Healthy Eating Determinants and Food Security Resource Opportunities: Urban-Dwelling American Indian and Alaska Native Older Adults Perspectives

Published:December 22, 2021DOI:



      To explore the perspectives of urban-dwelling American Indian and Alaska Native (AI/AN) older adults regarding determinants of healthy eating, food insecurity, and opportunities for an urban clinic to improve resources.


      Semistructured interviews (n = 24) with older adults (aged ≥ 60 years) at 1 urban AI/AN serving clinic. Telephone-based interviews were audio-recorded, professionally transcribed, and analyzed using thematic analysis.


      Four overarching themes were revealed: (1) hunger-mitigating resources exist but do not necessarily lessen food insecurity; (2) multiple layers of challenges related to social determinants of health present barriers to healthy nutrition for AI/AN older adults; (3) unique facilitators rooted in AI/AN culture can help decrease food insecurity; and (4) many clinic-based opportunities for programs to improve food insecurity exist.

      Conclusions and Implications

      Findings provide a foundation for urban-serving AI/AN clinics to develop healthy eating resources for their older adult patients. Greater benefit would result from resources that build on cultural strengths and address older adult-specific challenges to healthy eating.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access

      SNEB Member Login

      SNEB Members, full access to the journal is a member benefit. Login via the SNEB Website to access all journal content and features.


      Subscribe to Journal of Nutrition Education and Behavior
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Centers for Disease Control and Prevention. Social determinants of health: know what affects health. Accessed September 16, 2021.

      2. US Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Healthy People 2030. Accessed September 16, 2021.

        • Rimer B
        • Glanz K
        Theory at a Glance: A Guide for Health Promotion Practice.
        US Department of Health and Human Services, National Institutes of Health, National Cancer Institute, 2005: 1-64
      3. Manson SM. National Institute on Minority Health and Health Disparities Research Framework Adaptation. Accessed September 16, 2021.

        • Alvidrez J
        • Castille D
        • Laude-Sharp M
        • Rosario A
        • Tabor D
        The National Institute on Minority Health and Health Disparities research framework.
        Am J Public Health. 2019; 109: S16-S20
        • Slawson DL
        • Fitzgerald N
        • Morgan KT
        Position of the Academy of Nutrition and Dietetics: the role of nutrition in health promotion and chronic disease prevention.
        J Acad Nutr Diet. 2013; 113: 972-979
        • Amine EK
        • Baba NH
        • Belhadj M
        • et al.
        Diet, Nutrition and the Prevention of Chronic Diseases.
        World Health Organization, 2003
      4. US Department of Agriculture, Economic Research Service. Definitions of food security. Accessed September 16, 2021.

