PROJECT SUMMARY/ABSTRACT The food system is comprised of food production, access, and marketing. Public health efforts have been increasingly focused on food systems given that poor diet is the number one risk factor for preventable disease in the United States. American Indians (AIs) experience substantial diet-related health disparities: AI adults are 50% more likely to be obese, 30% more likely to have hypertension, and twice as likely to have diabetes compared to Whites. In 2013, the Osage Nation in Oklahoma launched Bird Creek Farm (BCF) with the mission to facilitate Indigenous food sovereignty, defined as the right and responsibility of Indigenous peoples to healthy and culturally appropriate foods produced through traditional Indigenous practices. By 2015, BCF had 12 employees and began providing food to tribal programs. In the same year, in collaboration with BCF, our team launched the NIMHD-funded FRESH farm-to-school program (R01MD011266). Preliminary findings from this tribally-driven community-based participatory research (CBPR) study show an increase in vegetable and fruit intake among children and adults and a decrease in food insecurity. Building upon our eight-year CBPR partnership, the proposed study will implement a new community supported agriculture (CSA) program in which Osage citizens will receive a weekly share of freshly grown farm produce for 6 months. CSAs have improved diet and health in non-AI populations, and are evidence-based strategies recommended by the Centers for Disease Control and Prevention and the Institute of Medicine to reduce health disparities, but no randomized controlled trial of a CSA program has been conducted in the AI population. Accordingly, we will test the efficacy of a CSA program combined with culturally-tailored nutrition and cooking education on diet and health outcomes among Osage adults, evaluate its cost-effectiveness, and develop a multimedia toolkit for disseminating findings. Our specific aims are to: 1) Conduct a randomized controlled trial to test the newly developed CSA program’s effect on diet, blood pressure, and blood lipids (primary outcomes) and on body mass index (BMI), hemoglobin A1c (HbA1c), food insecurity, and health status (secondary outcomes) among 600 AI adults (aged 18-75) with overweight/obesity; 2) Perform an economic evaluation for individual (e.g., health-related quality of life), organizational (e.g., healthcare utilization costs), and community-level (e.g., prevention of cardiometabolic diseases) outcomes; and 3) Document and disseminate study processes and findings using participatory video methods, and compile a web-based toolkit for other AI communities to use CBPR to improve tribal food systems. This study is the first to rigorously intervene across all components of the food system to address poor diet and health among AIs. Building upon Osage Nation assets and priorities, guided by a CBPR and Indigenous food sovereignty orientation, and based upon recommended strategies to eliminate disparities, study findings will inform research and policy efforts to create sustainable food access in reservations with high rates of chronic disease as well as urban AI communities where CSAs are available and could be tailored to AIs.

Project Narrative American Indians (AIs) have limited access to healthy food and a high prevalence of diet-related diseases. This study will implement a tribal community supported agriculture program in which AI adults receive a weekly box of local fresh fruits and vegetables along with culturally tailored nutrition and cooking education. The program’s effect on diet and health outcomes and it’s cost-effectiveness will be evaluated, and study processes and findings will be broadly disseminated to support tribes in improving diet and health.