# Understanding the Role of the Food Environment on Diet and Health in Rural American Indian Communities: the Strong Heart Food Environment Study

> **NIH NIH R01** · UNIVERSITY OF WASHINGTON · 2024 · $547,859

## Abstract

The research activities proposed in this application address a pressing need in American Indian (AI)
communities to better understand multi-level (i.e., community- , household- , and individual- level) factors in the
physical and socio-cultural environment that impact diet and cardiovascular diseases. The premise of the
proposed project was informed by: (1) our previous work in the Strong Heart Study (SHS) and the Strong Heart
Family Study (SHFS)—the largest multi-tribal cohort studies of risk factors for cardiovascular disease in AIs in
the USA—that highlighted the exceedingly high burden of obesity and poor diet quality among AIs; and (2)
findings from our Healthy Food, Healthy Families Feasibility Study—a small pilot study in a SHS/SHFS
community that assessed the major barriers and facilitators to eating healthy. Although the SHS/SHFS has
followed more than 4,000 AIs from 12 rural communities for the past 34 years, all data collected as part of the
study has focused on individual-level biological and behavioral factors associated with cardiovascular
diseases; no data has been collected on multi-level components of the physical or sociocultural food
environments in this cohort. As such, we have incomplete knowledge about the influence of these domains on
diet and cardiovascular health in these rural AI communities. To address these gaps, we will leverage existing
data from the SHS/SHFS, and add comprehensive assessments of multi-level factors related to the physical
and socio-cultural environment (factors selected based on previous pilot work) that may impact diet and
cardiovascular health to the upcoming SHS/SHFS exam in 12 rural AI communities.
 For this project, we will assess associations of community-level (e.g., food outlet availability, food cost,
norms around healthy eating), household-level (e.g., food insecurity, food outlet accessibility; food
preferences), and individual-level (e.g., perceived nutrition environment) aspects of the physical and socio-
cultural environment with diet (reported intake of fruits and vegetables; sugar-sweetened beverages) and
cardiovascular risk factors (BMI; fasting glucose) among SHS/SHFS participants from 12 tribes. We will also
assess the influence of participation in nutrition assistance programs (i.e., supplemental nutrition assistance
program (SNAP) or the Food Distribution Program on Indian Reservations) on diet and cardiovascular risk
factors (i.e., reported intake of fruits and vegetables; sugar-sweetened beverages; BMI; fasting glucose).
Exploratory outcomes include: HDL cholesterol, triglycerides, systolic blood pressure, incident diabetes and
incident cardiovascular diseases.
 Greater efforts are needed to understand the most salient factors that impact diet and cardiovascular
health in rural Tribal communities. This ancillary study will leverage existing resources from the SHS/SHFS,
while adding a comprehensive dietary assessment, measures of food security, and assessments of nutrition
econ...

## Key facts

- **NIH application ID:** 10918039
- **Project number:** 5R01HL166200-02
- **Recipient organization:** UNIVERSITY OF WASHINGTON
- **Principal Investigator:** Amanda Mae Fretts
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $547,859
- **Award type:** 5
- **Project period:** 2023-09-01 → 2027-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10918039

## Citation

> US National Institutes of Health, RePORTER application 10918039, Understanding the Role of the Food Environment on Diet and Health in Rural American Indian Communities: the Strong Heart Food Environment Study (5R01HL166200-02). Retrieved via AI Analytics 2026-08-13 from https://api.ai-analytics.org/grant/nih/10918039. Licensed CC0.

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