2015 CRCAIH Pilot Grants Program Awardees
Pregnancy Health Survey for Parents of Newborns on the Lake Traverse Indian Reservation
Sara DeCoteau, BA, Sisseton-Wahpeton Oyate of the Lake Traverse Reservation, Human Services/Division of Health Services
Bonny Specker, PhD, South Dakota State University, Ethel Austin Martin Program
Improved health of American Indian mothers and infants is the long-term goal of the Pregnancy Health Survey for Parents of Newborns on the Lake Traverse Indian Reservation (PHSPN Project). South Dakota American Indians (AI) have one of the worst infant mortality rates in the US (13.4/1,000 births in 2012). For Sisseton-Wahpeton Oyate (SWO) the rate was 16.2/1,000 (2008-2012). Despite the poor birth outcomes and infant health, little is known about parental behaviors and attitudes during pregnancy in relation to birth outcomes. The Pregnancy Risk Assessment Monitoring System (PRAMS) survey was developed by the Centers for Disease Control and Prevention (CDC) and enables states to obtain data on maternal health behaviors and attitudes. CDC currently funds 40 states to complete the PRAMS, which covers topics including barriers to and content of prenatal care and obstetric history; maternal use of alcohol, drugs and cigarettes; physical and emotional abuse; pregnancy intendedness and contraception; maternal stress and birth outcomes. In 2007 a South Dakota Tribal PRAMS was completed by the Great Plains Tribal Chairmen's Health Board Northern Plains Tribal Epidemiology Center (GPTCHB/NPTEC), which collected information on all AI births during a 9-month period. Tribe-specific data have been supplied to the individual Tribes throughout the state, including SWO. Currently a statewide SD PRAMS is being conducted on a sample of all 2014 births. The 2014 SD PRAMS is oversampling AI births (27%), but will still not allow for reporting of individual Tribe data. The specific aims of our proposed project are to 1) conduct a PRAMS survey on the Lake Traverse Reservation including all AI births for a 9-month period; 2) develop and administer a father’s PRAMS-like survey as part of the PHSPN; and 3) include the Adverse Childhood Experience (ACE) calculator in both parental surveys. It is expected that parents of about 110 infants will be eligible to participate in the PHSPN. Surveys will be completed in-person or online and data compiled and analyzed. Completion of the 2015
PHSPN will allow the SWO to compare changes in maternal and birth outcome indicators between 2007 and 2015 in order to improve programming. A unique aspect of the proposed project is the addition of a PRAMS survey targeting the fathers; this survey will help the Tribe better understand how fathers’ behaviors, attitudes, and ACE history affect maternal and infant health. Current programs in adolescent pregnancy and parenting are exploring ways to reach and engage young fathers, but little research has been done, regionally or nationally, on the influence of the father’s involvement and behaviors on maternal and birth outcomes.
Inclusion of the ACE calculator will provide Tribal-specific data on the extent to which toxic childhood stress has occurred in this population and whether parental ACE scores are associated with parental behaviors and infant health outcomes. This project can serve as a model for future maternal and infant health assessments for other Tribes.
Healthy Food Healthy Families Feasibility Study
Amanda Fretts, PhD, University of Washington, School of Public Health
Throughout the lifespan, American Indians (AIs) are more likely to be overweight/obese than non-Hispanic whites of similar age. As childhood obesity is associated with serious and debilitating health conditions later in life, identifying effective interventions for lowering risk of overweight/obesity in children is critical.
Although a poor diet is a major risk factor for obesity, the promotion of a healthy diet has done little to lower the burden of obesity among AIs. Moreover, merely increasing assess to healthy foods may not always translate into healthy food choices as unfamiliarity with healthy foods (e.g., taste, cooking methods) may deter families from purchasing these items. Without understanding the social-contextual factors that affect families’ dietary choices/food purchasing patterns, the implementation of sustainable interventions is difficult. Moreover, investments in interventions that do not recognize and address the underlying social-contextual factors that give rise to families’ dietary choices/food purchasing patterns may be ineffective.
Evidence-based point-of-purchase food store interventions (e.g., prime placement of healthy foods, shelflabeling, taste-testing) have been shown to influence the food purchasing patterns of AI adults. Few studies have tested the feasibility of family-friendly grocery store interventions even though school-aged children often accompany their caretakers to grocery stores and are known to be influenced by the local food environment.
