Table 1 List and description of the 49 studies identified in the literature search

Bright Start study

Story et al. [9]^{a, b}

Group-randomized school-based trial

Kindergarten and first grade Lakota American Indian Children in 14 schools on Pine Ridge reservation in South Dakota (n = 454)

To develop and test the effectiveness of a school environment intervention, supplemented with family involvement, to reduce excessive weight gain by increasing physical activity and healthy eating practices among kindergarten and first-grade American Indian children.

Physical activity intervention: school PE, class walks outdoors, in-class action breaks, and active recess. Dietary intervention: foodservice staff trained to offer 1% white milk instead of 2% or whole milk, eliminate chocolate or other flavored milks, serve recommended portion sizes, purchase and use low-calorie/fat foods, provide more fruits, etc. Behavioral messages delivered at family events: eat more fruits and vegetables, substitute water for sugar-sweetened beverages, limit high-fat and high-sugar snacks and fast foods, drink skim or 1% milk, promote physical activity, and limit TV and video time.

✓^c

✓^d

✓^c

Arcan et al. [36]^b

Pre-post study (sub-study)

Kindergarten and first grade teachers in 14 schools in South Dakota (n = 75)

To examine teachers’ classroom and school food practices and beliefs and the effect of teacher training on these practices and beliefs

Interactive training to explain causes and implications of childhood obesity

✓^c

Cancer 101

Hill et al. [17]^a

Longitudinal, pre-post study

Adults who were members of 43 tribes in the Pacific northwest, health professionals and community health representatives working with NA populations (n = 70)

To examine the impact of Cancer 101, a cancer education resource developed in collaboration with American Indians/Alaska Natives to improve cancer knowledge, action regarding cancer control in tribal settings, and survival rates for members of their communities

Topics addressed: [1] overview of the cancer concern among the AI/ AN population, [2] what is cancer?, [3] cancer screening and early detection, [4] cancer diagnosis and staging, [5] cancer risks and risk reduction, [6] basics of cancer treatment, [7] support for patients and caregivers.

✓^c

Cherokee Choices

Bachar et al. [37]^a

Pre-post study

Eastern Band of Cherokee Indians (EBCI) children (n = 55 for mentoring and after-school program; n = 85 for mentoring only) and adults (n = 86) in a worksite wellness program in 1 community in North Carolina

To develop and evaluate a community- based intervention to improve the health of a rural, mountainous community in North Carolina

Elementary school mentoring, worksite wellness for adults, and church-based health promotion. A social marketing strategy, including television advertisements and a television documentary series, supports the three components.

✓^e

✓^e

✓^e

Community Health Promotion Grants Program (CHPGP)

Wagner et al. [38]^b

Pre-post study

11 communities, including three rural/suburban counties, two Native American regions or reservations, four cities, and two states in the western United States

To present results from an outcome evaluation of the CHPGP in the West, which represented a major community-based initiative designed to promote improved health by changing community norms, environmental conditions, and individual behavior in 11 western communities.

A media campaign, nutrition education campaign in grocery stores, and school-based nutrition education

✓^d

✓^c

Community Health Worker intervention

Beckham et al. [39]^a

Pre-post study

Native Hawaiian and Samoans on Oahu, 18 years of age or older, diagnosis of type 2 diabetes and HbA1c readings over 10.0%; n = 116: n = 80 CHW intervention, n = 36 No CHW intervention

To examine the effectiveness of CHWs on diabetes management among a population with primarily Native Hawaiian and Samoan ethnic minority participants with HbA1c greater than 10%.

CHWs conducted diabetes self-management education for participants. Participants were given voluntary access to the Traditional Hawaiian Healing Center.

✓^c

Diabetes Prevention Program (DPP)

Mayer-Davis et al. [40]

RCT

Diverse adults age > 25 years, BMI > 24 kg/m2 (> 22 kg/m2 for Asian Americans), at high risk for diabetes (specifically, impaired glucose tolerance plus a fasting plasma glucose of 5.3–6.9 mmol/l [or ≤ 6.9 mmol/l for American Indians]). recruited from 27 clinical centers throughout the US (n = 2934)

To describe usual dietary intake assessment at baseline and 1-year post-randomization in the ethnically diverse DPP cohort.

