Foodborne illnesses remain an important public health issue in fast-growing urban areas of Nigerian cities and household food safety knowledge and practices are anomalously distributed. In Ibadan metropolis social, economic, and environmental conditions may play a role in increasing household vulnerability to food safety risks, but these influences are not well understood spatially. This study was based on household-level questions about food safety knowledge, practices and contamination, and was driven by a desire to understand food safety vulnerabilities at the household level and how this state is affected by socioeconomic and environmental factors across the city. This cross-sectional study was conducted across 604 households in five Local Government Areas of Ibadan Metropolis using proportional multi-stage sampling. A structured questionnaire administered via REDCap with GPS-recorded household locations captured food safety knowledge, behaviours, and perceived control. A random subsample of 250 households (500 food contact surfaces) underwent microbiological assessment using ATP bioluminescence and Total Coliform testing; a matched comparison group of 50 households (100 surfaces) was included; this group was not a randomised or experimental control, so “comparison group” is used throughout to avoid implying an experimental design. Spatial distribution of food safety indicators and household vulnerability were mapped using ArcGIS 10, with vulnerability levels derived from an index-based framework adapted from Schwarz and Kuleshov. Across 604 households in Ibadan, food safety knowledge and practices showed clear spatial and socioeconomic disparities. Between 22 and 27% of households exhibited unsafe food handling behaviours, particularly in low-income areas with limited infrastructure. Only 28.9% had access to piped water, 46.5% had adequate kitchen facilities, and 39.7% accessed formal waste collection services. More than half (53.5%) prepared food in semi-open or outdoor spaces. Perceived control over food safety was lowest in Ibadan North East and Ibadan South East. Microbiological testing of 500 food contact surfaces showed 48.2% ATP failure (threshold: manufacturer-recommended RLU cutoff), compared to 18% in the comparison group. Total Coliform analysis revealed that 61.2% of tested food contact surfaces (306 of 500) were contaminated, with 42.4% classified as highly contaminated (≥ 100 CFU/cm²) and 38.8% undetected. Visually apparent co-occurrence (not tested using formal spatial statistics) suggested that low knowledge, unsafe behaviours, limited perceived control, and high contamination co-occurred in high-vulnerability neighbourhoods. Household food safety risks in Ibadan are influenced by multiple, interlinking socioeconomic and environmental factors that create distinct spatial patterns in vulnerability. The study provides insights into targeted, context-bound interventions focusing on high-risk neighbourhoods, addressing both knowledge gaps and structural limitations in household food safety practices. Strengthening community-based education, improving household food-handling environments, and engaging local stakeholders are important for curbing foodborne illness risks in rapidly growing urban settings. These findings provide empirical evidence from Nigeria to inform equitable and place-based food safety planning for urban households.

Climate change is occurring at an accelerated pace in high-latitude regions, with implications for the health and well-being of rural northern communities– places that have long navigated significant health disparities with limited resources. Here, we present a community-driven effort to identify community priorities for improving health in the context of a changing climate. We used Q-methodology in four rural Alaska Native communities to systematically identify complex perspectives related to climate change and health priorities. The mixed qualitative-quantitative approach helped to engage the community, prioritize the most locally relevant issues, and identify targets for future interventions. Consistently top-ranked priorities include food security, Indigenous knowledge and practices, and the transmission of culture and traditional ways of living to the younger generations. Community perspectives reflect a holistic view of health that connects climate change to individual health and community well-being. These three components are linked together through the social-ecological landscape, providing resources that are embedded in the local and Indigenous cultural practices. We show that a community-engaged approach can generate consensus data, directing research and interventions towards the highest needs and priorities of Alaska Native communities highly affected by climate change. Overall, participating rural Alaska Native communities prioritized the impacts of climate change on traditional ways of living from the land to subsist and thrive in these remote, culturally important areas. Additionally, the well-being and futures of young people arose as a primary shared concern, directing interventions to address the impacts of climate change on health towards place-based solutions that protect and preserve environmental resources and engage young people in the transmission of traditional knowledge and practices on the land.

By nearly every conventional metric, Indigenous Peoples globally experience disproportionately high rates of food insecurity. Conventional approaches to measuring food security rely primarily on economic indicators to assess barriers to food access. This limits the utility of these tools when applied to Indigenous Peoples because conventional approaches do not account for additional sociocultural and biophysical variables associated with the harvest of traditional foods, and lack the ability to identify vulnerability to future food insecurity. Applying a holistic framework, such as One Health, to a vulnerability analysis of food insecurity may be a means to bridge these gaps. The objective of this scoping review was to evaluate the use of this approach when measuring food security in Indigenous populations. Following the Joanna Briggs Institute guidelines, a scoping review of English-language scholarly and gray literature was conducted to evaluate how food security has been measured in Indigenous populations that harvest traditional foods around the world. We defined the harvest of “traditional foods” as a way of living off the land to fulfil economic, physical, cultural, and spiritual needs, which include hunting, fishing, gathering, and cultivating one’s food to obtain a significant portion of one’s food, shelter, clothing, and tools. Peer-reviewed literature was retrieved from PubMed, Scopus, Wiley Online Library, Web of Science, and ProQuest. Gray literature was retrieved through searches on government pages and public health and nutrition assistance-related program websites. Results included 43 documents (39 peer-reviewed, two reports, and two graduate theses). A majority of the documents used a food security measurement tool that incorporated indicators of traditional food access (n = 38; 88

