Michelle Estradé1, Angela C B Trude2, Marla Pardilla3, Brittany Wenniserí Iostha Jock4, Jacqueline Swartz3, Joel Gittelsohn3. 1. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Electronic address: mestrad7@jhu.edu. 2. Department of Pediatrics, University of Maryland, College Park, MD. 3. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. 4. School of Human Nutrition, Centre for Indigenous Peoples' Nutrition and Environment (CINE), McGill University, Ste-Anne-de-Bellevue, Quebec, Canada.
Abstract
OBJECTIVE: To identify psychosocial and household environmental factors related to diet quality among Native Americans (NA). DESIGN: Analysis of baseline data from a community-randomized obesity prevention trial. SETTING: Six rural NA communities in the Midwest and the Southwestern US. PARTICIPANTS: A total of 580 tribal members, aged 18-75 years old (mean 45 years), 74% female, self-identified as the main household food purchaser. VARIABLES MEASURED: Diet quality (Healthy Eating Index-2015 [HEI]) was derived from a semiquantitative food frequency questionnaire. Sociodemographic, psychosocial, and home food environment factors were assessed via interviewer-administered questionnaires. ANALYSIS: One-way ANOVA, linear regression models, and 2-tailed t tests compared HEI scores among sociodemographic categories. Multiple linear regression models assessed the relationship between psychosocial factors, home food environment, and HEI. RESULTS: Prevalence of obesity was 59%. Mean HEI-2015 score was 49.3 (SD = 8.1). Average HEI scores were 3.0 points lower in smokers than nonsmokers (P < 0.001), and 2.2 points higher in females than males (P < 0.01). Higher self-efficacy (β = 0.97; P < 0.001) and healthier eating intentions (β = 0.78; P < 0.001) were positively associated with HEI. Healthier household food patterns score was associated with higher HEI (β = 0.48; P < 0.01). CONCLUSIONS AND IMPLICATIONS: Psychosocial factors were associated with diet quality, a finding that supports the use of social-cognitive intervention approaches in rural NA communities in the Midwest and Southwest, and warrants evaluation in other locations. There remains a need to elucidate the association between the Food Distribution Program on Indian Reservations and diet quality.
OBJECTIVE: To identify psychosocial and household environmental factors related to diet quality among Native Americans (NA). DESIGN: Analysis of baseline data from a community-randomized obesity prevention trial. SETTING: Six rural NA communities in the Midwest and the Southwestern US. PARTICIPANTS: A total of 580 tribal members, aged 18-75 years old (mean 45 years), 74% female, self-identified as the main household food purchaser. VARIABLES MEASURED: Diet quality (Healthy Eating Index-2015 [HEI]) was derived from a semiquantitative food frequency questionnaire. Sociodemographic, psychosocial, and home food environment factors were assessed via interviewer-administered questionnaires. ANALYSIS: One-way ANOVA, linear regression models, and 2-tailed t tests compared HEI scores among sociodemographic categories. Multiple linear regression models assessed the relationship between psychosocial factors, home food environment, and HEI. RESULTS: Prevalence of obesity was 59%. Mean HEI-2015 score was 49.3 (SD = 8.1). Average HEI scores were 3.0 points lower in smokers than nonsmokers (P < 0.001), and 2.2 points higher in females than males (P < 0.01). Higher self-efficacy (β = 0.97; P < 0.001) and healthier eating intentions (β = 0.78; P < 0.001) were positively associated with HEI. Healthier household food patterns score was associated with higher HEI (β = 0.48; P < 0.01). CONCLUSIONS AND IMPLICATIONS: Psychosocial factors were associated with diet quality, a finding that supports the use of social-cognitive intervention approaches in rural NA communities in the Midwest and Southwest, and warrants evaluation in other locations. There remains a need to elucidate the association between the Food Distribution Program on Indian Reservations and diet quality.
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