Pilot Investigator: Liz Anderson, DSW, LCSW
Despite high chronic disease and mortality rates, little is known about end-of-life care among American Indian and Alaska Native peoples (AIANs). AIANs have the highest diabetes rate of any racial or ethnic group. They are more likely to experience preventable hospitalizations and die from diabetes complications overall and at younger ages than non-Hispanic White adults. AIANs also have the highest premature mortality rate of any other race and are less likely to use hospice than Whites. Advance care planning (ACP) is a preventive intervention that allows people to express their medical wishes if they are unable to communicate and is associated with improved end-of-life care. Yet, research has found that 93% AIANs had never heard of a living will, a type of ACP. No study to date has examined hospitalization and hospice use at the end-of-life for a large nationally represented sample of AIANs. Thus, there is an urgent need to understand AIANs’ use of end-of-life health services. To address this gap, we will conduct secondary data analysis using Centers for Medicare and Medicaid Services 2019 Medicare data to understand end-of-life care with the following aims: 1) compare hospitalization and hospice use between AIAN and White beneficiaries by diabetes status; 2) examine associations between hospitalization and hospice use and personal characteristics between AIAN and White beneficiaries by diabetes status; and 3) conduct an exploratory analysis of ACP use in AIAN by patient characteristics to assess our ability to conduct a comprehensive multivariable analysis of ACP use in the future.
Pilot Investigator: Ginny Lane, PhD
The American Indian (AI) population experiences significant nutrition-related chronic disease health disparities, such as diabetes, cancer, and heart disease. These health disparities stem from the common experiences of historical trauma, boarding schools, adverse childhood events, poverty, federal food programs, and food deserts among the AI population. Addressing these disparities requires a multipronged approach to increase access to healthier foods. The DASH diet, which encourages the consumption of vegetables and fruits, lean meat and dairy products, and reduced sodium consumption, is a dietary intervention that has successfully lowered systolic blood pressure among various populations. However, it is unclear whether the provision of a DASH diet box to an AI population would result in healthier dietary intakes. Given the success of the DASH diet with various populations, this study will evaluate whether the provision of a DASH diet food box over 6 months to an AI population results in healthier dietary intakes and explore possible relationships to social support, resilience, stress, and discrimination. Data collected from 268 participants at baseline and at end of the six-month intervention will be compared, including mean values of fruit and vegetable intake and key nutrient intakes. The relationship between participants’ dietary improvement (change in their Healthy Eating Index between the two time points) and their social support, resilience, stress, and discrimination experiences will be analyzed to understand how participants’ lived experience of the social environment is related to dietary improvement.
Pilot Investigator: Chao Li, PhD
The adverse effects of smoking on diabetes have been widely studied in the general population. Numerous studies have reported that smoking can cause inflammation and dysfunction of endothelial, lipid and glucose metabolism and Beta-cell toxicity, damage tissue and vascular, increase insulin resistance and reduce insulin secretion. The direct effect of alcohol consumption on diabetes is complex and controversial. Some evidence indicates that moderate alcohol consumption may have a beneficial long-term effect on diabetes through improving glucose control and insulin sensitivity. On the contrary, low-level and binge alcohol consumption have been related with hypoglycemia and other adverse health outcomes, including increased risk of diabetic neuropathy and retinopathy, atherosclerosis, hepatocellular carcinoma, and problems of neuroendocrine, gastrointestinal, and sexual functioning. However, there is limited research that has been focused on the longitudinal and quantitative relationship between smoking and alcohol consumption and diabetes among American Indians (AIs). To evaluate the longitudinal relationship among smoking, alcohol consumption and key cardiovascular and diabetes biomarkers among AIs with diabetes. The hypothesis is that smoking has a negative, and alcohol consumption has a curvilinear, longitudinal dose-response effect on all or part of these key diabetes and cardiovascular biomarkers. This is a longitudinal cohort study, and the results will quantify the extent to which smoking and alcohol consumption, potentially modifiable factors, impact the evolution of HbA1c, fasting glucose, 2-h glucose and serum lipids among AIs with diabetes.
Project supported in part by American Diabetes Association.
Pilot Investigator: Susanna Lopez, PhD
American Indians (AIs) face significant disparities in obesity and diabetes due to colonization and their forced removal from their traditional homelands and foods. AIs are 3 times more likely to experience food insecurity, defined as limited or uncertain access to nutritious foods, compared to the general population. Food insecurity is significantly associated with poor diet, which, in turn, is the greatest risk factor for the development of obesity and diabetes. Depression, heavy alcohol use, and tobacco use are also associated with diabetes and poor diabetes management. Though less research has examined associations between depression, heavy alcohol use, tobacco use, and food insecurity, preliminary results suggest food insecurity is a risk factor for depression and risky substance use. More research is needed to further explore these relationships among AI communities. The present study is a secondary analysis seeking to investigate these associations using data from a larger study in partnership with the Chickasaw Nation. It is hypothesized that 1) AI adults with diabetes who are food insecure will report greater levels of depression, alcohol use, and smoking than those who are not food insecure, and 2) improvements in food insecurity over time will be associated with improvements in depression, alcohol use, and smoking; furthermore, these improvements will be stronger among those without diabetes than those with diabetes. The results of this study will advance knowledge in the relationships of both systemic and psychosocial factors on diabetes development, prevention, and management in a rural AI community.
Project supported in part by American Diabetes Association.
Pilot Investigator: Erin Morgan, PhD
American Indian (AI) men have the highest age-adjusted prevalence of type 2 diabetes (~18%) among U.S. men, while non-Hispanic White men have the lowest (~7%). Participation in clinical trials and diabetes intervention programs is quite low among AI men, which is perhaps due, in part, to the influence of perceived gender roles and social norms around health behavior. This project leverages the Strong Men, Strong Community (SMSC) study to understand the role of masculinity in diabetes prevention. The SMSC study was a clinical trial of a culturally appropriate adaptation of the Diabetes Prevention Program that aims to improve diet and increase exercise among AI men at high risk for diabetes. Data collection assessed self-reported engagement in diabetes prevention strategies (diet, exercise, healthcare engagement), perceived importance of various skills and behaviors in relation to masculinity, and influences on participants’ ideas of what it means to “be a man.” Using cross-sectional data from the baseline study visit (n = 270), we will evaluate relationships between perceptions of masculinity and current diabetes prevention strategies (diet, exercise, healthcare engagement) at baseline. Furthermore, we will conduct longitudinal analyses with data collected at follow-up visits over 12 months to assess how these relationships and views of masculinity change over time with continued participation in the intervention. Findings from these analyses will inform future diabetes interventions on the importance of incorporating cultural perspectives of masculinity into curriculum, and on whether influencing views on manhood may be one effective strategy to improve diabetes-related outcomes for AI men.
Pilot Investigator: Maja Pederson, PhD
Pilot Investigator: Brandon Varilek, PhD