Funded Pilot Projects

 

Evaluating the Association Between Mental Health and Diabetes Management Behaviors among American Indians and Alaska Natives Living with Diabetes

Kaipeng Wang, PhD

Mental health conditions, especially depression, appear to influence diabetes self- management behaviors, such as diet, exercise, and blood sugar monitoring. However, research on such relationships among AI/ANs with diabetes is limited. To address this gap, this project will evaluate the association between mental health and self-management behaviors (e.g., blood sugar testing, foot exams, taking diabetes management courses, self-monitoring of blood glucose, physical activity, routine health care visits) among AI/ANs with diabetes. Using data from the Behavioral Risk Factor Surveillance System (BRFSS), Dr. Wang will complete the following aims: (1) Explore the association between mental health, especially depression, and diabetes self-management behaviors among AI/AN with diabetes. (2) Explore the role of urban-rural residence status and education in affecting the relationship between mental health and diabetes self-management behaviors in AI/AN with diabetes.

Publication from this work:

Wang K, Jiang L, Zhu J, Manson SM. Depressive disorders, bad mental health days, and diabetes management behaviors among non-Hispanic American Indian/Alaska Native adults: Findings from the Behavioral Risk Factor Surveillance System. PLoS One. 2025;20(7):e0327870. doi: 10.1371/journal.pone.0327870

 

Longitudinal association among smoking, alcohol consumption and key diabetes and cardiovascular biomarkers among American Indians with diabetes

Li Chao, 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.

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Diabetic Ketoacidosis in Children: Risk Factors and Racial Disparities

Ginny Lane, PhD

Diabetic ketoacidosis (DKA) is an acute hyperglycemic emergency in people with diabetes. Noted risk factors for recurrent DKA include low socioeconomic status, adolescence, female sex, high glycated hemoglobin (HbA1c), previous episodes of DKA, and a history of mental health problems. Among children, risk factors for DKA include poor diabetes control, previous episodes of DKA, unstable or challenging family or social circumstances, adolescent age, being a peripubertal girl, and having limited access to medical services. It is unknown whether American Indian and Alaska Native children with diabetes experience the same risk factors for DKA. Using secondary data from the SEARCH for Diabetes in Youth project, the study team will address the following specific aims: (1) Evaluate the association of socioeconomic status, sex, HbA1c, treatment cost burden, diabetic instruction, episodes of missed medication, frequency of blood testing, disordered eating, quality of life, and dietary glycemic load with episodes of DKA among children; and (2) Evaluate whether there are differences in these relationships between various racial and ethnic groups.

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Understanding substance use and mental health symptoms in the relationship between food insecurity and diabetes in American Indian adults

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.

Publications from this work:

Cole AB, Lopez SV, Armstrong CM, et al. An updated narrative review on the role of alcohol among Indigenous communities. Current Addictiction Reports, 2023. doi:10.1007/s40429-023-00520-4.

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Perceptions of masculinity and health behaviors among Native men

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.

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Using CBPR and A Life Course Perspective to Examine Physical Activity among Rural American Indian Mid-life and Older Adults

Maja Pederson, PhD

American Indian (AI) adults are more likely to develop heart disease and die from it than non-Hispanic white (NHW) adults. Likewise, diabetes mellitus (diabetes) has a three-fold higher rate in AI adults than in NHWs and is the most important clinical risk factor for heart disease among AI populations. Physical activity (PA) is a powerful protective behavior known to reduce risk for heart disease and diabetes. Yet, PA rates are low among AI adults, and understanding of PA influences among this population is limited. This study responds to recent calls for advanced knowledge on PA among American Indians by attending to contextual factors (e.g., social, and environmental influences), and life course factors (e.g., life events and life transitions), that may impact PA engagement and participation. This study is part of an ongoing community-based participatory research (CBPR) partnership, including AI and non-AI study team members representing academic and tribal community-based entities. The team will use a CBPR approach and qualitative description to analyze data from semi-structured interviews (N=21) conducted among rural AI adults on topics of PA and wellbeing. The study is theoretically grounded in the NIMHD Health Disparities framework and the life course perspective. A collaborative, iterative content analysis process will be applied, guided by the theoretical framework. Findings will provide insight into contextual and life course factors influencing PA engagement and participation among AI adults, informing optimized timing and settings for customized interventions to increase PA, reduce diabetes and heart disease, and promote long-term wellbeing among AI populations.

