Traditional food security and diet quality in Alaska Native women

This dissertation addresses the need for a better understanding of traditional foods, food security, and diet quality and how they collectively influence health of low income Alaska Native women receiving the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The ultimate aims are to understand the beliefs and behaviors regarding traditional foods in low income Alaska Native women in Anchorage receiving WIC assistance and examine whether these foods moderate the relationship between food security and diet quality. Food security is a growing public health concern in Alaska, especially among Alaska Native people living in urban areas. I begin the dissertation by conducting a literature review on traditional food security research in Alaska, examining research that has been conducted in the past decades. The review yielded a total of 28 articles for the systematic review, where traditional food security was categorized into three main types of research: those that quantified traditional food intake (n=19), those that quantified food security (n=2), and qualitative articles that addressed at least one pillar of food security (n=8). The three categories were used to evaluate how traditional foods relate to the pillars of food security in Alaska and determine future research needs. I estimated the intake of traditional food among urban Alaska Native women receiving WIC assistance and examined the associations between participants' practices, attitudes, and beliefs of traditional foods. Results indicate that participants are mixed on their opinion of the economic value of traditional foods and the healthfulness of traditional foods over store bought foods. Linear regression analysis shows that participants who ate more traditional foods are more likely to have traveled to a rural Alaska Native community in the past year (p=.001) and have a preference for traditional foods over store bought foods (p=.001). Finally I estimated diet quality and food security of Alaska Native women receiving WIC assistance who are living in an urban community in order to understand how intake of traditional foods affects these estimates. Results indicate the average intake of traditional foods is 3.7% of total calories and participants' diet quality was lower than the national average, with a 48 on the Health Eating Index (HEI). Multivariate regression analysis with significance at P<= .05 indicates that participants with increasing traditional food intake are positively associated with higher diet quality scores. An increase of 10% of traditional foods yielded an increase of 7.3 points on the HEI. Increased education and advocacy of traditional food intake for this population can help increase overall nutrition and long-term health status. Based on the collective findings from the research I recommend the following measures: 1) ensure that nutrition education in food and nutrition assistance programs to be culturally relevant and address the barriers associated with access and availability of traditional foods in urban areas, 2) use the data to inform intervention programs to improve dietary adequacy in this high-risk population, and 3) modify the list of foods acceptable for purchase through the WIC program to promote diet quality and aid in chronic disease prevention in the Alaska Native population.