Food insecurity, defined as insufficient access to nutritious foods, is a social determinant of health that may underpin health disparities in the U.S. American Indian and Alaska Native (AI/AN) individuals experience many health inequities that may be related to food insecurity, but no systematic analyses of the existing evidence have been published. Thus, the objective of this scoping review was to assess the literature on food insecurity among AI/AN individuals and communities, with a focus on the prevalence of food insecurity and its relationships to sociodemographic, nutrition, and health characteristics. Systematic search and data extraction processes were used. Searches were conducted on PubMed as well as peer-reviewed journal and government websites. Of 3174 identified references, 34 publications describing 30 studies with predominantly AI/AN sample populations were included in the final narrative synthesis. Twenty-two studies (73%) were cross-sectional and the remaining eight (27%) described interventions. The weighted average prevalence of food insecurity across the studies was 45.7%, though estimates varied from 16–80%. Most studies used some version of the United States Department of Agriculture Food Security Survey Modules, although evidence supporting its validity in AI/AN respondents is limited. Based on the review, recommendations for future research were derived, which include fundamental validity testing, better representation of AI/AN individuals in federal or local food security reports, and consideration of cultural contexts when selecting methodological approaches. Advances in AI/AN food insecurity research could yield tangible benefits to ongoing initiatives aimed at increasing access to traditional foods, improving food environments on reservations and homelands, and supporting food sovereignty.

Food insecurity, defined as a lack of stable access to sufficient and nutritious food, is a global public health priority due to its relationships with diminished mental and physical human health. Indigenous communities experience disproportionality high rates of food insecurity as a byproduct of settler-colonial activities, which included forced relocation to rural reservation lands and degradation of traditional subsistence patterns. Many Indigenous communities have worked to revitalize their local food systems by pursuing food sovereignty, regularly expressed as the right and responsibility of people to have access to healthy and culturally appropriate foods, while defining their own food systems. Food sovereignty is a promising approach for improving health. However, limited literature is available that identifies the diverse practices of food sovereignty or strategies communities can implement to strengthen their food sovereignty efforts. This article reviews the scientific literature and highlights key indicators that may support community capacity building for food sovereignty and health. The seven indicators are: (1) access to resources, (2) production, (3) trade, (4) food consumption, (5) policy, (6) community involvement, and (7) culture. A total of 25 sub-indicators are outlined to allow communities to understand how an indicator is operationalized as well as explore their own community's progress within each indicator. It is not expected that every indicator and their subcategories will apply fully to any given Indigenous community, and the application of these indicators must be adapted for each community's local context, however the indicators may provide support for building and assessing efforts to create more sustainable Indigenous food systems.

Introduction. Evidence-based health promotion programs (EBPs) support older adults where they live, work, pray, play, and age. COVID-19 placed a disproportionate burden on this population, especially those with chronic conditions. In-person EBPs shifted to remote delivery via video-conferencing, phone, and mail during the pandemic, creating opportunities and challenges for older adult health equity. Method. In 2021–2022, we conducted a process evaluation of remote EBPs by purposively sampling diverse U.S. organizations and older adults (people of color, rural, and/or with disabilities). The Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) + Equity framework was used to understand program reach and implementation, including FRAME to describe adaptations for remote delivery. Analyses include descriptive statistics and thematic analysis of participant and provider surveys and interviews, and joint display tables to compare learnings. Results. Findings from 31 EBPs through 198 managers/leaders and 107 organizations suggest remote delivery increases EBP reach by improving access for older adults who are underserved. For programs requiring new software or hardware, challenges remain reaching those with limited access to—or comfort using—technology. Adaptations were to context (e.g., shorter, smaller classes with longer duration) and for equity (e.g., phone formats, autogenerated captioning); content was unchanged except where safety was concerned. Implementation is facilitated by remote delivery guidelines, distance training, and technology support; and hindered by additional time, staffing, and resources for engagement and delivery. Conclusions. Remote EBP delivery is promising for improving equitable access to quality health promotion. Future policies and practices must support technology access and usability for all older adults.

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