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Palliative care use among American Indians with end-stage renal disease caused by diabetes

Brandon Varilek, PhD

American Indians and Alaska Natives (AI/ANs) are twice as likely to be diagnosed with diabetes than non-Hispanic Whites (NHWs). Persons with diabetes are at greater risk of end-stage renal disease (ESRD) and nearly two-thirds of all ESRD in AI/AN populations was caused by diabetes in 2013. Implementation of health promotion practices, such as nutrition and exercise programs, are essential to preserve renal function. Palliative care is also a health promotion practice that can improve quality of life for those with ESRD. Additionally, kidney transplantation is a desirable option to treat ESRD. Inclusion of palliative care in ESRD settings can help balance patient goals of care with transplant requirements to promote transplant readiness. No studies exist to date that examine the use of palliative care prior to kidney transplant among AI/ANs with ERSD r/t diabetes or viewed this problem using ETR’s Health Equity Framework by correlating aims to the Area Deprivation Index (ADI). To address this gap, we will conduct a secondary data analysis using United States Renal Data System data to understand the following aims: 1) Between AI/ANs and NHWs, compare the prevalence of ESRD r/t diabetes and ADI ratings nationally and by IHS region, 2) Among AI/ANs and NHWs with ESRD r/t diabetes who received a kidney transplant, contrast the rate of hospice referrals nationally, by IHS region, and correlate to the ADI rating, and 3) Between AI/ANs and NHWs, evaluate survival time after diagnosis with ESRD r/t diabetes nationally, by IHS region, and correlate to the ADI rating.

Publications from this work:

Varilek BM, Isaacson MJ, Moradi Rekabdarkolaee H. Evaluating disparities in end-stage kidney disease survival among American Indian/Alaska Native persons with diabetes. Journal of Racial and Ethnic Health Disparities, 2024. doi:10.1007/s40615-024-02173-z

Rekabdarkolaee HM, Longacre LE, Isaacson MJ, Varilek BM. Hospice Referral Rate Disparities of American Indian/Alaska Native Kidney Transplant Recipients with End-Stage Kidney Disease: A Retrospective Cohort Analysis. American Journal of Hospice and Palliative Care. Jan 20 2025:10499091251315419. doi:10.1177/10499091251315419

End-of-life care among American Indian and Alaska Native Medicare enrollees with diabetes

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.

Publications from this work:

Anderson E, Goins RT, Abdulsalam R, Jiang L, O'Connell J. End-of life care disparities experienced by American Indian and Alaska Natives peoples: An analysis of data from the 2019 Medicare Master Beneficiary Summary File. J Palliat Med. 2025;28(9):1185-1192. doi: 10.1089/jpm.2024.0481

Gestational diabetes and breastfeeding among American Indian and Alaska Native women

Luciana E. Hebert, PhD

Gestational diabetes, defined as diabetes that develops during pregnancy, is a serious, common, and pressing maternal and child health issue that disproportionately affects American Indian and Alaska Native (AI/AN) women. Gestational diabetes can have lifelong impacts for both mothers and children. During pregnancy, gestational diabetes increases the risk for pre-eclampsia, pre-term birth, and cesarean delivery. Following delivery, gestational diabetes places both mothers and children at higher risk of type 2 diabetes. Although breastfeeding is protective against development of diabetes following gestational diabetes, AI/AN women are less likely to initiate breastfeeding than other groups of women. However, no previous study has rigorously evaluated gestational diabetes, breastfeeding, and risk and protective factors in AI/AN women. This study involves a multistate analysis using data from the Pregnancy Risk Assessment Monitoring System (PRAMS) to explore gestational diabetes and breastfeeding patterns (initiation and duration) among AI/AN women compared to other racial and ethnic groups. First, we will examine risk factors related to gestational diabetes and how they differ for AI/AN women compared to other racial and ethnic groups. Second, we will examine the association of gestational diabetes with breastfeeding patterns among AI/AN women in PRAMS. This study will use secondary data from multiple states (Alaska, Washington, Oklahoma, New Mexico, and South Dakota) and years (2016-2018). Findings will provide valuable information about gestational diabetes and breastfeeding among Native women and inform development of culturally appropriate interventions.