Training in diet, exercise and behavior modification skills, frequent contact with the interventionist, and delivery of the intervention in a culturally sensitive manner.

✓^c

Wing et al. [41]

RCT (secondary analysis)

Participants assigned to the intensive lifestyle intervention who were at least 25 years, BMI of 24 kg/m2 or greater (22 kg/m2 or higher in Asians), a fasting plasma glucose of 95 to 125 mg/dL (125 mg/dL in Native Americans) and a plasma glucose value of 140 to 199 mg/dL 2 h after a 75-g glucose load from 27 clinical centers throughout the US (n = 1079).

To examine demographic, psychosocial, and behavioral factors related to achieving weight loss and physical activity goals in the DPP lifestyle participants.

Participants were assigned an individual case manager. Core curriculum introduced basic skills related to nutrition, exercise, and behavior change.

✓^e

Family Education Diabetes Series (FEDS)

Mendenhall et al. [42]^a

Pre-post study

American Indian adults in a Midwestern community with type 2 diabetes (n = 36).

To describe the FEDS as an example of CBPR, and highlight pilot findings assessing its value and impact across key diabetes-relevant variables.

Members check and record each other’s blood sugars, weight, and conduct foot checks. Participants cook and eat meals together consistent with AI cultures and traditions and discussion follows regarding the meal’s ingredients, cost and availability, portion sizes, and relevance to diabetes and healthy weight maintenance. Educational sequences follow in talking circles on basic diabetes education, obesity and weight loss, foot care, stress management, exercise, etc.

✓^c

✓^c

Five a Day, the Rio Grande Way

Buller et al. [43]^a

Pre-post study embedded in RCT

Rural Multicultural adults in the Upper Rio Grande Valley living at least 6 months or more in the region, at least 18 years of age, and able to speak and read English; n = 755 (380 in intervention, 373 in control group). Two-thirds were Hispanic, 9% AIAN

To evaluate effectiveness of a website promoting fruits and vegetables in the rural multicultural Upper Rio Grande Valley.

The 5 a Day, the Rio Grande Way website was created for this study to encourage fruit and vegetable consumption in the region. Participants were instructed to log on to the website at least once a month over the 4-month study period.

✓^c

Hawai‘i Community Resource Obesity Project: Lifestyle Enhancement Program

Bradley et al. [44]^a

Quasi experimental pre-post study

Over half of participants (58%) were of Native Hawaiian descent; 18 years of age or older, BMI > 30 kg/m2; Intervention group: n = 217 (158 women, 59 men); Control group: n = 89

To describe the effects of a community-based, multidisciplinary team-led, lifestyle modification program on short-term weight loss in a morbidly obese predominantly Native Hawaiian population.

Physical activity, nutrition education, and behavioral counseling.

✓^c

Healthy Foods Hawaii

Gittelsohn et al. [45]^{a, b}

Pre-post study

Children and their adult caregivers in two low-income multiethnic communities in Hawaii (n = 174 caregiver-child pairs)

To decrease risk for obesity in children by modifying the food environment and conducting point-of-purchase promotions that will lead to changes in psychosocial factors and behaviors associated with healthier food choices among low-income communities with a preponderance of Native Hawaiians and Pacific Islanders

The intervention aimed to increase the availability of healthy foods in stores in the two intervention communities, and promote healthier food choices and food preparation methods. The intervention comprised of four phases (healthier beverages, healthier snacks for children, healthier condiments, and healthier meals).

✓^c

✓^c

Healthy Living in Two Worlds

Weaver et al. [12]^a

Pre-post study

Young urban Northeastern population, the Haudenosaunee (six interrelated Native American nations) people (n = 16).

To report the results of the initial delivery of the Healthy Living in Two Worlds curriculum, which sought to increase physical activity, decrease or prevent recreational tobacco use, and increase healthy eating practices.

The curriculum was implemented using a summer day camp format and included field trips and guest presenters covering topics such as Haude-nosaunee dance skills, lacrosse skills, and the traditional role of tobacco in Native American societies.

✓^d

Ho-Chunk Youth Fitness Program

Carrel et al. [46]

Pre-post study

Children aged 6–18 years, native and non-native to the Ho-Chunk Tribe in Wisconsin; n = 38

To evaluate whether risk of type 2 diabetes can be decreased by interventions that affect the lifestyles of children at high risk.

