Native American (NA) women experience higher rates of intimate partner violence (IPV) compared to other U.S. racial/ethnic groups, yet previous research has not sufficiently examined the complex determinants shaping their IPV experiences. This research explores the interplay of family networks and legal systems influencing NA women’s IPV experiences. Data were collected through in-depth individual and group interviews with 42 NA survivors and 41 health/social service providers from July 2016 to June 2017 in NA communities from three different U.S. regions. We used Grounded Theory to develop emergent themes from the data, focusing on system-level risk and protective factors of women’s of IPV experiences. In terms of family systems, participants indicated that NA communities were comprised of highly influential and interwoven family systems, making them powerful sources of support for both survivors and their partners who use violence. Participants described how intergenerational violence exposures contributed to the normalization of violence. In terms of legal systems, participants described inconsistent consequences for abusers of NA women, insufficient protection from legal systems, and manipulation of jurisdictional complexities. Interactions between family and legal systems influenced decision-making and outcomes. Family and community-based approaches, and the incorporation of traditional language and cultures, are needed to promote healing. Our findings reflect the complex ways that family and legal systems shape NA women’s IPV experiences. Results provide insight into how NA women interact with and navigate these systems when experiencing IPV and how these systems impact decision-making and the ability to be safe from IPV. Research is needed to advance understanding of the inter-relationships between intergenerational trauma, family systems, and legal systems on IPV survivors’ mental health and wellness. To make meaningful change, further research examining IPV from an interdisciplinary perspective that explores the interplay of social determinants of health inequities is needed.

The next international gathering of the global health promotion family will be in Montreal, in May 2022. The 24th IUHPE conference is themed ‘Promoting policies for health, well-being and equity’. Conference organizers have decided to transcend the ‘usual suspects’ rhetoric and frame a conference program that truly challenges these key notions for health promotion. In this contribution, members of the Canadian National and Global Scientific Committees reflect on the state of play and the opportunities ahead. We propose three themes as follows: (a) breaking news (the promise and opportunities for disruptions and tipping points, whether from pandemic health challenges, climate change, geopolitical shifts, social unrest or technological promise); (b) breaking free (from world-views that favor only market solutions, divisions between North and South, toward emancipatory decolonizing practices and knowledge systems); and (c) breaking through (disciplines, silos, boundaries and identities engrained in our practices and understandings for innovation.)

Native Americans (NA) have the highest rates of diet-related chronic diseases in the country. Yet, the relationship between dietary patterns and chronic diseases in this population has not been well explored. We aimed to characterize common dietary patterns among adults from six NA communities (n = 580) and assess their relationship with body mass index (BMI), % body fat, waist-to-hip ratio, hypertension, and self-reported type 2 diabetes and cardiovascular disease. We conducted a baseline assessment of an obesity prevention study (n = 580). Dietary intake data was collected using a modified Block Food Frequency Questionnaire. Exploratory factor analysis was used to characterize dietary patterns. We used multivariate linear and logistic regression analyses to assess associations between dietary patterns and health outcomes, controlling for age, sex, employment status, smoking status, geographic region, and energy intake. Trial was registered under Engaging Tribal Policy Makers to Improve the Food and Physical Activity Environments in American Indian Communities (OPREVENT2). NCT02803853 (06/17/2016). Five dietary patterns, explaining 81.8% of variance in reported food consumption were identified: “meat and fried foods”, “processed foods”, “fruits and vegetables”, “sugary snacks”, and “meat alternatives and high-protein foods”. Higher consumption of “meat and fried foods” was associated with higher mean waist-to-hip ratio (0.03; 95% confidence interval (CI):0.01–0.04), higher mean BMI (2.45; CI:0.83–4.07 kg/m²), and increased odds of being overweight or obese (OR 2.63; CI:1.10–6.31). Higher consumption of “processed foods” was associated with increased odds of self-reported type 2 diabetes (OR 3.41; CI:1.31–8.90). No protective effect in consumption of “fruits and vegetables” was observed, although average consumption was below national recommendation levels. NA dietary patterns corroborate nutritional concerns previously reported among NA populations. Future interventions should discourage overconsumption of meat, fried foods, and processed foods, and promote fruits and vegetables consumption to reduce chronic disease burden in this population.

