Understanding Food Insecurity and Its Effects on Gestational Diabetes Risk Among American Indian and Alaska Native Females Can Lead to Better Outcomes

Food insecurity, defined as the lack of consistent access to sufficient food for an active, healthy life, has been exacerbated in Tribal communities by systemic anti-indigenous racism, including policies that disrupt traditional food practices and access. A recent qualitative study in the Journal of Nutrition Education and Behavior, published by Elsevier, explores the connection between food insecurity and gestational diabetes risk among young American Indian and Alaska Native females. The study highlights how targeted risk reduction methods could significantly improve diabetes health outcomes for this population, which is disproportionately impacted by health disparities. Lead author Sarah Stotz, PhD, RDN, CDCES, Department of Food Science and Human Nutrition, Colorado State University, explains, "For many Native communities, the lasting impacts of colonization, forced removal from traditional lands, boarding schools,and both past and present-day food commodity programs have influenced how Native peoples eat and why those dietary habits are passed down through generations.” The research, conducted between September 2022 and February 2023, recruited experts in American Indian and Alaska Native food, nutrition, food systems, reproductive health, adolescent health, and women’s health to discuss the relationship(s) between food insecurity and gestational diabetes risk. Using a semistructured moderator guide, interviews and focus groups were recorded teleconference interviews or in-person focus groups (e.g., Zoom). The moderator guide was developed by five qualitative researchers with expertise in food systems, reproductive health, and Native communities, including three of whom are Native themselves. Qualitative findings revealed three key themes: 1) diet and nutrition habits are formed through intergenerational food preferences and are driven by lasting implications of colonization; 2) young people are influenced by what their peers eat and the food environment, including outside of the home; and 3) the methods used to understand household food insecurity and nutrition habits in the randomized controlled trial (e.g., parent study) were likely limited. Future interventions would benefit from employing strengths-based, culturally centered, trauma-informed, multilevel frameworks to better address healthy eating and dietary behaviors among Native youth, emphasizing the integration of peer-focused resources and family-centered strategies in programs for diabetes risk reduction. This community-centered approach should include culturally grounded and trauma-informed assessments of household food insecurity and foster collaborative partnerships between healthcare, food retail, and public health sectors. Such efforts will help create healthful environments and Native-centered resources, aiming to achieve holistic health for Native adolescent females and reduce disparities in diabetes. Dr. Stotz states, “Within public health frameworks, it is important to address upstream factors and systems that shape downstream factors (e.g., individual behaviors). It is important to emphasize that many communities already know the strengths-based solutions that would improve holistic health for their people, and interventions and programming should center these community-generated ideas and solutions. Notes for editors The article is “Relationship Between Food Insecurity and Healthy Eating Behavior for Gestational Diabetes Risk Reduction Among American Indian and Alaska Native Adolescent and Young Adult Females: A Qualitative Exploration,” Sarah A. Stotz, PhD, RDN, CDCES; Luciana E. Hebert, PhD; Lisa Scarton, PhD, RN; Kelli Begay, MS, MBA, RDN; Kelly Gonzales, PhD, MPH; Heather Garrow, BS, CHES; Spero M. Manson, PhD; Susan M. Sereika, PhD; and Denise Charron-Prochownik, PhD, RN, CNCP, FAAN (https://doi.org/10.1016/j.jneb.2024.06.004). It appears in the Journal of Nutrition Education and Behavior, Volume 56, Issue 9 (September 2024), published by Elsevier. The article is openly available at https://www.jneb.org/article/S1499-4046(24)00354-3/fulltext. The authors would like to thank the support provided by the National Institutes of Health’s National Institute on Minority Health and Health Disparities (grant no. R21MD016126; PI, Stotz). Full text of the article is also available to credentialed journalists upon request; contact Eileen Leahy at +1 732 406 1313 or [email protected] to obtain a copy or additional information. To schedule an interview with the author(s), please contact Sarah A. Stotz, PhD, RDN, CDCES, Department of Food Science and Human Nutrition, Colorado State University, at [email protected]. An audio podcast featuring an interview with Sarah A. Stotz, PhD, RDN, CDCES, and other information for journalists are available at www.jneb.org/content/media. Excerpts from the podcast may be reproduced by the media with permission from Eileen Leahy. About the Journal of Nutrition Education and Behavior (JNEB) The Journal of Nutrition Education and Behavior (JNEB), the official journal of the Society for Nutrition Education and Behavior (SNEB), is a refereed, scientific periodical that serves as a resource for all professionals with an interest in nutrition education and dietary/physical activity behaviors. The purpose of JNEB is to document and disseminate original research, emerging issues, and practices relevant to nutrition education and behavior worldwide and to promote healthy, sustainable food choices. It supports the Society's efforts to disseminate innovative nutrition education strategies, and communicate information on food, nutrition, and health issues to students, professionals, policymakers, targeted audiences, and the public. The Journal of Nutrition Education and Behavior features articles that provide new insights and useful findings related to nutrition education research, practice, and policy. The content areas of JNEB reflect the diverse interests of health, nutrition, education, Cooperative Extension, and other professionals working in areas related to nutrition education and behavior. As the Society's official journal, JNEB also includes occasional policy statements, issue perspectives, and member communications. www.jneb.org.

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