Sociodemographic and Psychosocial Factors Associated With Diet Quality in 6 Rural Native American Communities

Objective: To identify psychosocial and household environmental factors related to diet quality among Native Americans (NA). Design: Analysis of baseline data from a community-randomized obesity prevention trial. Setting: Six rural NA communities in the Midwest and the Southwestern US. Participants: A total of 580 tribal members, aged 18–75 years old (mean 45 years), 74% female, self-identified as the main household food purchaser. Variables Measured: Diet quality (Healthy Eating Index–2015 [HEI]) was derived from a semiquantitative food frequency questionnaire. Sociodemographic, psychosocial, and home food environment factors were assessed via interviewer-administered questionnaires. Analysis: One-way ANOVA, linear regression models, and 2-tailed t tests compared HEI scores among sociodemographic categories. Multiple linear regression models assessed the relationship between psychosocial factors, home food environment, and HEI. Results: Prevalence of obesity was 59%. Mean HEI–2015 score was 49.3 (SD = 8.1). Average HEI scores were 3.0 points lower in smokers than nonsmokers (P < 0.001), and 2.2 points higher in females than males (P < 0.01). Higher self-efficacy (β = 0.97; P < 0.001) and healthier eating intentions (β = 0.78; P < 0.001) were positively associated with HEI. Healthier household food patterns score was associated with higher HEI (β = 0.48; P < 0.01). Conclusions and Implications: Psychosocial factors were associated with diet quality, a finding that supports the use of social-cognitive intervention approaches in rural NA communities in the Midwest and Southwest, and warrants evaluation in other locations. There remains a need to elucidate the association between the Food Distribution Program on Indian Reservations and diet quality.