TABLE 2.
Summary of quantitative studies (n = 25) included in the review by year of publication and alphabetical order of first author's last name1
| First author (year) (ref) and quality score | Study objective | Sample size, setting, eligibility criteria | Sociodemographic characteristics | Prevalence of food insecurity |
|---|---|---|---|---|
| Pandey (2001) (38)Quality score: 3 | To monitor the impact of the 1996 federal welfare reform legislation over a period of 5 y | Sample: 350Setting: Salt River, San Carlos, and NavajoCriteria: Former or current welfare families with children | Race: NRGender: 95% womenAge: mean 38 yEducation: 72% high school or lessMarital status: 42% never marriedEmployment: 15% currently employedIncome: NR | 45% |
| Brown (2007) (31)Quality score: 6 | To explore the relations and environmental connections between food insecurity and health-associated outcomes and food characteristics of AI households | Sample: 187Setting: Reservation in Montana Northern Plains regionCriteria: NR | Race: 89% AI or ANSex: 72% femaleEducation: 23% completed high school or GED; 48% some college or Associate's degreeMarital status: NREmployment: NRIncome: 68% earned <$30,000 | 44% |
| Gundersen (2008) (17)Quality score: 8 | To portray the extent, depth, and severity of food insecurity among AIs | Sample: 1143Setting: NationwideCriteria: NR | Race/ethnicity: 100% AIGender: NRAge: mean 36.1 (0.4) to 51.0 (0.6) yEducation: 21–22%2Marital status: 36–66% married2Employment: NRIncome: NR | 16–28%2 |
| Whiting (2009) (51)Ward (2008) (24)Whiting (2007) (25)Quality score: 8 | To assess the relative effects of background characteristics, food insecurity, and use of actual food acquisition strategies on stress levels among reservation residents | Sample: 445 (survey); 70 (interviews)Setting: Northern Cheyenne Indian ReservationCriteria: NR | Race: NRGender: 56% womenAge: 46% 25–44 y oldEducation: 37% completed high schoolMarital status: 50% marriedEmployment: 36% full-time employmentIncome: NR | 72% |
| Dammann (2011) (34)Quality score: 5 | To examine racial/ethnic differences in relations between food-related environmental, behavioral, and personal factors and low-income women's weight status using Social Cognitive Theory | Sample: 367Setting: NationwideCriteria: NR | Race/ethnicity: NRGender: NRAge: mean 36.6 ± 11.4 yEducation: 43% less than high schoolMarital status: NREmployment: 83% unemployedIncome: 51% <$5000/y | 73% |
| Bauer (2012) (27)Quality score: 9 | To better understand the prevalence and consequences of food insecurity among AI families with young children | Sample: 432Setting: Pine Ridge ReservationCriteria: All kindergarten children and caregivers | Race: NRGender: NRAge: NREducation: 46% high school or lessMarital status: 49% marriedEmployment: 48% unemployedIncome: 50% <$15,000/y | 40% |
| Ray (2012) (42)Quality score: 8 | To investigate the relation of food security to produce intake and behaviors, health status, and diabetes risk among women 18 y and older with a least 1 child less than 18 y old enrolled in primary school living on a Navajo reservation | Sample: 42Setting: Greasewood, AZCriteria: Adult women with ≥1 child less than 18 y old attending a primary school on the reservation | Race: 97% AI/AN and 2% NHPIGender: NRAge: 42 ± 12 yEducation: 76% graduated high schoolMarital status: 45% marriedEmployment: NRIncome: NR | 58% |
| Bennett (2013) (28)Quality score: 7 | To understand how different socioeconomic factors affect food security for the Citizen Potawatomi Nation in Oklahoma | Sample: 91Setting: Citizen Potawatomi Nation in OKCriteria: Households with ≥1 member of the tribe that lived within 3 zip codes | Race: NRSex: NRAge: NREducation: 50% high school or lessMarital status: NREmployment: 54% unemployedIncome: 48% earned $39,999/y or less | 35% |
| Blue Bird Jernigan (2013) (29)Quality score: 7 | Estimate the prevalence of food insecurity in low-income AIs/ANs and Whites; examine the association between food insecurity and obesity in low-income AIs/ANs and Whites | Sample: 592 AI/AN adults and 7371 White adultsSetting: CACriteria: Household incomes ≤200% the FPL | Race: NRSex: 53% maleAge: 52% 18–40 y oldEducation: 35% less than high schoolMarital status: 43% marriedEmployment: NRIncome: 46% 100–199% FPL | 39% |
