title: Food Insecurity and Chronic Diseases Among American Indians in Rural Oklahoma: The THRIVE Study.
abstract: OBJECTIVE
  To examine food insecurity and cardiovascular disease-related health outcomes among American Indians (AIs) in rural Oklahoma.
  
  
  METHODS
  We surveyed a cross-sectional sample of 513 AI adults to assess food insecurity domains (i.e., food quality and quantity) and obesity, diabetes, and hypertension.
  
  
  RESULTS
  Among AIs surveyed, 56% reported inadequate food quantity and 62% reported inadequate food quality. The unadjusted prevalence of diabetes (28.4% vs 18.4%), obesity (60.0% vs 48.3%), and hypertension (54.1% vs 41.6%) was higher among participants with inadequate food quantity than among those with adequate food quantity. These associations did not reach statistical significance after adjustment for age, gender, study site, education, and income. The unadjusted prevalence of obesity (60.7% vs 45.8%), diabetes (27.3% vs 18.8%), and hypertension (52.5% vs 42.5%) was higher among those with inadequate food quality than among those with adequate food quality, even after adjustment for age, gender, study site, education, and income.
  
  
  CONCLUSIONS
  Tribal, federal, and state policymakers, as well as businesses and nonprofit organizations, must collaboratively take aggressive action to address food insecurity and its underlying causes, including improving tribal food environments, reducing barriers to healthy foods, and increasing living wages.
authors.affiliation: Valarie Blue Bird Jernigan, Marianna S. Wetherill, Jordan Hearod, Alicia L. Salvatore, and Tvli Jacob are with the College of Public Health, Department of Health Promotion Sciences, University of Oklahoma, Tulsa. Tamela Cannady and Mandy Grammar are with the Office of Preventive Health, Choctaw Nation of Oklahoma, Talihina, OK. Joy Standridge, Jill Fox, Jennifer Spiegel, and AnDina Wiley are with the Nutrition Services Department, Chickasaw Nation, Ada, OK. Carolyn Noonan and Dedra Buchwald are with Elson S. Floyd College of Medicine, Washington State University, Seattle.
authors.forename: Valarie
authors.initials: V
authors.lastname: Blue Bird Jernigan
authors.affiliation: Valarie Blue Bird Jernigan, Marianna S. Wetherill, Jordan Hearod, Alicia L. Salvatore, and Tvli Jacob are with the College of Public Health, Department of Health Promotion Sciences, University of Oklahoma, Tulsa. Tamela Cannady and Mandy Grammar are with the Office of Preventive Health, Choctaw Nation of Oklahoma, Talihina, OK. Joy Standridge, Jill Fox, Jennifer Spiegel, and AnDina Wiley are with the Nutrition Services Department, Chickasaw Nation, Ada, OK. Carolyn Noonan and Dedra Buchwald are with Elson S. Floyd College of Medicine, Washington State University, Seattle.
authors.forename: Marianna S
authors.initials: MS
authors.lastname: Wetherill
authors.affiliation: Valarie Blue Bird Jernigan, Marianna S. Wetherill, Jordan Hearod, Alicia L. Salvatore, and Tvli Jacob are with the College of Public Health, Department of Health Promotion Sciences, University of Oklahoma, Tulsa. Tamela Cannady and Mandy Grammar are with the Office of Preventive Health, Choctaw Nation of Oklahoma, Talihina, OK. Joy Standridge, Jill Fox, Jennifer Spiegel, and AnDina Wiley are with the Nutrition Services Department, Chickasaw Nation, Ada, OK. Carolyn Noonan and Dedra Buchwald are with Elson S. Floyd College of Medicine, Washington State University, Seattle.
authors.forename: Jordan
authors.initials: J
authors.lastname: Hearod
authors.affiliation: Valarie Blue Bird Jernigan, Marianna S. Wetherill, Jordan Hearod, Alicia L. Salvatore, and Tvli Jacob are with the College of Public Health, Department of Health Promotion Sciences, University of Oklahoma, Tulsa. Tamela Cannady and Mandy Grammar are with the Office of Preventive Health, Choctaw Nation of Oklahoma, Talihina, OK. Joy Standridge, Jill Fox, Jennifer Spiegel, and AnDina Wiley are with the Nutrition Services Department, Chickasaw Nation, Ada, OK. Carolyn Noonan and Dedra Buchwald are with Elson S. Floyd College of Medicine, Washington State University, Seattle.
authors.forename: Tvli
authors.initials: T
authors.lastname: Jacob
authors.affiliation: Valarie Blue Bird Jernigan, Marianna S. Wetherill, Jordan Hearod, Alicia L. Salvatore, and Tvli Jacob are with the College of Public Health, Department of Health Promotion Sciences, University of Oklahoma, Tulsa. Tamela Cannady and Mandy Grammar are with the Office of Preventive Health, Choctaw Nation of Oklahoma, Talihina, OK. Joy Standridge, Jill Fox, Jennifer Spiegel, and AnDina Wiley are with the Nutrition Services Department, Chickasaw Nation, Ada, OK. Carolyn Noonan and Dedra Buchwald are with Elson S. Floyd College of Medicine, Washington State University, Seattle.
authors.forename: Alicia L
authors.initials: AL
authors.lastname: Salvatore
authors.affiliation: Valarie Blue Bird Jernigan, Marianna S. Wetherill, Jordan Hearod, Alicia L. Salvatore, and Tvli Jacob are with the College of Public Health, Department of Health Promotion Sciences, University of Oklahoma, Tulsa. Tamela Cannady and Mandy Grammar are with the Office of Preventive Health, Choctaw Nation of Oklahoma, Talihina, OK. Joy Standridge, Jill Fox, Jennifer Spiegel, and AnDina Wiley are with the Nutrition Services Department, Chickasaw Nation, Ada, OK. Carolyn Noonan and Dedra Buchwald are with Elson S. Floyd College of Medicine, Washington State University, Seattle.