Publications from this work:

Hebert LH, Nikolaus CJ, Zamora-Kapoor A, Sinclair K. Gestational diabetes and breastfeeding among women of different races/ethnicities: Evidence from the Pregnancy Risk Assessment Monitoring Surveys. Journal of Racial and Ethnic Disparities, 2022. doi:10.1007/s40615-022-01356-w

 

Food insecurity as a longitudinal predictor of diet sensitive cardiometabolic risk factors among American Indian and Alaska Native adults

Cassandra Nikolaus, PhD 

American Indians and Alaska Natives (AI/ANs) are at elevated risk for diet sensitive chronic diseases, including diabetes. This may, in part, be explained by food insecurity, defined as insufficient access to nutritious foods, and reported by 25% of AI/AN households. In the general population, food insecurity is associated with chronic diseases, healthcare costs, and premature mortality. However, these associations have not been established in data where AI/AN are identified, weakening the ability to develop culturally relevant interventions. Further, most prior research relies on cross-sectional data. To address these gaps, Add Health data will be analyzed to assess the relationship between food insecurity and diet sensitive cardiometabolic risk factors among AI/AN respondents. This pilot will use data from the two most recent assessment waves: wave 4, collected in 2008, and wave 5, collected in 2016-2018. Food security was measured in wave 4. Diet sensitive cardiometabolic risk factors (weight, fasting glucose, A1c, blood lipids, and blood pressure) were assessed at both waves. Using these data, the aims for this pilot are to: 1) assess the cross-sectional association of food insecurity and diet sensitive cardiometabolic risk factors among AI/AN adults during young adulthood in comparison with non-Hispanic white, non-Hispanic Black, and Hispanic respondents; and 2) assess the longitudinal relationship between food insecurity in young adulthood and changes in diet sensitive cardiometabolic risk factors across ten years among AI/AN, non-Hispanic white, non-Hispanic Black, and Hispanic adults.

Publications from this work:

Nikolaus CJ, Hebert LE, Zamora-Kapoor A, Sinclair KI. Risk of food insecurity in young adulthood and longitudinal changes in cardiometabolic health: Evidence from the National Longitudinal Study of Adolescent to Adult Health. Journal of Nutrition, 2022. doi:10.1093/jn/nxac055

Nikolaus CJ, Zamora-Kapoor A, Hebert LE, Sinclair K. Association of food security with cardiometabolic health during young adulthood: Cross-sectional comparison of American Indian adults with other racial/ethnic groups. BMJ Open, 2022 doi:10.1136/bmjopen-2021-054162

Food insecurity and healthful eating for American Indian and Alaska Native adults with type 2 diabetes: Perspectives from key stakeholders

Sarah Stotz, PhD, MS, RD, CDE, LD

Food insecurity is well documented as a barrier to healthful eating and diabetes self-management. American Indians and Alaska Natives (AI/AN) are twice as likely to experience food insecurity and type 2 diabetes (T2D) than non-AI/ANs. For this proposed project, we will conduct secondary analyses on the qualitative data collected as part of a needs assessment aimed to inform the cultural adaptation of an existing diabetes nutrition education program for AI/AN adults with T2D. This project will explore themes regarding food insecurity and healthful eating for diabetes management in AI/AN communities, as described by AI/ANs with T2D and key stakeholders. Findings from the project will serve as preliminary study to support a future large-scale grant proposal to develop AI/AN-specific nutrition education interventions that address food insecurity as it pertains to diabetes self-management.

Publications from this work:

Stotz S, Brega AG, Henderson JN, Lockhart S, Moore K. Food Insecurity and Associated Challenges to Healthy Eating Among American Indians and Alaska Natives With Type 2 Diabetes: Multiple Stakeholder Perspectives. Journal of Aging and Health, 2021 doi: 10.1177/08982643211013232.

Stotz SA, Ricks KA, Eisenstat SA, Wexler DJ, Berkowitz SA. Opportunities for Interventions That Address Socioeconomic Barriers to Type 2 Diabetes Management: Patient Perspectives. The Science of Diabetes Self-Management and Care, 2021. doi: 10.1177/0145721721996291

Stotz SA, McNealy K, Begay RL, DeSanto K, Manson SM, Moore KR. Multi-level Diabetes Prevention and Treatment Interventions for Native People in the USA and Canada: A Scoping Review. Current Diabetes Reports, 2021. doi: 10.1007/s11892-021-01414-3

 

 

Spatial clustering and associated determinants of diabetes in Navajo youth

Christine Wey Hockett, PhD

(with Dana Dabelea, MD, PhD, Sonya S. Shin, MD, MPH, Michael C. Wimberly, PhD, Phoutdavone Phimphasone-Brady, PhD, and Anna Bellatorre, PhD)