| Mullany (2013) (37)Quality score: 5 | To identify factors associated with food insecurity and household eating patterns among AI families with young children | Sample: 425Setting: 4 reservations in AZ and NMCriteria: Adult (≥18 y) heads of household with children 0–5 y old living in study site | Race: NRSex: 84% femaleAge: mean 36.2 ± 14.2 yEducation: NRMarital status: NREmployment: NRIncome: NR | 45% of adults and 29% of children |
| Pardilla (2014) (39)Quality score: 9 | "What are the levels of food insecurity on the Navajo Nation?”“What factors are associated with food insecurity in this setting?”“What is the association between food insecurity and obesity among adults?" | Sample: 276Setting: 10 communities in Navajo Nation (AZ, NM, and UT)Criteria: Main food preparer/shopper, ≥18 y old, tribal member in household, residency within Navajo Nation for ≥1 mo, no plans to move off the reservation for 1 y, not pregnant | Race: NRSex: NRAge: NREducation: NRMarital status: NREmployment: NRIncome: NR | 77% |
| Chambers (2015) (33)Quality score: 4 | To test the feasibility of a family-based, home-visiting diabetes prevention/management intervention for AI youth with or at risk for type 2 diabetes | Sample: 255Setting: 3 Navajo communities and the White Mountain Apache TribeCriteria: Lived within 50-mile radius of local medical facility; youth had 1 of the following: diagnosis of prediabetes or type 2 diabetes or at risk for diabetes | Race: NRSex: 56% boys Age: median 13.2 yEducation: 92% currently in schoolMarital status: NREmployment: NRIncome: NR | 38% |
| Gray (2015) (35)Bliss (2004) (22)Quality score: 5 | To identify basic relations between food security, cultural identification, physical health, mental health, and nutrition within a subgroup of the AI/AN population, specifically Northern Plains Indians | Sample: 458 adultsSetting: Northern Plains (North and South Dakota, Minnesota, Montana, and Wyoming)Criteria: NR | Race: 100% AIAge: mean 37.0 ± 14.1 yGender: NREducation: 40% high school/GED or lessMarital status: NREmployment: 43% full-time employmentIncome: 53% $20,000/y or less | 26% |
| Blue Bird Jernigan (2017) (18)Quality score: 9 | To analyze the food insecurity trends of AI/AN adults compared with other racial and ethnic groups in the United States | Sample: 1513 AI/AN adultsSetting: United StatesCriteria: Households under 185% FPL or those who screened at risk of food insecurity | Race: NRSex: 50% femaleAge: 39 ± 0.6 yEducation: 26% less than high schoolMarital status: 44% marriedEmployment: NRIncome: 45% >185% of poverty level | 25% |
| Blue Bird Jernigan (2017) (30)Quality score: 6 | To assess food insecurity and prevalence of obesity, diabetes, and hypertension among AIs in the Chickasaw Nation and Choctaw Nation of Oklahoma | Sample: 513 AI adultsSetting: Choctaw Nation and Chickasaw Nation tribal jurisdictional areasCriteria: ≥18 y old, live within study areas, and self-identify as AI/AN | Race: NRSex: 75% femaleAge: mean 44 y oldEducation: 64% at least some collegeMarital status: NREmployment: 77% employedIncome: 58% earned <$40,000/y | 56% inadequate quantity and 62% inadequate quality |
| Berryhill (2018) (15)Quality score: 5 | To determine levels of food security among American Indians living in the Midwest and possible correlations between food security levels and various health outcomes, diet, and demographic variables | Sample: 362Setting: MidwestCriteria: ≥18 y old, self-identify as AI, and willing to complete survey | Race: NRSex: NRAge: median 39–41 y2Education: NRMarital status: 51% marriedEmployment: NRIncome: NR | 58% |
| Kahn (2018) (47)Quality score: 6 | To document urban AI adult food access, food security, BMI, and barriers and strategies in using Tucson, Arizona's food system to explore social determinants of health that impact food availability and accessibility | Sample: 275 (survey) and 89 (qualitative stages)Setting: Tucson, AZCriteria: ≥18 y old, self-identify as AI, and resided in Tucson, AZ | Race: NRSex: 64% femaleAge: 49% <45 y oldEducation: 55% some college or moreMarital status: NREmployment: NRIncome: 69% earned <$25,000/y | 71% |