Native Americans (NAs) experience a high burden of obesity and diabetes, yet previous research has not holistically described the unique food environments of NA communities. The objective of this paper is to describe the subgroups and demographic characteristics related to NA household food environments. Surveys collected food getting, food assistance, and sociodemographic variables from randomly selected adults from three NA communities (n = 300) in the Midwest and Southwest. Exploratory latent class analysis (LCA) identified the appropriate number of subgroups based on indicator responses. After assigning participants to classes, demographic differences were examined using bivariate analyses. NA household food environments could be described using two subgroups (“lower” and “higher access household food environments”). The “lower access” group had significantly higher age, smaller household size, and fewer children per household than the “higher access” group, while body mass index (BMI) did not significantly vary. This is the first LCA of NA household food environments and highlights the need for approaches that characterize the complexity of these environments. Findings demonstrate that NA household food environments can be described by developing subgroups based on patterns of market and traditional food getting, and food assistance utilization. Understanding NA household food environments could identify tailored individual and community-level approaches to promoting healthy eating for NA Nations.

Obesity and chronic disease rates continue to be disproportionally high among Native Americans (NAs) compared with the US general population. Policy, systems, and environmental (PSE) changes can address the root causes of these health inequalities by supporting access to healthy food and physical activity resources. We aim to describe the actors and processes involved in developing PSE changes supporting obesity prevention in NA Nations. As part of the Obesity Prevention Research and Evaluation of InterVention Effectiveness in NaTive North Americans 2 (OPREVENT2) trial (ClinicalTrials.gov registration: NCT02803853), we collected 46 in-depth interviews, 1 modified Talking Circle, 2 workshops, and 14 observations in 3 NA communities in the Midwest and Southwest regions of the United States. Participants included Tribal government representatives/staff, health staff/board members, store managers/staff, and school administrators/staff. We used a Grounded Theory analysis protocol to develop themes and conceptual framework based on our data. Health staff members were influential in identifying and developing PSE changes when there was a strong relationship between the Tribal Council and health department leaders. We found that Tribal Council members looked to health staff for their expertise and were involved in the approval and endorsement of PSE changes. Tribal grant writers worked across departments to leverage existing initiatives, funding, and approvals to achieve PSE changes. Participants emphasized that community engagement was a necessary input for developing PSE changes, suggesting an important role for grassroots collaboration with community members and staff. Relevant contextual factors impacting the PSE change development included historical trauma, perspectives of policy, and “tribal politics”. This article is the first to produce a conceptual framework using 3 different NA communities, which is an important gap to be addressed if structural changes are to be explored and enacted to promote NA health. The journey to change for these NA Nations provides insights for promoting future PSE change among NA Nations and communities.

Knowledge translation (KT) research aims to bridge the gap between research results and application which is vital to addressing health inequities. Despite the increasing emphasis on engaging Indigenous communities in research, there is limited research examining how to effectively engage communities to achieve Indigenous KT. The Food, Environment, Health, and Nutrition of First Nations Children and Youth (FEHNCY) is a nationally representative survey collaborating with First Nations’ (FNs) communities across Canada to inform policies and programs. The FEHNCY Community Engagement and Mobilization (CEM) supports partnerships with participating FNs communities and the application of study findings into action. This formative research aimed to examine how, for whom, and in which circumstances community engagement approaches support KT within FNs communities. Data were generated with one rural and one semi-urban community participating in the FEHNCY pilot from the Atlantic and Eastern regions of Canada, respectively. A total of 26 in-depth interviews were conducted, 1 modified Talking Circle with community partners and 2 focus group discussions with the FEHNCY team. We used a realist approach combining inductive and deductive coding stages to develop a middle-range theory examining the connections between community engagement and KT. Our findings highlight the contexts, interventions, mechanisms, and outcomes that create pathways to KT. The participants described the societal, study and community contexts that affected engagement processes. The essential community engagement strategies included supporting Indigenous leadership in the research, supporting community decision-making, promoting project visibility, applying youth-specific engagement strategies, and incorporating FNs knowledges. The participants also described that centering positive relationships between research and community partners and valuing FNs knowledge systems were essential mechanisms for supporting KT. Lastly, participants highlighted KT outcomes namely, community self-determination in research, improved research findings and application of results for FNs benefit. This research can inform the strategic use of community engagement in research for KT among FNs. This study is the first to generate a middle-range theory using primary data collection for supporting KT through community engagement approaches in Indigenous health research.