American Indian youth (aged 0-19 years) have the highest incidence of pediatric type 2 diabetes (T2D) in the United States; however, there is limited research on the geographic variation of T2D in youth, and none in high-risk populations, such as American Indians. In response to this gap in the literature, this project will build upon our long-standing collaborations between academic researchers and Native stakeholders to identify areas within Navajo Nation that have a higher than expected burden of T2D (hotspots) and explore what ecological characteristics explain these hotspots. The specific aims of our project are 1) to identify spatial clusters of T2D incident cases in Native youth on Navajo Nation from 2002 through 2016, 2) determine what social and environmental determinants are associated with high-risk clusters of T2D on Navajo Nation; and 3) host a half-day mini-summit, involving key community stakeholders, to disseminate the results of the project. Key community stakeholders may be able to use these results to prioritize resources and target efforts for pediatric diabetes prevention.​

Clinical and social determinants of health for obesity: A Lifespan investigation of overweight/obesity among American Indians and Alaska Natives

Cheryl Conway, PhD,  Amber Fyfe-Johnson, PhD, Vanessa Hiratsuka, PhD, Kimberly Huyser, PhD, and Michelle Johnson-Jennings, PhD

American Indians and Alaska Natives (AI/ANs) have a prevalence of diabetes that is 2 to 3 times that of the general U.S. population. Obesity, a key risk factor for type 2 diabetes, is common in AI/AN populations and often begins in early childhood. 
 The prevalence of obesity is significantly higher among Native preschoolers, school-aged children, youth, and adults than in the comparable subgroups of the general U.S. population. Social determinants of health (SDOH), or the conditions in which
 people are born, grow, live, and work (e.g., socioeconomic conditions, access to health care, and food access and security), are known to influence racial disparities in health outcomes. Although some research suggests that SDOH may play an important
 role in the high rates of obesity, diabetes, and cardiovascular disease among Native people, the literature does not provide clear conclusions regarding the association of SDOH with diabetes-related outcomes in Native populations.



The objective of this pilot project is to investigate the relationship between SDOH and diabetes outcomes in AI/ANs, using a life course perspective. Analyzing longitudinal data available from the Indian Health Service’s (IHS) Improving Health Care
 Delivery Data Project (IHCDDP), five Early-Stage Investigators from our collaborating Satellite Centers are addressing three specific aims: 1) the association of SDOH with diabetes-related outcomes among AI/AN mothers (obesity, gestational diabetes)
 and birthweight of Native newborns; 2) the association of SDOH with diabetes-related outcomes among Native children,  adolescents, and young adults (Body Mass Index, pre-diabetes, diabetes); and 3) the association of food access and security
 with diabetes-related outcomes among Native elders.




Publications from this work:

Fyfe-Johnson AL, Reid MM, Jiang L, Chang JJ, Huyser KR, Hiratsuka VY, Johnson-Jennings MD, Conway CM, Goins TR, Sinclair KA, Steiner JF, Brega AG, Manson SM, O'Connell J. Social determinants of health and body mass index in American Indian/Alaska Native children. Child Obesity, 2022. doi:10.1089/chi.2022.0012 

Goins RT, Conway C, Reid M, Jiang L, Chang J, Huyser KR, Brega AG, Steiner JF, Fyfe-Johnson AL, Johnson-Jennings M, Hiratsuka V, Manson SM, O'Connell J. Social determinants of obesity in American Indian
 and Alaska Native peoples aged ≥ 50 years. Public Health Nutrition, 2022. doi:10.1017/s1368980022000945 

Hiratsuka VY, Reid M, Chang J, Jiang L, Brega AG, Fyfe-Johnson AL, Huyser KR, Johnson-Jennings M, Conway C, Steiner JF, Rockell J, Dillard DA, Moore K, Manson SM, O'Connell J. Associations between
 rurality, pre-pregnancy health status, and macrosomia in American Indian/Alaska Native populations. Maternal and Child Health Journal, 2022. doi:10.1007/s10995-022-03536-w 



Johnson-Jennings MD, Reid M, Jiang L, Huyser KR, Brega AG, Steiner JF, Manson SM, Chang J, Fyfe-Johnson AL, Hiratsuka V, Conway C, O'Connell J. American Indian Alaska Native (AIAN) adolescents and obesity:
The influence of social determinants of health, mental health, and substance use. International Journal of Obesity, 2023. doi:10.1038/s41366-022-01236-7 

Huyser KR, Brega AG, Reid M, Parker T, Steiner JF, Chang J, Jiang L, Fyfe-Johnson AL, Johnson-Jennings M, Hiratsuka VY, Tsosie N, Manson SM, O'Connell J. Impact of social determinants of health on obesity among American Indian and Alaska Native young adults. PLoS One. 2025. doi:10.1371/journal.pone.0322164

Engaging families to improve diabetes management at an Urban Indian Health Organization