authors.forename: Tamela
authors.initials: T
authors.lastname: Cannady
authors.affiliation: Valarie Blue Bird Jernigan, Marianna S. Wetherill, Jordan Hearod, Alicia L. Salvatore, and Tvli Jacob are with the College of Public Health, Department of Health Promotion Sciences, University of Oklahoma, Tulsa. Tamela Cannady and Mandy Grammar are with the Office of Preventive Health, Choctaw Nation of Oklahoma, Talihina, OK. Joy Standridge, Jill Fox, Jennifer Spiegel, and AnDina Wiley are with the Nutrition Services Department, Chickasaw Nation, Ada, OK. Carolyn Noonan and Dedra Buchwald are with Elson S. Floyd College of Medicine, Washington State University, Seattle.
authors.forename: Mandy
authors.initials: M
authors.lastname: Grammar
authors.affiliation: Valarie Blue Bird Jernigan, Marianna S. Wetherill, Jordan Hearod, Alicia L. Salvatore, and Tvli Jacob are with the College of Public Health, Department of Health Promotion Sciences, University of Oklahoma, Tulsa. Tamela Cannady and Mandy Grammar are with the Office of Preventive Health, Choctaw Nation of Oklahoma, Talihina, OK. Joy Standridge, Jill Fox, Jennifer Spiegel, and AnDina Wiley are with the Nutrition Services Department, Chickasaw Nation, Ada, OK. Carolyn Noonan and Dedra Buchwald are with Elson S. Floyd College of Medicine, Washington State University, Seattle.
authors.forename: Joy
authors.initials: J
authors.lastname: Standridge
authors.affiliation: Valarie Blue Bird Jernigan, Marianna S. Wetherill, Jordan Hearod, Alicia L. Salvatore, and Tvli Jacob are with the College of Public Health, Department of Health Promotion Sciences, University of Oklahoma, Tulsa. Tamela Cannady and Mandy Grammar are with the Office of Preventive Health, Choctaw Nation of Oklahoma, Talihina, OK. Joy Standridge, Jill Fox, Jennifer Spiegel, and AnDina Wiley are with the Nutrition Services Department, Chickasaw Nation, Ada, OK. Carolyn Noonan and Dedra Buchwald are with Elson S. Floyd College of Medicine, Washington State University, Seattle.
authors.forename: Jill
authors.initials: J
authors.lastname: Fox
authors.affiliation: Valarie Blue Bird Jernigan, Marianna S. Wetherill, Jordan Hearod, Alicia L. Salvatore, and Tvli Jacob are with the College of Public Health, Department of Health Promotion Sciences, University of Oklahoma, Tulsa. Tamela Cannady and Mandy Grammar are with the Office of Preventive Health, Choctaw Nation of Oklahoma, Talihina, OK. Joy Standridge, Jill Fox, Jennifer Spiegel, and AnDina Wiley are with the Nutrition Services Department, Chickasaw Nation, Ada, OK. Carolyn Noonan and Dedra Buchwald are with Elson S. Floyd College of Medicine, Washington State University, Seattle.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Spiegel
authors.affiliation: Valarie Blue Bird Jernigan, Marianna S. Wetherill, Jordan Hearod, Alicia L. Salvatore, and Tvli Jacob are with the College of Public Health, Department of Health Promotion Sciences, University of Oklahoma, Tulsa. Tamela Cannady and Mandy Grammar are with the Office of Preventive Health, Choctaw Nation of Oklahoma, Talihina, OK. Joy Standridge, Jill Fox, Jennifer Spiegel, and AnDina Wiley are with the Nutrition Services Department, Chickasaw Nation, Ada, OK. Carolyn Noonan and Dedra Buchwald are with Elson S. Floyd College of Medicine, Washington State University, Seattle.
authors.forename: AnDina
authors.initials: A
authors.lastname: Wiley
authors.affiliation: Valarie Blue Bird Jernigan, Marianna S. Wetherill, Jordan Hearod, Alicia L. Salvatore, and Tvli Jacob are with the College of Public Health, Department of Health Promotion Sciences, University of Oklahoma, Tulsa. Tamela Cannady and Mandy Grammar are with the Office of Preventive Health, Choctaw Nation of Oklahoma, Talihina, OK. Joy Standridge, Jill Fox, Jennifer Spiegel, and AnDina Wiley are with the Nutrition Services Department, Chickasaw Nation, Ada, OK. Carolyn Noonan and Dedra Buchwald are with Elson S. Floyd College of Medicine, Washington State University, Seattle.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Noonan
authors.affiliation: Valarie Blue Bird Jernigan, Marianna S. Wetherill, Jordan Hearod, Alicia L. Salvatore, and Tvli Jacob are with the College of Public Health, Department of Health Promotion Sciences, University of Oklahoma, Tulsa. Tamela Cannady and Mandy Grammar are with the Office of Preventive Health, Choctaw Nation of Oklahoma, Talihina, OK. Joy Standridge, Jill Fox, Jennifer Spiegel, and AnDina Wiley are with the Nutrition Services Department, Chickasaw Nation, Ada, OK. Carolyn Noonan and Dedra Buchwald are with Elson S. Floyd College of Medicine, Washington State University, Seattle.
authors.forename: Dedra
authors.initials: D
authors.lastname: Buchwald
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003710:Demography; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D005523:Food Supply; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D007198:Indians, North American; D008297:Male; D009765:Obesity / Q000453:epidemiology*; D009825:Oklahoma / Q000453:epidemiology; D012424:Rural Population