Promoting Healthy Food Access and Food Security in Urban American Indians through Adaptations to the Local Food Systems and Digital Storytelling

Abstract

BACKGROUND: Food systems are shaped by social determinants that influence health outcomes. American Indian (AI) food systems have been disrupted over the last 200 years by historical factors including policies of removal from traditional lands and food systems and reliance on government provided foods. This dissertation will identify barriers and develop strategies using three studies to improve the connection between urban AIs and a food system that affords healthy food and food security. STUDY AIMS: These studies aim to: (1) document urban AI adult food access, food security, body mass index (BMI), and barriers and strategies in using Tucson, AZ’s food system to explore social determinants of health that impact food availability and accessibility; (2) use a Social Cognitive Theory (SCT) framework and strategies documented in Aim 1 to collaboratively plan the development of a digital storytelling (DST) food system curriculum that promotes personal, behavioral, and environmental strategies to access healthy foods and promote food security; and (3) evaluate the development and application of the DST food system curriculum. METHODS: Aim 1 is a secondary analysis of existing qualitative and quantitative data sampled from the Tucson Indian Center (TIC) Community Health Assessment (CHA). Aim 2 is the development of DST food system curriculum. Aim 3 is the qualitative analysis of the DST curriculum from the perspective of the DST team and AI community members. RESULTS: Urban AIs in Tucson experience high rates of low food security and low food access associated with social determinants of health. AI adults with low food security were more likely to not have access to personal vehicles and lived more than 0.5 miles from full-service grocery stores. Combined overweight/obese status among AI adults was associated with low food security based on adjusted models (OR 2.0, CI 1.0, 4.0). Barriers for food access and security occurred at the individual level to environmental level, e.g. food preferences, not having access to community gardening space. Strategies to build food security and access were identified, e.g. build social support, create opportunities for cultural sharing. A food system conceptual model was developed from the participating community members’ perspectives and demonstrates the interconnections of social and cultural determinants between culture, social, economic, political, and biophysical systems that influence food access and security. Gaps in the model can be leveraged by efforts of food revitalization, policy, and indigenous-centered approaches. A DST curriculum offers a unique tool to help urban AI community members understand their food system to identify ways to create personal, behavioral, and environmental level changes. CONCLUSION: Food security and food access impacts the health of urban AIs in Tucson. The urban AI food system is comprised of multilevel factors shaped by social determinants of health. Current barriers included individual behavior to institutional level policies that challenge food security. Strategies that involve community engagement could increase social support and social influence to connect urban AIs to food systems in Tucson that support access to healthy foods and food security. Such strategies include working with community members to develop DST curriculum, consisting of videos and an activity/discussion guide, which can be shared as educational tools and motivators for action.