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Exploring Food Insecurity as a Social Determinant of Health Among American Indian and Alaska Native Adolescents at Risk for Gestational Diabetes

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PROJECT SUMMARY / ABSTRACT American Indian and Alaska Native (AI/AN) women are twice as likely to have gestational diabetes mellitus (GDM) and subsequent diagnosis of type 2 diabetes as non-Hispanic White females. GDM and obesity can cause severe perinatal complications for both mother and baby. Weight management through healthy diet and physical activity are key factors in decreasing risk for GDM. However, there are barriers to healthful eating in many AI/AN communities. Food insecurity, defined as the lack of consistent access to enough food for an active, healthy life, is a risk factor for unwanted weight gain. Living in a food insecure household during preconception and pregnancy may increase risk of greater weight gain and perinatal complications for both mother and baby. Our team recently developed and conducted a randomized controlled trial evaluation of an innovative GDM risk reduction and preconception counseling program for AI/AN adolescent girls who are at high risk for GDM. This tribally-supported, online, theory-and evidence-based program, entitled Stopping GDM, focuses on healthy GDM risk reduction behaviors, such as weight management, through healthy eating and physical activity, prior to pregnancy. Our formative findings from this work suggest that AI/AN women view food insecurity as a key barrier to healthful eating, both before and during pregnancy. Currently, however, Stopping GDM does not specifically address food insecurity as a content area of focus. In this proposed project, we will employ a mixed-methods study design to examine the relationship between food insecurity with healthy eating self-efficacy and behaviors among AI/AN adolescent girls (n=149) through secondary analysis of the existing Stopping GDM dataset. We hypothesize that AI/AN adolescent girls who live in food insecure households will have poorer self-efficacy for healthy eating and poorer healthy eating behaviors, both of which are related to increased risk of GDM. After this secondary quantitative data analysis, we will use qualitative inquiry through individual interview methods to engage key stakeholders to assist with the interpretation and implications of these findings. Through teleconference or phone-based interviews, we will recruit AI/AN mothers of adolescent girls, AI/AN adolescent girls, and AI/AN women with a history of GDM from the Stopping GDM trial in two collaborating AI/AN communities (Saint Regis Mohawk of Akwesasne, NY and a multi-tribal urban center in Portland, OR). Additionally, we will recruit nationwide experts on topics such as: AI/AN food insecurity, traditional AI/AN foods, traditional AI/AN food acquisition habits, and health care providers who serve AI/AN girls such as registered dietitians. Using this qualitative method we will reintroduce the voice of AI/AN community members to inform next steps in the adaptation of Stopping GDM to effectively address food insecurity as a contributor to GDM health disparities through innovative, multi-systems approaches. This work is critical to break the intergenerational cycle of diabetes in AI/AN communities, starting during the preconception period.
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