Abstract
BackgroundHigh food insecurity has been demonstrated in rural American Indian households, but little is known about American Indian families in urban settings or the association of food insecurity with diet for these families. The purpose of this study was to examine the prevalence of food insecurity in American Indian households by urban-rural status, correlates of food insecurity in these households, and the relationship between food insecurity and diet in these households.MethodsDyads consisting of an adult caregiver and a child (2–5 years old) from the same household in five urban and rural American Indian communities were included. Demographic information was collected, and food insecurity was assessed using two validated items from the USDA Household Food Security Survey. Factors associated with food insecurity were examined using logistic regression. Child and adult diets were assessed using food screeners. Coping strategies were assessed through focus group discussions. These cross-sectional baseline data were collected from 2/2013 through 4/2015 for the Healthy Children, Strong Families 2 randomized controlled trial of a healthy lifestyles intervention for American Indian families.ResultsA high prevalence of food insecurity was determined (61%) and was associated with American Indian ethnicity, lower educational level, single adult households, WIC participation, and urban settings (p = 0.05). Food insecure adults had significantly lower intake of vegetables (p < 0.05) and higher intakes of fruit juice (<0.001), other sugar-sweetened beverages (p < 0.05), and fried potatoes (p < 0.001) than food secure adults. Food insecure children had significantly higher intakes of fried potatoes (p < 0.05), soda (p = 0.01), and sports drinks (p < 0.05). Focus group participants indicated different strategies were used by urban and rural households to address food insecurity.ConclusionsThe prevalence of food insecurity in American Indian households in our sample is extremely high, and geographic designation may be an important contributing factor. Moreover, food insecurity had a significant negative influence on dietary intake for families. Understanding strategies employed by households may help inform future interventions to address food insecurity.Trial registration (NCT01776255). Registered: January 16, 2013. Date of enrollment: February 6, 2013.
Highlights
High food insecurity has been demonstrated in rural American Indian households, but little is known about American Indian families in urban settings or the association of food insecurity with diet for these families
Data on food insecurity in American Indian families are lacking in national datasets, but food insecurity rates as high as 75% have been reported in smaller studies of tribal communities [8,9,10]
The average age was 31.5 ± 8.5 years, 95% were female, and 81.3% selfidentified as American Indian; for children, average age was 45.0 ± 13.0 months, 50.0% were female, and 86.3% were identified by their caregiver as American Indian
Summary
High food insecurity has been demonstrated in rural American Indian households, but little is known about American Indian families in urban settings or the association of food insecurity with diet for these families. Data on food insecurity in American Indian families are lacking in national datasets, but food insecurity rates as high as 75% have been reported in smaller studies of tribal communities [8,9,10]. Rates of food insecurity are known to differ between urban and rural areas in the general US population [14], and ~78% of people who identify as American Indian report living outside of tribaldesignated areas, which are predominately rural [15]. It is imperative to consider differences that may exist in food insecurity among American Indians in urban and rural settings
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