Classes with supervision for both nutrition and exercise, including fitness and nutrition education, physical activity, and making a healthy snack.

✓^d

✓^c

Journey to Native Youth Health Program

Brown et al. [47]^a

RCT

Northern Plains Indian youth 10–14 years old in Montana (n = 76)

To develop a lifestyle change program for Native American youth by modifying the Diabetes Prevention Program (DPP) and assess implementation indicators and short term behavioral and physiological outcomes of the intervention among a small pilot sample.

The Journey DPP included 9 small group sessions led by a Native American community member. Cultural activities, hands on activities, keeping and discussing weekly activity and nutrition diaries, and group games were incorporated throughout the program.

✓^d

✓^d

✓^d

Ke’ Ano Ola (KAO)

Gellert et al. [48]

Pre-post study

Individuals representing the ethnic and socioeconomic status of the Molokai community: 64% Native Hawaiian, 25% Filipino, 5% white (n = 74).

To evaluate a community-based 12-week healthy lifestyle program in Molokai which was developed to decrease chronic disease risk through health education emphasizing weight loss, exercise and risk factor reduction.

KAO participants attended sessions. Each week the program leader introduced an educator who would conduct an interactive educational session focusing on 1 aspect of chronic disease prevention. The second class focused on physical activity.

✓^c

✓^c

Life in BALANCE pilot study

Benyshek et al. [49]

Pre-post study

Urban American Indian/Alaskan Native (AI/ANs) residents in Las Vegas, Nevada. 21 years of age or older, AI/AN self-identification, BMI ≥ 25 kg/m2, HbA1c level between 5.4 and 6.4% (n = 22)

To describe the translational type 2 diabetes prevention program specifically modified for an urban AI/AN population and utilize the results of the pilot project to inform larger future type 2 diabetes prevention programs targeting urban AI/AN populations through diet modification and increased physical activity.

Type 2 diabetes prevention core curriculum and regular follow up. Curriculum included: weight-loss curriculum, meal planning, fat gram and calorie counting, portion size, and food content education.

✓^c

✓^c

Medicine Wheel Nutrition Intervention

Kattelmann et al. [50]^a

RCT

Northern Plains Indians from Cheyenne River Sioux Tribe in South Dakota aged 18 to 65 years, with type 2 diabetes (n = 114).

To determine if Northern Plains Indians with type 2 diabetes mellitus who are randomized to receive culturally adapted educational lessons based on the Medicine Wheel Model for Nutrition in addition to their usual dietary education will have better control of their type 2 diabetes than a nonintervention, usual care group who received usual dietary education from personal providers.

The education group received nutrition lessons based on the Medicine Wheel Nutrition Model to encourage consumption of a diet patterned after the traditional consumption of macronutrients for Northern Plains Indians; protein (25% of energy), moderate in carbohydrate (45 to 50% of energy), low in fat (25 to 30% of energy). A registered dietitian and tribal member, trained in the curriculum, led the classes.

✓^d

✓^d

✓^c

Native American Cardiovascular Risk Reduction Program

Burden et al. [51]

Retrospective study

Native Americans/ All patients enrolled in the cardiovascular risk reduction program from March 1997–October 1999. Populations of 11 Rio Grande pueblos and numerous Native Americans living in urban areas in New Mexico; n = 74 (36 men, 38 women)

To report lipid management outcomes associated with a cardiovascular risk reduction program for Native Americans

Each patient enrolled in the program were managed by a pharmacist clinician (PhC)-registered dietitian team. The primary nutrition intervention strategy utilized the American Heart Association diet in conjunction with increases in dietary fiber and physical activity.

✓^c

Native Hawaiian Diabetes Intervention Program

Mau et al. [52]

Quasi-experimental

NHs age 30 years with diabetes or high risk for diabetes in two rural communities in Hawai’i (n 147)

To examine the association of stage of change with diet and exercise behaviors in response to a lifestyle intervention for NHs.

Participants received the ‘ohana support (OS) (in which a support person attended all activities with them) or the standard intervention from community peer educators.

