663-P: Online Diabetes Nutrition Education for American Indian and Alaska Native Adults with Type 2 Diabetes: Stakeholder Perspectives

The Tribal Maternal, Infant, and Early Childhood Home Visiting (Tribal MIECHV) Program provides federal grants to tribes, tribal consortia, tribal organizations, and urban Indian organizations to implement evidence-based home-visiting services for American Indian and Alaska Native (AI/AN) families. To date, only one evidence-based home-visiting program has been developed for use in AI/AN communities. The purpose of this article is to describe the steps that four Tribal MIECHV Programs took to assess community needs, select a home-visiting model, and culturally adapt the model for use in AI/AN communities. In these four unique Tribal MIECHV Program settings, each program employed a rigorous needs-assessment process and developed cultural modifications in accordance with community strengths and needs. Adaptations occurred in consultation with model developers, with consideration of the conceptual rationale for the program, while grounding new content in indigenous cultures. Research is needed to improve measurement of home-visiting outcomes in tribal and urban AI/AN settings, develop culturally grounded home-visiting interventions, and assess the effectiveness of home visiting in AI/AN communities.

Facilitators and Barriers to Healthy Eating Among American Indian and Alaska Native Adults with Type 2 Diabetes: Stakeholder Perspectives

To explore stakeholder perspectives regarding online diabetes nutrition education for American Indians and Alaska Natives (AI/AN) with type 2 diabetes (T2D). Qualitative data were collected through focus groups and interviews. Focus group participants completed a brief demographic and internet use survey. Focus groups and community participant interviews were conducted in diverse AI/AN communities. Interviews with nationally recognised content experts were held via teleconference. Eight focus groups were conducted with AI/AN adults with T2D (n 29) and their family members (n 22). Community participant interviews were conducted with eleven clinicians and healthcare administrators working in Native communities. Interviews with nine content experts included clinicians and researchers serving AI/AN. Qualitative content analysis used constant comparative method for coding and generating themes across transcripts. Descriptive statistics were computed from surveys. AI/AN adults access the internet primarily through smartphones, use the internet for many purposes and identify opportunities for online diabetes nutrition education. Online diabetes nutrition education may be feasible in Indian Country. These findings will inform the development of an eLearning diabetes nutrition education programme for AI/AN adults with T2D.

673-P: Food Insecurity and Intervention Opportunities for American Indians and Alaska Natives with Type 2 Diabetes: A Qualitative Analysis

662-P: Facilitators and Barriers to Healthy Eating among American Indian/Alaska Native Adults with Type 2 Diabetes: Stakeholder Perspectives

BackgroundResearch on social engagement, community connectedness, and health outcomes in American Indian and Alaska Native (AI/AN) adults is limited. This study examined associations of social engagement and community overlap with cognitive function, distress, and mental and physical health in middle‐aged and older AI/AN adults.MethodData were collected from a cross‐sectional survey conducted from 2019‐2023 among urban and rural AI/AN volunteers aged 45+ years residing in the Rocky Mountain area. Social engagement was measured using a five‐item social frequency instrument, and community overlap was assessed using the Inclusion of Community in Self scale. Health outcomes included the number of “Yes” responses to culturally tailored Ascertain Dementia 8‐item Questionnaire (i.e., AD8 scores), distress measured by the Kessler Psychological Distress Scale (K6), and self‐reported mental and physical health. Mental and physical health assessments were based on a four‐point Likert scale (‘1‐Excellent’, ‘2‐Very good’, ‘3‐Good’, ‘4‐Fair’), with ratings of ‘3‐Good’ or ‘4‐Fair’ classified as suboptimal. Poisson regression was applied to model associations of social engagement and community overlap with AD8 scores, while logistic regression was used to assess their associations with the other outcomes.ResultThe study included 586 AI/AN participants, of whom 69.6% were female and 64.0% resided in urban areas (Table 1). Greater social engagement and community overlap were significantly associated with reduced risks of adverse cognitive and physical health outcomes (Table 2). In multivariate models, greater social engagement was significantly associated with lower AD8 scores [incidence rate ratio (IRR)=0.76], lower odds of distress [odds ratio (OR)=0.44], suboptimal mental health (OR=0.59), and suboptimal physical health (OR=0.52) among AI/AN females but not males. Conversely, among AI/AN males, greater community overlap was significantly or marginally associated with lower AD8 scores and reduced odds of the other outcomes. Urban AI/AN adults exhibited stronger associations than those in rural areas (Figure 1).ConclusionHigher levels of social engagement and community overlap were associated with better cognitive and physical outcomes among these AI/AN volunteers, emphasizing the need for culturally tailored health interventions to strengthen social connections and enhance well‐being of AI/AN adults. Future investigations on AI/AN sex and residence differences in these relationships are warranted.