        • Larson N
        • Laska MN
        • Neumark-Sztainer D
        Food insecurity, diet quality, home food availability, and health risk behaviors among emerging adults: findings from the EAT 2010-2018 study.
        Am J Public Health. 2020; 110: 1422-1428
        • Leung CW
        • Epel ES
        • Ritchie LD
        • Crawford PB
        • Laraia BA
        Food insecurity is inversely associated with diet quality of lower-income adults.
        J Acad Nutr Diet. 2014; 114: 1943-1953.e2
        • Gregory CA
        • Mancino L
        • Coleman-Jensen A
        Food Security and Food Purchase Quality Among Low-income Households: Findings from the National Household Food Acquisition and Purchase Survey (FoodAPS).
        US Department of Agriculture, Economic Research Service, 2019 (Accessed October 16, 2021)
        • Seligman HK
        • Laraia B
        • Kushel MB
        Food insecurity is associated with chronic disease among low-income NHANES participants.
        J Nutr. 2010; 140: 304-310
        • Macario E
        • Emmons KM
        • Sorensen G
        • Hunt MK
        • Rudd RE
        Factors influencing nutrition education for patients with low literacy skills.
        J Am Diet Assoc. 1998; 98: 559-564
        • Pan L
        • Sherry B
        • Njai R
        • Blanck HM
        Food insecurity is associated with obesity among US adults in 12 states.
        J Acad Nutr Diet. 2012; 112: 1403-1409
        • Seligman HK
        • Schillinger D
        Hunger and socioeconomic disparities in chronic disease.
        N Engl J Med. 2010; 363: 6-9
        • Hazzard VM
        • Loth KA
        • Hooper L
        • Becker CB
        Food insecurity and eating disorders: a review of emerging evidence.
        Curr Psychiatry Rep. 2020; 22: 74
        • Becker CB
        • Middlemass K
        • Taylor B
        • Johnson C
        • Gomez F
        Food insecurity and eating disorder pathology.
        Int J Eat Disord. 2017; 50: 1031-1040
        • Olson CM
        • Bove CF
        • Miller EO
        Growing up poor: long-term implications for eating patterns and body weight.
        Appetite. 2007; 49: 198-207
        • Jernigan VBB
        • Huyser KR
        • Valdes J
        • Simonds VW
        Food insecurity among American Indians and Alaska Natives: a national profile using the current population survey–food security supplement.
        J Hunger Environ Nutr. 2017; 12: 1-10
        • Bauer KW
        • Widome R
        • Himes JH
        • et al.
        High food insecurity and its correlates among families living on a rural American Indian reservation.
        Am J Public Health. 2012; 102: 1346-1352
        • Pardilla M
        • Prasad D
        • Suratkar S
        • Gittelsohn J
        High levels of household food insecurity on the Navajo Nation.
        Public Health Nutr. 2014; 17: 58-65
        • Gundersen C
        Measuring the extent, depth, and severity of food insecurity: an application to American Indians in the USA.
        J Popul Econ. 2008; 21: 191-215
        • Tomayko EJ
        • Mosso KL
        • Cronin KA
        • et al.
        Household food insecurity and dietary patterns in rural and urban American Indian families with young children.
        BMC Public Health. 2017; 17: 611
        • Mitchell FM
        Water (in)security and American Indian health: social and environmental justice implications for policy, practice, and research.
        Public Health. 2019; 176: 98-105
        • Deitz S
        • Meehan K
        Plumbing poverty: mapping hot spots of racial and geographic inequality in U.S. household water insecurity.
        Ann Am Assoc Geogr. 2019; 109: 1092-1109
        • Gurney RM
        • Caniglia BS
        • Mix TL
        • Baum KA
        Native American food security and traditional foods: a review of the literature.
        Sociology Compass. 2015; 9: 681-693
        • Stotz S
        • Brega AG
        • Henderson JN
        • Lockhart S
        • Moore K
        • Group AI/AN WCIE Study
        Food insecurity and associated challenges to healthy eating among American Indians and Alaska natives with type 2 diabetes: multiple stakeholder perspectives.
        J Aging Health. 2021; 33: 31S-39S
        • Maxwell JA
        Qualitative Research Design: An Interactive Approach.
        2nd ed. SAGE Publications, 2004
        • Swift JA
        • Tischler V
        Qualitative research in nutrition and dietetics: getting started.
        J Hum Nutr Diet. 2010; 23: 559-566
        • Saunders B
        • Sim J
        • Kingstone T
        • et al.
        Saturation in qualitative research: exploring its conceptualization and operationalization.
        Qual Quant. 2018; 52: 1893-1907
        • Jaidin JH
        Scenario-based interview: an alternative approach to interviewing children?.
        Pac Early Child Educ Res Assoc. 2018; 12: 23-37
        • Barter C
        • Renold E
        ‘I wanna tell you a story’: exploring the application of vignettes in qualitative research with children and young people.
        Int J Soc Res Methodol. 2000; 3: 307-323
        • Swales S
        • May C
        • Nuxoll M
        • Tucker C
        Neoliberalism, guilt, shame and stigma: a Lacanian discourse analysis of food insecurity.
        J Community Appl Soc Psychol. 2020; 30: 673-687
        • Hager ER
        • Quigg AM
        • Black MM
        • et al.
        Development and validity of a 2-item screen to identify families at risk for food insecurity.
        Pediatrics. 2010; 126: e26-e32
        • Paulus T
        • Lester J
        • Deptster P
        Digital Tools for Qualitative Research.
        1st ed. SAGE Publications, 2014
        • Saldaña J
        The Coding Manual for Qualitative Researchers.
        2nd ed. SAGE Publications, 2012
        • Vaismoradi M
        • Turunen H
        • Bondas T
        Content analysis and thematic analysis: implications for conducting a qualitative descriptive study.
        Nurs Health Sci. 2013; 15: 398-405
        • Tong A
        • Sainsbury P
        • Craig J
        Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.
        Int J Qual Health Care. 2007; 19: 349-357
        • Pooler JA
        • Hartline-Grafton H
        • Debor M
        • Sudore RL
        • Seligman HK
        Food insecurity: a key social determinant of health for older adults.
        J Am Geriatr Soc. 2019; 67: 421-424
        • Ziliak JP
        • Gundersen C
        The State of Senior Hunger in America 2018: An Annual Report.
        Feeding America, 2020
      5. National Council on Aging. Get the facts on SNAP and senior hunger. Accessed September 16, 2021.

