No abstract

This study supports the efficacy of the paraprofessional-delivered Family Spirit home-visiting intervention for young AI mothers on maternal knowledge and infant behavior outcomes. A longer, larger study is needed to replicate results and evaluate the durability of child behavior outcomes.

A paraprofessional-delivered, family-strengthening home-visiting program significantly increased mothers' child care knowledge and involvement. A longer and larger trial is needed to understand the intervention's potential to improve adolescent parenting and related child outcomes in American Indian communities.

Objective: To identify factors associated with food insecurity and household eating patterns among American-Indian families with young children. Design: Cross-sectional survey among households with young children that were receiving emergency food services. We collected information on food insecurity levels, household eating patterns, experiences with commercial and community food sources and demographics, and used multivariate regression techniques to examine associations among these variables. Setting: Four Southwestern American-Indian reservation communities. Subjects: A total of 425 parents/caregivers of young children completed the survey. Results: Twenty-nine per cent of children and 45 % of adults from households participating in the survey were classified as 'food insecure'. Larger household size was associated with increased food insecurity and worse eating patterns. Older respondents were more likely than younger respondents to have children with food insecurity (relative risk 5 2?19, P , 0?001) and less likely to have healthy foods available at home (relative risk 5 0?45, P , 0?01). Consumption of food from food banks, gas station/convenience stores or fast-food restaurants was not associated with food insecurity levels. Respondents with transportation barriers were 1?46 times more likely to be adult food insecure than respondents without transportation barriers (P , 0?001). High food costs were significantly associated with greater likelihoods of adult (relative risk 5 1?47, P , 0?001) and child (relative risk 5 1?65, P , 0?001) food insecurity. Conclusions: Interventions for American-Indian communities must address challenges such as expense and limited transportation to accessing healthy food. Results indicate a need for services targeted to older caregivers and larger households. Implications for innovative approaches to promoting nutrition among American-Indian communities, including mobile groceries and community gardening programmes, are discussed. Keywords American Indian Food insecurity Early childhoodFood insecurity is defined as 'limited or uncertain availability of nutritionally adequate and safe foods and limited or uncertain ability to acquire foods in socially acceptable ways'. According to the US Department of Agriculture, 14?7 % of US households experienced food insecurity in 2009. Rates of food insecurity were substantially higher for households with low income, single parents and ethnic minorities (2) . American Indians (AI) have the lowest health, economic and social status of any ethnic or racial group in the USA; they also have the highest food insecurity rates in the country. Recent data suggest that approximately twice as many American-Indian (AI) households with children are food insecure as non-AI households (3) . Diet and activity patterns of AI have changed dramatically in the past three generations. Traditional foods, such as wild game, nuts, fruits and berries, have been replaced by less diverse, processed commodities and convenience foods (4,5) . Thus, in rural A...