American Indian and Alaska Native (AI/AN) multiracial subgroups are underrecognized in health outcomes research. We performed a cross-sectional analysis of Behavioral Risk Factor Surveillance System surveys (2013-2019), including adults who self-identified as AI/AN only (single race AI/AN, n = 60,413) or as AI/AN and at least one other race (multiracial AI/AN, (n = 6056)). We used log binomial regression to estimate the survey-weighted prevalence ratios (PR) and 95% confidence intervals (CI) of lifetime asthma, current asthma, and poor self-reported health among multiracial AI/AN adults compared to single race AI/AN adults, adjusting for age, obesity, and smoking status. We then examined whether associations differed by sex and by Latinx identity. Lifetime asthma, current asthma, and poor health were reported by 25%, 18%, and 30% of multiracial AI/AN adults and 18%, 12%, and 28% single race AI/AN adults. Multiracial AI/AN was associated with a higher prevalence of lifetime (PR 1.30, 95% CI 1.18-1.43) and current asthma (PR 1.36, 95% CI 1.21-1.54), but not poor health. Associations did not differ by sex. The association of multiracial identity with current asthma was stronger among AI/AN adults who identified as Latinx (PR 1.77, 95% CI 1.08-2.94) than non-Latinx AI/AN (PR 1.18, 95% CI 1.04-1.33), p-value for interaction 0.03. Multiracial AI/AN adults experience a higher prevalence of lifetime and current asthma compared to single race AI/AN adults. The association between multiracial identity and current asthma is stronger among AI/AN Latinx individuals. The mechanisms for these findings remain under-explored and merit further study.

The goal of this current descriptive study was to examine the roles and relationships of evaluators with the tribal communities in which they work. First, we describe a participatory community research model with a strong capacity-building component as the standard for assessing successful working partnerships between evaluators, programs, tribes, and tribal organizations. This model serves as a yardstick against which we examine the success and challenges of program-evaluation partnerships. Second, we report on a survey of tribal Maternal, Infant, and Early Childhood Home Visiting program leaders and outline their impressions of successes and challenges related to program-evaluation partnerships. Survey participants discussed the importance of working with evaluators who have deep investment in and understanding of the tribal community; respect for cultural relevance and honor for cultural ways; collaboration that includes transparency, trust, and translation of research for community leaders and members; a focus on strength-based design without losing the need to consider challenges; and relationships of mutual trust that can weather addressing stressors when issues of conflict, limited resources, and/or mixed expectations arise.

IntroductionThe objective of this study was to examine recent trends in diagnosed diabetes prevalence for American Indian and Alaska Native (AI/AN) adults aged 18 years and older in the Indian...

American Indian and Alaska Native (AI/AN) adults experience disproportionate cardiovascular disease (CVD) morbidity and mortality compared to other races, which may be partly attributable to higher burden of hypertension (HTN). Dietary Approaches to Stop Hypertension (DASH) is a high-impact therapeutic dietary intervention for primary and secondary prevention of CVD that can contribute to significant decreases in systolic blood pressure (BP). However, DASH-based interventions have not been tested with AI/AN adults, and unique social determinants of health warrant independent trials. This study will assess the effectiveness of a DASH-based intervention, called Native Opportunities to Stop Hypertension (NOSH), on systolic BP among AI/AN adults in three urban clinics. NOSH is a randomized controlled trial to test the effectiveness of an adapted DASH intervention compared to a control condition. Participants will be aged ≥18 years old, self-identify as AI/AN, have physician-diagnosed HTN, and have elevated systolic BP (≥ 130 mmHg). The intervention includes eight weekly, tailored telenutrition counseling sessions with a registered dietitian on DASH eating goals. Intervention participants will be provided $30 weekly and will be encouraged to purchase DASH-aligned foods. Participants in the control group will receive printed educational materials with general information about a low-sodium diet and eight weekly $30 grocery orders. All participants will complete assessments at baseline, after the 8-week intervention, and again 12 weeks post-baseline. A sub-sample of intervention participants will complete an extended support pilot study with assessments at 6- and 9-months post-baseline. The primary outcome is systolic BP. Secondary outcomes include modifiable CVD risk factors, heart disease and stroke risk scores, and dietary intake. NOSH is among the first randomized controlled trials to test the impact of a diet-based intervention on HTN among urban AI/AN adults. If effective, NOSH has the potential to inform clinical strategies to reduce BP among AI/AN adults. https://clinicaltrials.gov/ct2/show/NCT02796313, Identifier NCT02796313.