✓^d

✓^d

Navajo Healthy Stores program

Gittelsohn et al. [53]^{a, b}

RCT

Adult Navajo consumers (baseline, n = 276; postintervention, n = 145)

To examine the impact of the NHS program on Navajo community members by measuring changes in psychosocial variables, food-related behavior, and BMI.

The intervention sought to increase availability of healthier foods in local food stores and to promote these foods at the point of purchase and through community media.

✓^c

✓^d

Partners in Care

Sinclair et al. [54]^a

Pre-post study embedded in RCT

Self-reported physician-diagnosed type 2 diabetes, 18 years of age or older, self-reported Native Hawaiian, Filipino, or other Pacific Islander, English-speaking, and baseline A1c > 7% in Hawaii (n = 82)

To pilot test the effectiveness of a culturally-adapted diabetes self-management intervention.

Curriculum materials emphasized American Diabetes Association clinical guideline goals for blood glucose, A1c, blood pressure, and lipids. Group meetings were delivered by trained peer educators

✓^c

✓^c

Pathways

Caballero et al. [55, 56]^{a, b}

RCT

American Indian schoolchildren followed from 3rd to 5th grade; n = 1704 children in 41 schools in Arizona, New Mexico, and South Dakota

To evaluate the effectiveness of a school-based, multicomponent intervention for reducing percentage body fat in American Indian schoolchildren.

The intervention had 4 components: 1) change in dietary intake, 2) increase in physical activity, 3) a classroom curriculum focused on healthy eating and lifestyle, and 4) a family involvement program.

✓^c

✓^d

✓^d

✓^c

Cunningham-Sabo et al. [57]^{a, b}

RCT

American Indian schoolchildren at 39 schools

To reduce fat content of school meals to 30% or fewer calories from fat without compromising dietary quality.

The food service intervention included the development of nutrient guidelines operationalized as behavioral guidelines. These behavioral guidelines included specific steps and skill-building techniques for lowering the fat content of menu items. To support the behavioral guidelines, training sessions were conducted with all food service staff. These training sessions were reinforced by kitchen visits in the first year and additional visits to each school in the second and third years.

✓^c

Davis et al. [58]^{a, b}

RCT

American Indian schoolchildren (n = 1704) in 3rd to 5th grade from 41 schools in New Mexico, Arizona, Utah, and South Dakota

To promote healthful eating and increased physical activity in seven American Indian communities.

The classroom curricula incorporated culturally appropriate lessons through the use of tribal knowledge, maps of Pathways Nations, and AI stories comprising in-class and take-home activities that promoted healthful eating behaviors and increased physical activity. The family component of the intervention included two main family intervention strategies: 1) Information reinforcing a health education message taught in the classroom curricular lessons and healthful nutrition tips; 2) Events with interactive booths, printed educational materials, and displays that included educational and behavioral messages about low-fat foods and physical activity.

✓^d

✓^c

Himes et al. [59]^b

Pre/Post for school lunch observations. Post-test only for 24-h recalls.

American Indian school grade [grade 2 (baseline) to grade 5 (follow-up)] children representing 7 American Indian Nations; Direct Observation: n = 470. 24-h recalls at follow-up for the whole day: n = 620.

To report the impact of the Pathways intervention on diet, using data from two sources: the direct observation of children eating school lunch, and 24-h dietary recalls.

The intervention included a school curriculum, a physical activity/physical education component, a school foodservice component, and a family component. The nutritional aspects of the curriculum and family component emphasized healthy eating and low-fat food alternatives. The food- service intervention focused on nutrient and behavioral guidelines to reduce the amount of fat in school meals.

✓^c

Stevens et al. [60, 61]^{a, b}

RCT

American Indian school children from 41 schools located in Arizona, New Mexico, and South Dakota (n = 1447)

To examine the impact of the Pathways intervention on psychosocial variables related to physical activity and diet in American Indian children.

Four components: (a) food service intervention which modified foods served in the school cafeteria; (b) physical education component which increased physical activity at school; (c) classroom curriculum that focused on knowledge and practices related to healthy eating and lifestyle habits; and (d) family component aimed at involving parents of children participating in the program, to create a positive and supportive environment for modifying dietary practices and physical activity.