Meredith Fort, PhD


Type 2 diabetes is one of the most common chronic conditions in the US, and disproportionately affects American Indians who have the highest prevalence among all racial and ethnic groups. One promising approach to support patients in managing their diabetes
 is the engagement of family members. Families are important in chronic disease management and care among American Indians/Alaska Natives, but much less is known about urban American Indians, whose families may be dispersed between urban and reservation
 communities. We propose a study building on the infrastructure of a recently-funded, collaborative study including the Centers for American Indian and Alaska Native Health and the Institute for Health Research aimed at improving hypertension management
 among clients who receive care at the First Nations Community Healthsource (FNCH) in Albuquerque, New Mexico. In specific aim 1, we will use a combination of qualitative methods including individual and family interviews, genograms and eco-maps, to
 identify the roles, relationships and resources of patients and their family members that influence improved or inhibited medication adherence, appointment-keeping, and implementation of self-management plans. In specific aim 2, we will engage patients,
 family members and an advisory board in the development of family-focused strategies for improved disease management. The results of this study will inform the parent study and will lay the foundation for a future study that will assess ways to engage
 families in supporting patients with diabetes and hypertension in ongoing self-care.






Pediatric obesity and type 2 diabetes in American Indian youth


Katherine Sauder, PhD



Pediatric obesity and type 2 diabetes (T2D) are global public health problems worldwide, and American Indian (AI) youth have the highest incidence and prevalence of T2D in the United States. We recently completed an 8-month pilot and feasibility trial
 of a behavioral intervention designed to reduce these risks in 62 overweight/obese AI youth aged 7-10 years. To maintain the momentum of this research and to guide dissemination and implementation plans across AI communities, we conducted a 1-year
 community-based participatory research process with Navajo Nation in conjunction with the Special Diabetes Program for Indians (SDPI). Our specific aims are: 1) to share the findings of the pilot study with study participants, TTPP research team,
 local community leaders, and relevant stakeholders; 2) to explore opportunities for the sustainable implementation of the program within the larger Navajo Nation community; 3) to plan for a larger dissemination and implementation research study that
 will expand the program to additional AI communities. By continuing our collaboration with Navajo Nation and using lessons learned from SDPI, we can prepare to expand the TTPP for youth in AI communities in a sustainable, effective manner.

 

American Indian and TOPS Collaboration for Health (AITCH)

Nia Mitchell, MD

American Indians are at increased risk for Type 2 diabetes compared to other Americans. A primary risk factor for diabetes is being overweight or obese, and American Indians are more likely to be overweight or obese than other Americans.  Therefore, effective interventions focused on weight management hold promise for diminishing the diabetes-related disparities American Indians face.  Take Off Pounds Sensibly (TOPS) is a nonprofit, low-cost, peer-led, nationally available weight loss program, and a recent study showed that TOPS helped people lose 5% of their initial weight and maintain the weight loss for up to 3 years.  Each TOPS chapter decides the types of programs it would like to include; therefore each chapter can be tailored to fit the needs of its members. The objective of this project is to explore and address barriers to the diffusion of TOPS in the American Indian community in the Denver metropolitan area by offering the program to 50 American Indian participants through a local community organization that serves the American Indian community.  Both qualitative and quantitative assessments will be utilized. Surveys will be used to evaluate the eating and physical activity patterns, self efficacy, and stages of change pre- and post-intervention.  Focus groups will be used to determine the feasibility and acceptability of the program and to get feedback on ways to tailor the program to the American Indian community.  We will also assess the weight change of participants over a 12 week intervention.

 

Numeracy Intervention to Improve Diabetes Self-care (NIIDS) 

Angela Brega, PhD

Growing evidence suggests that the ability to understand and use numbers (“numeracy”) may have important implications for diabetes self-care.  Compared to patients with stronger numerical skills, those with limited numeracy check their blood sugar levels less frequently, are less likely to adjust their insulin doses based on carbohydrate intake and blood sugar levels, have less confidence that they can manage their diabetes (i.e., self-efficacy), and have worse glycemic control. The objective of this project is to develop a computerized intervention to teach American Indian patients a subset of the numeracy skills needed to manage diabetes.  The intervention will focus on three sets of self-care skills (understanding blood glucose values, monitoring carbohydrate intake, managing cardiovascular risk) and will be culturally tailored for the American Indian tribe that is participating in the project.  The computerized intervention will incorporate audio- and video-based education and will comply with recommendations for clear communication of health information.  Pilot testing of the intervention will be conducted with 50 American Indian patients with diabetes from a large Indian Health Service clinic serving our partner tribe.  Using a pre-post design, we will examine change over time in diabetes numeracy, self-efficacy, stage of change, and self-care behavior.