American Indians and Alaska Natives (AI/AN) adults > or = 65 years of age (older adults) have the second highest age group-specific infectious disease (ID) hospitalization rate. To assess morbidity and disparities of IDs for older AI/AN adults, this study examined the epidemiology of overall and specific infectious disease hospitalizations among older AI/AN adults. ID hospitalization data for older AI/AN adults were analyzed by using Indian Health Service hospital discharge data for 1990 through 2002 and comparing it with published findings for the general U.S. population of older adults. ID hospitalizations accounted for 23% of all hospitalizations among older AI/AN adults. The average annual ID hospitalization rate increased 5% for 1990-1992 to 2000-2002; however, the rate increased more than 20% in the Alaska and the Southwest regions. The rate for older AI/AN adults living in the Southwest region was greater than that for the older U.S. adult population. For 2000-2002, lower respiratory tract infections accounted for almost half of all ID hospitalizations followed by kidney, urinary tract, and bladder infections, and cellulitis. The ID hospitalization rate increased among older AI/AN adults living in the Southwest and Alaska regions, and the rate for the older AI/AN adults living in the Southwest region was higher than that for the U.S. general population. Prevention measures should focus on ways to reduce ID hospitalizations among older AI/AN adults, particularly those living in the Southwest and Alaska regions.

BackgroundPalliative care, including advance care planning (ACP), ensures a patient’s medical care aligns with their values, goals, and priorities throughout serious illness or injury. The Alaska Native and American Indian (AN/AI) population is greatly increasing and less likely to have documentation on ACP conversations. AN/AI peoples are more likely to engage in ACP when it is culturally-tailored to their specific needs. Jumpstart AN/AI is a culturally-tailored tool to assist providers and customer-owners with starting ACP conversations. We conducted a qualitative study to gather feedback from customer-owners and employees to inform implementation of Jumpstart AN/AI within primary care at Southcentral Foundation (SCF), a Tribal health system.MethodsWe conducted a qualitative, descriptive study using a community-based participatory research approach. Semi-structured interviews and focus groups were conducted with customer-owners (n=14) and SCF employees (n=16). We used template analysis, a rapid qualitative data reduction technique, to analyze results from the qualitative interviews and focus groups. Results were then presented to the research team and SCF leadership to finalize implementation plans for Jumpstart AN/AI within SCF.ResultsAll participant groups were in favor of implementing Jumpstart AN/AI and expressed the importance of ACP conversations for AN/AI peoples. SCF employees stated Jumpstart AN/AI delivery would need to be flexible and meet the needs of customer-owners as well as providers and staff. Customer-owners reported they trust their care teams to deliver Jumpstart AN/AI and would also value patient-facing materials so they could ask their provider about Jumpstart AN/AI.ConclusionsQualitative data collected from SCF employees and customer-owners, rapid template analysis, and collaboration with Tribal health system leaders resulted in successfully and quickly developing a flexible implementation plan to integrate Jumpstart AN/AI into the Tribal health system. Implementation of Jumpstart AN/AI will contribute to the limited evidence base for AN/AI-tailored ACP interventions and inform implementation research and practice.For clinical trials, the trial registry name and URL, and registration number must be included at the end of the abstract.

