A qualitative study on parenting practices to sustain adolescent health behaviors in American Indian families

Authors: HODGSON, CHRISTINE - University Of California San Francisco (UCSF); DECKER, DYLAN - University Of Arizona; O'CONNOR, TERESIA - Children'S Nutrition Research Center (CNRC); HINGLE, MELANIE - University Of Arizona; GACHUPIN, FRANCINE - University Of Arizona

Submitted to: International Journal of Environmental Research and Public Health
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/31/2023
Publication Date: 11/3/2023
Citation: Hodgson, C., Decker, D., O'Connor, T.M., Hingle, M., Gachupin, F.C. 2023. A qualitative study on parenting practices to sustain adolescent health behaviors in American Indian families. International Journal of Environmental Research and Public Health. 20(21). Article 7015. https://doi.org/10.3390/ijerph20217015.
DOI: https://doi.org/10.3390/ijerph20217015

Interpretive Summary: American Indian (AI) youth who practice healthy behaviors of sleep, nutrition, physical activity, and limited screen time can lower their lifetime risk of diet-sensitive disease. The 'Achieving American Indian Youth Energy and Mental Health Balance' (AYEM-B) is an intervention that grew from a decades-long partnership between several southwestern U.S. tribes and a university multidisciplinary healthcare team, led by researchers at the University of Arizona. AYEM-B was originally a residential camp intervention for AI youth (ages 10–15) at risk for diet-related diseases. During the 2019 COVID pandemic, AYEM-B transitioned to a Camp in a Box delivered to the whole family during a one-week intensive period of activities for the family to perform at home in the summer, followed by eight booster session packages delivered by mail every couple of weeks. With this transition, parents were engaged more to support their youth towards healthy lifestyle behaviors. However, little is known about how AI parenting practices influence the health behaviors of youth. The objective of the qualitative study reported in this paper was to explore how a group of AI parents of youths at risk of disease influenced their youth's health behaviors after the AYEM-B CAMP in a Box intervention. A secondary objective was to understand the role of AI parents in supporting and sustaining health behavior change in their youths following the intervention. Semi-structured in-depth interviews were conducted with AI parents (n=11) and their young adolescents, 10–15 years old. Parents reported facilitators to how they enacted healthy lifestyle behaviors, including family togetherness, routines, youth inclusion in cooking, and motivation due to a health condition in the family. Barriers to enacting healthy behaviors included a lack of time, a lack of access to health resources, negative role modeling, and the pervasiveness of screen media. Three major themes about the role of AI parenting emerged inductively from the interview data: "Parenting in nontraditional families", "Living in the American grab-and-go culture", and "Being there and teaching responsibility". The importance of culture in raising youths was emphasized in the interviews. These findings can inform strategies to promote long-term adherence to behavior changes within the intervention. This study contributed to potential public health approaches regarding health-promotion for AI youths and families, who are not well represented in previous health behavior research.

Technical Abstract: American Indian (AI) adolescents who practice healthy behaviors of sleep, nutrition, physical activity, and limited screen time can lower their lifetime risk of diet-sensitive disease. Little is known about how AI parenting practices influence the health behaviors of youth. The objective of this qualitative study was to explore how a group of AI parents of youths at risk of disease influenced their youth's health behaviors after a family intervention. A secondary objective was to understand the role of AI parents in supporting and sustaining health behavior change in their youths following the intervention. Semi-structured in-depth interviews were conducted with AI parents (n=11) and their young adolescents, 10-15 years old (n=6). Parents reported facilitators to how they enacted healthy lifestyle behaviors, including family togetherness, routines, youth inclusion in cooking, and motivation due to a health condition in the family. Barriers to enacting healthy behaviors included a lack of time, a lack of access to health resources, negative role modeling, and the pervasiveness of screen media. Three major themes about the role of AI parenting emerged inductively from the interview data: "Parenting in nontraditional families", "Living in the American grab-and-go culture", and "Being there and teaching responsibility". The importance of culture in raising youths was emphasized. These findings inform strategies to promote long-term adherence to behavior changes within the intervention. This study contributes to public health conversations regarding approaches for AI youths and families, who are not well represented in previous health behavior research.