| Adams (2019) (26)Tomayko (2017) (23)Quality score: 6 | To describe sociodemographic factors and health behaviors among AI families with young children and determine predictors of adult/child weight status among these factors | Sample: 450Setting: 1 urban area and 4 rural American Indian reservationsCriteria: Child between 2 and 5 y old and a primary caregiver, ability to provide data, and a working cell phone | Race: NRGender: 95% femaleAge: mean 31.4 ± 8.5 yEducation: 52% some collegeMarital status: 24% singleEmployment: NRIncome: 58% earned <$20,000/y | 61% |
| Pindus (2019) (40)Quality score: 6 | To describe FDPIR participant characteristics and program operations | Sample: 849 householdsSetting: FDPIR sites across the United StatesCriteria: All FDPIR participating households in September 2013 | Race: NRGender: 62% womenAge: 56% between 45 and 74 y oldEducation: NRMarital status: 77% singleEmployment: NRIncome: average $1144 monthly income | 56% |
| Porter (2019) (41)Quality score: 4 | To share data on adult health status in the Wind River Indian Reservation | Sample: 176 adultsSetting: Wind River Indian ReservationCriteria: Lived in the study site, ≥1 family member enrolled in a tribe, ≥1 adult willing to participate in 2-y study, interested in maintaining a home food garden | Race: NRSex: 63% femaleAge: 85% 20–59 y oldEducation: NRMarital status: NREmployment: NRIncome: NR | 65% |
| Sowerwine (2019) (16)Quality score: 7 | “Can promoting access to native foods reduce hunger and food insecurity in Native American communities?” | Sample: 711Setting: 4 tribes in the Klamath River BasinCriteria: Tribal members and descendant households | Race: NRSex: 63% femaleAge: Median 55 yEducation: 25% some collegeMarital status: NREmployment: NRIncome: 43% below the FPL | 63% |
| Byker Shanks (2020) (32)Quality score: 5 | “Does dietary quality of residents of the Flathead Nation vary based on food security status and demographic factors?” | Sample: 80Setting: Eight communities on the Flathead NationCriteria: 18 y of age and residents of the Flathead Nation | Race: 73% Native AmericanSex: FemaleAge: NREducation: 82% high school graduatesMarital status: NREmployment: NRIncome: 51% less than $25,000 | 51% |
| Johnson-Jennings (2020) (46)Quality score: 3 | To examine the feasibility of gardening as an obesity intervention among a school- aged Indigenous population at risk for homelessness | Sample: 27 adults and 7 children (focus groups), 7 children (survey), and 6 adults (interviews)Setting: MinnesotaCriteria: Adults and children at risk of homelessness | Race: NRSex: NRAge: Children ranged from 5 to 11 y oldEducation: NRMarital status: NREmployment: NRIncome: NR | 100% |
| Jones (2020) (36)Quality score: 5 | To assess the impact of FVRx on changes in health behavior, BMI, and household food insecurity among children enrolled in the first 4 y of implementation | Sample: 212 childrenSetting: Health care facilities on the Navajo NationCriteria: Families with a pregnant woman (“maternal group”) or a child <6 y of age (“pediatric group”) | Race: NRSex: 50% femaleAge: 3.96 ± 1.87Education: NRMarital status: NREmployment: NRIncome: NR | 80% |
| Walch (2020) (43)Quality score: 5 | To understand the links between intake of traditional foods, food security, and diet quality in low-income AN women living in an urban center | Sample: 73Setting: Urban, AKCriteria: AN women ≥ 18 y old, neither pregnant nor lactating, and enrolled in WIC | Race: NRSex: NRAge: 88% between 18 and 39 y oldEducation: 65% no college experienceMarital status: 62% singleEmployment: NRIncome: 69% <$25,000/y | 51% |
1
AI, American Indian; AN, Alaska Native; FDPIR, Food Distribution Program on Indian Reservations; FPL, Federal Poverty Line; FVRx, Fruit and Vegetable Prescription Program; GED, General Educational Development; NHPI, Native Hawaiian or Pacific Islander; NR, not reported; ref, reference; WIC, Special Supplemental Nutrition Assistance Program for Women, Infants, and Children.
2
Ranges reflect differences for households with and without children.