Gardening for Health Utilizing Traditions (GHUTS) is a new diabetes prevention intervention for urban American Indian and Alaska Native (AI/AN) adults receiving mental health treatment in Los Angeles County. The two main objectives of this study are to: 1) further our understanding of diabetes prevention and the role of gardening for urban AI/AN adults receiving mental health treatment and 2) finalize the development of GHUTS. To inform the feasibility of the intervention and to gain perspective, three focus groups were conducted among urban AI/AN adults receiving mental health treatment (n = 7), providers who serve urban AI/AN people (n = 7), and the GHUTS Community Advisory Board (n = 5). Three overarching conceptual themes emerged: 1) Diabetes is an important issue among urban AI/AN people receiving mental health treatment, 2) AI/AN traditional practices have an important role in diabetes prevention among urban AI/AN adults receiving mental health treatment, and 3) Gardening is beneficial for AI/AN people. Feedback on the GHUTS curriculum featured diabetes education, cultural elements, concerns specific to AI/AN people in Los Angeles County, cooking, physical exercise and diet, prayer and mindfulness, community sharing, and field trips. This study highlights the process of developing a community-grounded diabetes prevention intervention for urban AI/AN adults receiving mental health treatment.

An examination of cancer incidence patterns in American Indians and Alaska Native (AI/AN) young adults may provide insight into their present and future cancer burden. To reduce racial misclassification, incidence data were linked with the Indian Health Service (IHS) patient services database. Age-adjusted cancer incidence rates per 100,000 (AAR) and corresponding rate ratios (RR) for young adults (ages 20-44 years) were compared across IHS regions and for selected cancers within Contract Health Service Delivery Area counties by race (AI/AN vs non-Hispanic whites [NHW]) and sex. The all-sites cancer incidence rate was lower for AI/ANs (AAR of 83.8) than for NHWs (AAR of 111.2) (RR of 0.75) but varied by IHS regions. Among the leading cancers in AI/AN females the risk was elevated for stomach (RR of 3.22), colorectal (RR of 1.30), uterine (RR of 1.61), and kidney (RR of 1.39) cancers and was lower for breast (RR of 0.70) and thyroid (RR of 0.71) cancers. Among AI/AN young adult males the risk was elevated for stomach (RR of 2.62), liver (RR of 1.89), and kidney (RR of 1.59) cancers and lower for testicular germ cell cancer (RR of 0.64) and lymphoma (RR of 0.60). The risk for these and other cancers varied across IHS regions. Many of the cancer patterns that characterize the AI/AN population overall are apparent among young adults. Compared with NHW young adults, the overall cancer burden among AI/AN young adults was lower but varied for selected cancers and across IHS regions. Cancer control and research strategies are needed to address the unique genetic, social, cultural, and lifestyle aspects of AI/AN young adults.

BackgroundThe number of American Indian and Alaska Native (AI/AN) older adults 65+ years old is growing. It is estimated that 1 in 3 AI/AN older adults will develop Alzheimer's disease or related dementias in their lifetime. With the number of AI/AN older adults expected to double by 2060, the number of older adults living with dementia is projected to increase four‐fold in the same time frame. Further, recent research has shown that AI/AN dementia‐research participants are retained at a lower rate than non‐Hispanic White participants. We sought to identify factors that predict retention of AI/AN participants as a vital step toward informing future research in potential areas of intervention.MethodWe used logistic regression and 5‐fold cross‐validation to identify factors that maximize Area Under the Receiver Operating Characteristic Curve (AUC) for predicting retention to first follow‐up visit among AI/AN participants in the National Alzheimer's Coordinating Center Uniform Data Set. We defined retention to first follow‐up as a visit within 18 months of the initial visit. Over 500,000 first‐order models with 28 demographic and health‐related variables were considered.ResultFor 220 AI/AN participants, the average AUC from most predictive model of retention was 0.76. This model consisted of baseline‐measured variables: 1) Evaluator's opinion of validity of participant's responses, 2) Educational attainment, 3) Living situation, 4) Is subject's vision normal?, 5) Is subject's hearing normal?, 6) Total number of medications reported, 7) any Motor function‐related comorbidities, 8) any other comorbidities (excluding CVD, motor, cognition, behavioral, sleep, mental health, TBI, diabetes, and cancer). The second‐place model with an average AUC differing by less than 0.0002 additionally identified 1) sex, 2) any CVD‐related comorbidities, 3) any reported difficulties with daily activities as predictive variables.ConclusionThe retention of AI/AN research participants likely requires removing barriers to participation, as is true for all participants. The variables identified suggest that future interventions should consider removing barriers related to living situation and comorbidities affecting daily functioning (such as vision, hearing, and motor function impairments). Future work will consider predictors for the overall population and how those factors differ from the factors for specifically AI/AN participants.