✓^c

✓^c

Stone et al. [62]^{a, b}

RCT

American Indian third grade students in seven different American Indian communities in Arizona, New Mexico, and South Dakota (n = 1704)

To provide a brief overview of the Pathways study design and results.

Four components: (a) food service intervention which modified foods served in the school cafeteria; (b) physical education component which increased physical activity at school; (c) classroom curriculum that focused on knowledge and practices related to healthy eating and lifestyle habits; and (d) family component aimed at involving parents of children participating in the program, to create a positive and supportive environment for modifying dietary practices and physical activity.

✓^c

✓^c

✓^d

✓^c

Story et al. [63]^{a, b}

RCT

American Indian third grade students in seven different American Indian communities in 41 schools in South Dakota (n = 1704)

To evaluate the Pathways food service intervention, designed to lower the fat in school lunches over a 3-year period.

Food service intervention which modified foods served in the school cafeteria in line with the Dietary Guidelines for Americans.

✓^c

Phoenix Indian Medical Center (PIMC) Breastfeeding Support Program

Murphy et al. [13]^a

Pre-post study

NA new mothers in the southwestern United States (n = 5556)

To evaluate an innovative program that targets promotion of breastfeeding among Native women as a type 2 diabetes prevention intervention.

A registry of new mothers delivering or entering care at the medical center was maintained to ensure that services were provided to as many mothers as possible, track feeding choices, and ensure follow-up. The PIMC also implemented a toll-free phone service for patients and staff to call for information and support. Regularly scheduled breastfeeding education classes for women and their families and for health care professional staff were initiated.

✓^c

PILI ‘Ohana Pilot Project

Mau et al. [14]^a

Pre-post study

NH, Filipino or OPI overweight/ obese adults ≥18 years or older in Hawai’i (n = 239)

To implement and examine the effectiveness of the culturally-adapted Diabetes Prevention Program Lifestyle Intervention (DPP-LI) to promote weight loss in 5 NHOPI communities.

Community peer educators delivered lessons on lifestyle change, being active, healthy eating, managing stress, and communicating with health professionals.

✓^c

Kaholokula et al. [64, 65]^a

Pre-post study

Native Hawaiian, Filipino or other Pacific Islander ancestry (i.e., Chuukese, Samoan), 18 years of age, overweight/obese in Hawaii (n = 239).

To elucidate the sociodemographic, behavioral, and biological factors associated with early weight-loss efforts among four ethnically and organizationally diverse groups with members at high risk for diabetes.

The POP translated the Diabetes Prevention Program Lifestyle Intervention (DPP-LI) to initiate weight- loss efforts as part of a larger community-based lifestyle intervention. The intervention focused on evidence- based behavioral weight loss strategies for healthy eating, physical activity and stress/negative emotions management utilizing individual action planning.

✓^c

✓^c

✓^c

✓^c

Sacred Beginnings

Richards et al. [66]^a

Pre-post study embedded in RCT

AI girls aged 11–14 years old in the Northern Plains region (n = 77)

To examine the influence of a CBPR preconception health intervention among AI adolescent females

The educational intervention consisted of 15 preconception health education sessions and was piloted during a summer high school residential academic program. Topics included nutrition; fitness and exercise; diabetes; prescription medication abuse; Lakota cultural perspectives on womanhood, pregnancy, and parenting.

✓^c

Special Diabetes Program for Indians Diabetes Prevention (SDPI-DP)

Jiang et al. [67]^a

Pre-post study

AI and AN at least 18 years of age, no previous diagnosis of diabetes, and having either impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) (n = 2553).

To evaluate a translational implementation of the Diabetes Prevention Program (DPP) (showing that lifestyle intervention can prevent or delay the onset of diabetes for those at risk) intervention in a diverse set of American Indian and Alaska Native (AI/ AN) communities.

The curriculum was delivered in group settings. It was supplemented by individual lifestyle coaching sessions to individualize goals and plan and to identify and solve barriers to participation. Participants were encouraged to use a Keeping Track booklet to monitor their fat and calorie intake and weekly physical activity. If used, booklets were reviewed by lifestyle coaches who gave feedback to the participants during the lifestyle coaching sessions.

