Alaska Native adult populations as an example. Clin Transl Sci 2012; 5:295-300. [PMID: 22686210 PMCID: PMC4407991 DOI: 10.1111/j.1752-8062.2011.00364.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The rates of obesity, diabetes, and heart disease in Native Americans and Alaska Natives far exceed that of the general US population. There are many postulating reasons for these excessive rates including the transition from a traditional to a contemporary diet. Although information on the dietary intakes of Native American and Alaska Native communities are limited, there seems to be a consensus that the Native American and Alaska Native diet is high in total fat, saturated fat, cholesterol, and sodium. Further information on the diet needs to be attained so that dietary interventions can effectively be implemented in these communities. An approach that is community based is proposed as the best solution to understanding the Native diet and developing culturally tailored interventions to sustainably improve diet.
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Affiliation(s)
- Marie K. Fialkowski
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana, USA
| | - Titilayo A. Okoror
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana, USA
| | - Carol J. Boushey
- Department of Foods and Nutrition, Purdue University, West Lafayette, Indiana, USA
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Lanier AP, Redwood DG, Kelly JJ. The Alaska Education and Research Towards Health (EARTH) Study: cancer risk factors. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2012; 27:S80-5. [PMID: 22298198 PMCID: PMC9888362 DOI: 10.1007/s13187-012-0333-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The Alaska Education and Research Towards Health (EARTH) Study assessed cancer risk among 3,821 Alaska Native people (AN). We present the prevalence of selected cancer risk factors and comparison with Healthy People 2010 goals. Participants completed extensive computer-assisted self-administered questionnaires on diet, physical activity, tobacco and alcohol use, cancer screening, family history of cancer, and environmental exposures. Measurement data were collected on blood pressure, height, weight, waist/hip circumference, fasting serum lipids, and glucose. Cancer risk factors are high for the Alaska EARTH study population. For all risk factors studied except for vegetable consumption, Alaska EARTH Study participants did not meet Healthy People 2010 goals. This study is unique in providing questionnaire and measurement data of cancer risk factors on a larger study sample than any previous study among AN living in Alaska. Data show that the prevalence of most cancer risk factors exceeded national recommendations. Given the disease disparities that exist for the AN population, these data provide important baseline data that can be used to target health interventions and reduce health disparities.
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Affiliation(s)
- Anne P Lanier
- Alaska Native Tribal Health Consortium, 4000 Ambassador Drive, Anchorage, AK 99508, USA
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Johnson JS, Nobmann ED, Asay E. Factors related to fruit, vegetable and traditional food consumption which may affect health among Alaska Native People in Western Alaska. Int J Circumpolar Health 2012; 71:17345. [PMID: 22456043 PMCID: PMC3417710 DOI: 10.3402/ijch.v71i0.17345] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objectives Determine intake of fruits, vegetables and traditional foods (TF), availability of foods, and attitudes towards increasing their consumption. Study design Establish community baseline through a cross-sectional sample of residents who were weighed, measured and interviewed. Village stores were surveyed for food availability, price and quality. Methods Eighty-eight respondents self-identified as the household member primarily responsible for food shopping and cooking were surveyed in 3 Western Alaska Native villages using a food frequency questionnaire, and village stores were evaluated using food environment surveys. Results Overweight (BMI[kg/m2] >25) was present in 68% of participants. Fruit and vegetable intake (3.3 median servings/day) was low in comparison to recommended intakes of 5–9 servings/d. Seventy-two per cent were eating less than 5 servings/d of fruits and vegetables combined. Thirty-four per cent of respondents were trying to eat more vegetables; 41% were trying to eat more fruits. The median number of servings of TF was 3.2/d (mean 4.3/d). Seventy-seven per cent of respondents reported that they ate enough TF. Conclusion Recommendations to continue use of TF and increase intake of fruits and vegetables are consistent with local attitudes. Our findings indicate that increasing the availability of fruits and vegetables would be well received. Information from this study provides a basis for nutrition education and food supplement programs that is responsive to the needs and perceptions of the residents. Continued TF intake and increased fruit and vegetable intake have the potential to benefit the health of rural residents.