        • Sattler ELP
        • Lee JS
        • Bhargava V
        Food insecurity and medication adherence in low-income older medicare beneficiaries with type 2 diabetes.
        J Nutr Gerontol Geriatr. 2014; 33: 401-417
        • Bishop NJ
        • Wang K
        Food insecurity, comorbidity, and mobility limitations among older U.S. adults: findings from the Health and Retirement Study and Health Care and Nutrition Study.
        Prev Med. 2018; 114: 180-187
        • Jih J
        • Stijacic-Cenzer I
        • Seligman HK
        • Boscardin WJ
        • Nguyen TT
        • Ritchie CS
        Chronic disease burden predicts food insecurity among older adults.
        Public Health Nutr. 2018; 21: 1737-1742
        • Kendall A
        • Olson CM
        • Frongillo Jr, EA
        Relationship of hunger and food insecurity to food availability and consumption.
        J Am Diet Assoc. 1996; 96 (quiz 1025–1026): 1019-1024
        • Wolfson JA
        • Leung CW
        • Kullgren JT
        Food as a critical social determinant of health among older adults during the coronavirus disease 2019 (COVID-19) pandemic.
        JAMA Health Forum. 2020; 1e200925
        • Myers CA
        Food insecurity and psychological distress: a review of the recent literature.
        Curr Nutr Rep. 2020; 9: 107-118
        • Jones LJ
        • VanWassenhove-Paetzold J
        • Thomas K
        • et al.
        Impact of a fruit and vegetable prescription program on health outcomes and behaviors in young navajo children.
        Curr Dev Nutr. 2020; 4: nzaa109
        • Swartz H
        Produce RX programs for diet-based chronic disease prevention.
        AMA J Ethics. 2018; 20: E960-E973
        • Ridberg RA
        • Bell JF
        • Merritt KE
        • Harris DM
        • Young HM
        • Tancredi DJ
        Effect of a fruit and vegetable prescription program on children's fruit and vegetable consumption.
        Prev Chronic Dis. 2019; 16: E73
        • Stotz SA
        • Thompson JJ
        • Bhargava V
        • Scarrow A
        • Capitano K
        • Lee JS
        A supplemental produce and eLearning nutrition education program for Georgians who use safety-net clinics for their health care.
        J Nutr Educ Behav. 2019; 51: 1099-1106
        • Bisogni CA
        • Connors M
        • Devine CM
        • Sobal J
        Who we are and how we eat: a qualitative study of identities in food choice.
        J Nutr Educ Behav. 2002; 34: 128-139
        • Grandbois DM
        • Sanders GF
        The resilience of Native American elders.
        Issues Ment Health Nurs. 2009; 30: 569-580
        • Kahn CB
        • Reinschmidt K
        • Teufel-Shone NI
        • Oré CE
        • Henson M
        • Attakai A
        American Indian elders’ resilience: sources of strength for building a healthy future for youth.
        Am Indian Alsk Native Ment Health Res. 2016; 23: 117-133
      6. Manson SM. Strength-based approaches to wellness in Indian country. Centers for American Indian and Alaska Native Health; 2016. in-Indian-Country.pdf. Accessed October 16, 2021.

        • Young R
        American Indian and Alaskan Native Strength-Based Health Promotion: Worldviews, Indigenous Knowledge, Cultural Competency, and Approaches: A Literature Review.
        National Council of Urban Indian Health, 2015
        • Blue Bird Jernigan V
        • D'Amico EJ
        • Duran B
        • Buchwald D
        Multilevel and community-level interventions with Native Americans: challenges and opportunities.
        Prev Sci. 2020; 21: 65-73
        • Israel BA
        • Schulz AJ
        • Parker EA
        • Becker AB
        Review of community-based research: assessing partnership approaches to improve public health.
        Annu Rev Public Health. 1998; 19: 173-202