✓^c

✓^c

Special Diabetes Program for Indians Healthy Heart Demonstration Project

Moore et al. [68]

Pre-post study

AI/AN 18 years or older with diabetes (n = 3373)

To evaluated the effect on multiple CVD disease risk factors among AI/ANs with diabetes who participated in a large-scale, multidisciplinary, intensive case management intervention.

Multidisciplinary teams implemented an intensive case management intervention. The case manager developed an individualized care plan for CVD risk reduction for each participant and periodically updated it in response to participant progress.

✓^c

Stanford Chronic Disease Self-Management Program (CDSMP)

Jernigan et al. [69]^a

Post-test

Native American adults, aged 18 years and older, with Type 2 diabetes in the Santa Clara Valley (n = 12)

To demonstrate how the CBPR process facilitates the successful translation of the Stanford program and how CBPR is used within this community to build community capacity.

The Stanford CDSMP is a peer-led program that integrates self-efficacy theory through guided mastery experiences, acquisition of skills and enhancement of self-confidence through peer modeling, reinterpretation of physiological symptoms, and social persuasion.

✓^e

Stop Atherosclerosis in Native Diabetics Study (SANDS)

Howard et al. [70, 71]

Pre-post study

AI men and women (n = 548) with type 2 diabetes, aged 40 years or older in Oklahoma, Arizona, and South Dakota

To compare progression of subclinical atherosclerosis in adults with type 2 diabetes treated to reach aggressive targets of low-density lipoprotein cholesterol (LDL-C) of 70 mg/dL or lower and systolic blood pressure (SBP) of 115 mmHg or lower vs standard targets of LDL-C of 100 mg/dL or lower and SBP of 130 mmHg or lower.

Study personnel performed BP and lipid management. Participants receive nutrition counseling and physical activity recommendations consistent with Indian Health Service (IHS) guidelines for people with diabetes, hypertension, and dyslipidemia, and were referred to IHS provider for diabetes management.

✓^c

Strong in Body and Spirit

Gilliland et al. [11]^a

Nonrandomized community-based intervention

Native Americans ≥ 18 years with type 2 diabetes in New Mexico (n = 159)

To determine the effects of a culturally appropriate diabetes lifestyle intervention for Native Americans with risk factors or complications of diabetes.

The intervention was designed to improve participants’ overall risk factor profiles and focused on making healthy changes (e.g. eating less sugar and fat, more exercise) and was not a weight -loss program.

✓^c

Toddler overweight and tooth decay prevention study (TOTS)

Karanja et al. [72]^b

Pre-post study

Expectant mothers and their families recruited from three AI tribes in Portland assigned to a community-wide intervention alone (tribe A; n = 63 families) or community-wide intervention containing a family component (tribes B and C; n = 142 families).

To assess the feasibility, acceptability and efficacy of these approaches in preventing toddler overweight.

Community-wide interventions used five strategies: (a) raising awareness (b) providing health education (c) facilitating individual behavior change, (d) augmenting public health practice and (e) modifying environments and/or policies related to breastfeeding, sugar-sweetened beverages and water consumption.

✓^c

Uli’eo Koa Program

Leslie et al. [73]

Pre-post study

12 Native Hawaiian adult males and 4 adult females ages 22–64 years old in Hawaii. All were active members of a Hawaiian group that practiced a traditional Hawaiian art of fighting

To demonstrate the efficacy of the program in maintaining and increasing physical fitness levels of moderately active Native Hawaiian adults.

Phase I consisted of daily exercise and meals- provided 3 daily meals and snacks. Phase II reduced meals to 2 evening meals per week. PA was less frequent and participants were responsible for the level of exercise they desired to maintain and responsible on their own for all other meals.

✓^e

Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN)

Witmer et al. [74]

Pre-post study embedded in RCT

AN and AI women aged 40–64 who lived on the road system within a 50-mile radius of Anchorage (n = 76)

To describe the design and implementation of a heart disease prevention pilot program tailored for Alaska Native women, pilot study outcomes, and modifications made to the study protocol to increase the feasibility of large-scale implementation.