The overall goal of this application is to determine the feasibility of a kid-friendly grocery-store-based obesity prevention intervention on the Cheyenne River Sioux reservation. This effort comprises 2 aims to be completed over a one year period: (1) characterize the local food environment of the Cheyenne River Sioux community, and investigate the decision-making process underlying family food-purchasing patterns. This will include an evaluation of the availability, price, and variety of foods offered at retail food stores on and around the Cheyenne River Sioux reservation using the USDA Community Food Store Survey Instrument, as well as focus groups and key-informant interviews with AIs who reside in the community to determine what external and internal factors are the primary facilitators and barriers of healthy dietary decisions; and (2) work in partnership with the Lakota Thrifty Mart—the tribally-owned and centrally-located major grocery store in Eagle Butte South Dakota—to develop a kid-friendly food-store intervention to promote healthy food choices for school-aged children and their families. Intervention activities will be based on the formative research collected as part of aim 1, as well as evidence-based grocery store intervention strategies that were successful in other communities. Feasibility, reach, and acceptability of the intervention’s components will be pilot tested and evaluated during the study period.
The long-term goal of this project is to generate the knowledge necessary to develop a culturally-appropriate and sustainable grocery store-based obesity prevention intervention in the Cheyenne River Sioux community. If successful, this feasibility work will be expanded into a formal pilot intervention trial in the future as an R01grant.
East-Metro American Indian Diabetes Initiative: An Evaluation of Innovative Community-based Programs to Improve the Health of Native Men and Youth
Tai Mendenhall, PhD, University of Minnesota, Family Social Sciences
Kathy Denman-Wilke, MEd, Interfaith Action, Department of Indian Work
The East-Metro American Indian Diabetes Initiative (EMAIDI) represents a purposeful partnership uniting four American Indian (AI) serving organizations that collectively serve urban-dwelling youth, adults, and elders. This well-established partnership was created in response to gaps in research, care, and outreach that have: 1) neglected complex hardships of living in urban contexts; 2) failed to effectively engage minority men; 3) not tapped powerful processes in family- and community- support; and 4) advanced fragmented knowledge and services secondary competitive (vs. collaborative) structures for limited funding. This initiative is driven by a community-based participatory research (CBPR) approach embraced by AI community members working with medical- and mental health- professionals at the University of Minnesota.
Our primary goal is to evaluate two of our overlapping and interconnected interventions: Our Men’s Group purposefully integrates sacred cultural/spiritual activities, reclaims men’s roles as strong/valued family and community members, and gives support facilitative toward healthy behavior change. Our Youth Education advances CBPR-adapted versions of the Diabetes in Tribal Schools (DETS) curriculum, which integrates culturally-based notions of “walking in balance” with empirically-supported knowledge about health/disease management.
Our pilot investigation will assess whether participants evidence change in their: 1) physical health (measured by weight and body mass index), 2) knowledge/understanding about diabetes (measured by the Diabetes Knowledge Test), and 3) health behaviors (tracked via logbook regarding physical activities and disease management tasks). Employing a single-group/repeated-measures design, we will collect these data at three time periods (study months 2, 6, and 10). Participants will include AIs who are both new to the programs described above and those who are returning for another intervention sequence.
Changes in physiological and knowledge data will be analyzed within the entire sample (n170). Health behaviors will be described and summarized. Physiological and knowledge data will be analyzed using paired t-tests, both for the entire sample and for new subjects. We expect to be able to detect a small to moderate effect size (d=.35 to .45) on our primary physiological outcomes with a power of .80. For subjects new to each program (n35), we would still expect to find moderate to large effects (d=.50 to .65). While lacking power to meaningfully compare the new group with the experienced group in this small sample, our comparison will inform the development of a larger, well-powered, randomized controlled trial (for which we will seek federal funding).
We expect that results will reflect improvement across all measures, thereby informing others about innovative ways to engage high-risk AI men and youth residing in urban contexts. Additionally, our findings will justify the following: 1) testing of dose-response relationships between program participation and outcomes (e.g., does a child in Youth Education whose father is in the Men’s Group and whose family participates in other EMAIDI family-based programming do better than a child whose family is not engaged in simultaneous interventions?); 2) continuance of current funding to sustain EMAIDI programs; 3) CBPR adaptation and extension of our interventions into other metropolitan areas (where prevalence of diabetes is highest across all Native groups).