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Nash SH, Bersamin A, Kristal AR, Hopkins SE, Church RS, Pasker RL, Luick BR, Mohatt GV, Boyer BB, O’Brien DM. Stable nitrogen and carbon isotope ratios indicate traditional and market food intake in an indigenous circumpolar population. J Nutr 2012; 142:84-90. [PMID: 22157543 PMCID: PMC3237231 DOI: 10.3945/jn.111.147595] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The transition of a society from traditional to market-based diets (termed the nutrition transition) has been associated with profound changes in culture and health. We are developing biomarkers to track the nutrition transition in the Yup'ik Eskimo population of Southwest Alaska based on naturally occurring variations in the relative abundances of carbon and nitrogen stable isotopes (δ(15)N and δ(13)C values). Here, we provide three pieces of evidence toward the validation of these biomarkers. First, we analyzed the δ(15)N and δ(13)C values of a comprehensive sample of Yup'ik foods. We found that δ(15)N values were elevated in fish and marine mammals and that δ(13)C values were elevated in market foods containing corn or sugar cane carbon. Second, we evaluated the associations between RBC δ(15)N and δ(13)C values and self-reported measures of traditional and market food intake (n = 230). RBC δ(15)N values were correlated with intake of fish and marine mammals (r = 0.52; P < 0.0001). RBC δ(13)C values were correlated with intake of market foods made from corn and sugar cane (r = 0.46; P < 0.0001) and total market food intake (r = 0.46; P < 0.0001). Finally, we assessed whether stable isotope ratios captured population-level patterns of traditional and market intake (n = 1003). Isotopic biomarkers of traditional and market intake were associated with age, community location, sex, and cultural identity. Self-report methods showed variations by age and cultural identity only. Thus, stable isotopes show potential as biomarkers for monitoring dietary change in indigenous circumpolar populations.
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Affiliation(s)
- Sarah H. Nash
- Center for Alaska Native Health Research, Institute of Arctic Biology,Department of Biology and Wildlife,To whom correspondence should be addressed. E-mail:
| | - Andrea Bersamin
- Center for Alaska Native Health Research, Institute of Arctic Biology,Department of Biology and Wildlife
| | - Alan R. Kristal
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Rebecca S. Church
- Center for Alaska Native Health Research, Institute of Arctic Biology
| | - Renee L. Pasker
- Center for Alaska Native Health Research, Institute of Arctic Biology,Department of Biology and Wildlife
| | | | - Gerald V. Mohatt
- Center for Alaska Native Health Research, Institute of Arctic Biology,Department of Psychology, University of Alaska, Fairbanks, AK; and
| | - Bert B. Boyer
- Center for Alaska Native Health Research, Institute of Arctic Biology,Department of Biology and Wildlife
| | - Diane M. O’Brien
- Center for Alaska Native Health Research, Institute of Arctic Biology,Department of Biology and Wildlife
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Wetterhall S, Burrus B, Shugars D, Bader J. Cultural context in the effort to improve oral health among Alaska Native people: the dental health aide therapist model. Am J Public Health 2011; 101:1836-40. [PMID: 21852624 DOI: 10.2105/ajph.2011.300356] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The Alaska Native people in rural Alaska face serious challenges in obtaining dental care. Itinerant care models have failed to meet their needs for more than 50 years. The dental health aide therapist (DHAT) model, which entails training midlevel care providers to perform limited restorative, surgical, and preventive procedures, was adopted to address some of the limitations of the itinerant model. We used quantitative and qualitative methods to assess residents' satisfaction with the model and the role of DHATs in the cultural context in which they operate. Our findings suggest that the DHAT model can provide much-needed access to urgent care and is beneficial from a comprehensive cultural perspective.
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Redwood DG, Lanier AP, Johnston JM, Asay ED, Slattery ML. Chronic disease risk factors among Alaska Native and American Indian people, Alaska, 2004-2006. Prev Chronic Dis 2010; 7:A85. [PMID: 20550843 PMCID: PMC2901583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The Alaska Education and Research Towards Health (EARTH) Study is being conducted to determine the prevalence of clinically measured chronic disease risk factors in a large population of American Indian/Alaska Native people (AI/AN). We report these estimates and compare them with those for the overall US population, as assessed by the National Health and Nutrition Examination Survey (NHANES). METHODS We measured blood pressure, height, weight, and fasting serum lipids and glucose in a prospective cohort of 3,822 AI/AN participants who resided in Alaska during 2004 through 2006. We categorized participants as having chronic disease risk factors if their measurements exceeded cutoffs that were determined on the basis of national recommendations. We analyzed the prevalence of risk factors by sex and age and compared the age-adjusted prevalence with 1999-2004 NHANES measurements. RESULTS EARTH participants were significantly more likely than NHANES participants to be overweight or obese and to have impaired fasting glucose, low high-density lipoprotein cholesterol, high low-density lipoprotein cholesterol, and hypertension. The prevalence of high total cholesterol and triglycerides was not significantly different between the 2 study populations. CONCLUSION We provide baseline clinical measurements for chronic disease risk factors for a larger study sample than any previous study of AI/AN living in Alaska. The prevalence of most risk factors measured exceeded national rates. These data can be used to tailor health interventions and reduce health disparities.
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Affiliation(s)
- Diana G. Redwood
- Alaska Native Tribal Health Consortium Community Health Services
| | - Anne P. Lanier
- Alaska Native Tribal Health Consortium, Anchorage, Alaska
| | | | - Elvin D. Asay
- Alaska Native Tribal Health Consortium, Anchorage, Alaska
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