The intervention included weekly sessions on lifestyle change and goal setting

✓^c

✓^d

✓^d

Zuni high school diabetes prevention progra

Ritenbaugh et al. [10]^{a, b}

Multiple cross-sectional study

Zuni (n = 72) and Anglo (n = 37) high school youth of Zuni Pueblo in New Mexico

To test the feasibility and efficacy of a high school-based diabetes prevention intervention.

The prevention program included an educational component targeting decreased consumption of sugared beverages, knowledge of diabetes risk factors, and a youth-oriented fitness center

✓^d

✓^c

N/A

DeWeese et al. [75]^a

Pre-post study

Tribal leaders, fish harvesters, women of childbearing age, children, and elders, as well as the broader tribal population in the Great Lakes Region; n = 193 (fish consumption study) (23 tribal members 15 males and 8 females from 5 of 6 GLIFWC (The Great Lakes Indian Fish and Wildlife Commission) member tribes for focus groups for the Advisory Map Development intervention)

To determine whether a map based advisory program (GLIFWC) would affect harvest and consumption behaviors in ways to reduce exposure to methyl mercury in Ogaa (Walleye) to levels that do not exceed the EPA RfD, while maintaining an important Anishinaabe tribal lifeway (the harvest and consumption of Ogaa).

Dissemination of advisory maps to target groups via oral presentations which included detailed training on use of maps, general information about adverse health effects of mercury exposure, information on how map-based consumption advice was developed.

✓^c

N/A

Driscoll et al. [76]

Pre-post study

Residents in 3 communities of Robeson County, North Carolina. African American Residents of the township of Redsprings, Hispanic residents of St. Pauls, and Native American (Lumbee Tribe) residents of Lumberton, North Carolina (n = 194). All participants were aged 18 years or older, fluent in either English or Spanish, and had caught or consumed local fish at least once in the previous year.

To assess the determinants of subsistence fishing and promote informed fish consumption among culturally distinct and lower income subsistence fishers in south eastern North Carolina.

Three sets of fish advisories, in the form of trifold brochures, were developed base on formative data collected in each community. Brochures provided info necessary to make informed fish consumption decisions. Brochures were evaluated to assess immediate pre/post changes.

✓^e

N/A

Harvey-Berino et al. [15]

Pre-post study

Native American mothers in New York, Quebec, and Ontario with BMI over 25 kg/m [2] and children between 9 months and 3 years.

To determine whether maternal participation in an obesity prevention plus parenting support (OPPS) intervention would reduce the prevalence of obesity in high-risk Native-American children when compared with a parenting support (PS)-only intervention.

Subjects were randomly assigned to one of two treatment groups: PS or OPPS. Subjects in both conditions participated in a program conducted by an Indigenous peer educator in the home of each participant.

✓^d

N/A

Rinderknecht et al. [16]^a

Single-group pretest, posttest

104 urban Native American youth (65 children and 39 adolescents) attending an after-school program in Minneapolis.

To improve dietary self-efficacy through a 7-month nutrition intervention for Native American children (5 to 10 years) and adolescents (1 l to 18 years).

Lessons focused on improving self-efficacy by exposing the youth to more healthful foods, providing opportunities for the youth to successfully choose the more healthful alternatives (taste-testing), discussing ways to achieve balance through healthful eating and physical activity, and conducting the participative learning activities with peer groups, allowing modeling opportunities.

✓^c

N/A

Smith et al. [77]

Pre-post study

WIC clients from the Aleutian Islands (51% Alaskan Aleut, 27% white Non-Hispanic, 15% Asian, and 6% Hispanic) (n = 400). Other ethnic groups represented were Filipino, Eskimo, and Native American. Educational back- ground varied from high school or less to graduate degrees; English was a second language for most.

To get a better understanding of how television can serve a Native population to enhance nutrition education.

Fifteen 30-min programs were produced featuring a central nutrition theme consistent with WIC project objectives and were broadcasted throughout the summer through state- supported Alaska Rural Communication Systems.

✓^c

N/A

Thompson et al. [78]

Pre-post study embedded in RCT

Young urban American Indian women aged 18–40 years in New Mexico (n = 200)

To describe the effects of a culturally influenced intervention on behavioral risk factors for type 2 diabetes among asymptomatic AI women recruited from the general urban community.

Five discussion group sessions were held focusing on healthful eating, physical activity, goal-setting, and social support.

✓^c