American Indian and Alaska Native children experience disparities in obesity. Home caregiver diet and weight status may be important for obesity prevention efforts. The goals of this study were (1) to examine the concordance of diet and body mass index (BMI) between Yup’ik caregivers and preschoolers in remote Alaska and (2) to examine the association of dietary factors with BMI for caregivers. Study data came from “Got Neqpiaq?”, a culturally centered multilevel intervention focused on Yup’ik preschool-aged children (n = 155) and caregivers (n = 144) in 12 communities in Southwest Alaska. Dietary factors of interest were measured using biomarkers: traditional food intake (nitrogen stable isotope ratio), processed food intake (carbon stable isotope ratio), and vegetable and fruit intake (skin carotenoid concentration). Associations among variables were evaluated using confounder-adjusted linear regression with BMI modeled as a continuous outcome. Dietary biomarkers were highly concordant between caregivers and children, but caregiver and child BMI were not. Among caregivers, traditional food intake was positively associated with BMI (beta = 1.57; 95

Acculturation/enculturation has been found to impact childhood health and obesity status. The objective of this study is to use cross-sectional data to examine the association between proxies of adult/caregiver acculturation/enculturation and child health status (Body Mass Index [BMI], waist circumference [WC], and acanthosis nigricans [AN]) in the U.S.-Affiliated Pacific Islands (USAPI), Alaska, and Hawaiʻi. Study participants were from the Children’s Healthy Living (CHL) Program, an environmental intervention trial and obesity prevalence survey. Anthropometric data from 2–8 year olds and parent/caregiver questionnaires were used in this analysis. The results of this study (n = 4121) saw that those parents/caregivers who identified as traditional had children who were protected against overweight/obesity (OWOB) status and WC > 75th percentile (compared to the integrated culture identity) when adjusted for significant variables from the descriptive analysis. AN did not have a significant association with cultural classification. Future interventions in the USAPI, Alaska, and Hawaiʻi may want to focus efforts on parents/caregivers who associated with an integrated cultural group as an opportunity to improve health and reduce child OWOB prevalence.

Background Household-level food safety, which is underrepresented in research on food safety, represents a significant economic and public health concern in Nigeria. Exposure to unsafe food in the household creates a vicious cycle of diarrhea and other foodborne illnesses and threatens the nutritional status of the most vulnerable, especially infants and young children. Objective Our objective was to document mothers’ lived experiences in providing safe and nutritious foods for their families using a participatory and qualitative approach. Study Design, Settings, Participants Mothers of children <5 years (n=55) were recruited from 5 local government areas in Ibadan Metropolis, Nigeria. Mothers took photos and recorded written or audio narratives using the Our Voice Discovery Tool App, following prompts about food safety vulnerability over 5 days. Measurable Outcome/Analysis In follow-up discussions, mothers shared their photos and discussed potential solutions. Results Lack of access to resources, equipment and basic amenities; presence of pests; lack of control over food safety in eating out occasions; environmental conditions; shared kitchen and toilet facilities were identified as threats to food safety in the household. Mothers shared many of their strategies to mitigate threats and proposed solutions to improve conditions. Conclusions Mothers identified various factors at multiple levels of the socio-ecological model that contributed to or detracted from their household's food safety. These findings will be shared with key stakeholders and policymakers to identify and implement sustainable solutions. Funding USAID

Household-level food safety practices may have a long-term outcome on the nutrition and health status of under-five children. This study explores the relationships between caregivers’ self-reported food safety knowledge, behavior, perception of food safety control, and their young child’s (< 5 years) nutrition status. In a cross-sectional study design, 664 caregivers from five Local Government Areas (LGAs) in Ibadan, Nigeria were surveyed using an interviewer-administered questionnaire on their food safety knowledge, behavior and perceived food safety control. Anthropometric measurements of the household’s index child (aged 6–59 months) were also taken. Variables for food safety knowledge and behavior score were selected using principal component analyses. The nutritional status of the children (Z-scores for weight-for-height (WAZ), height-for-age (HAZ), and weight-for-age (WHZ)) were calculated. Description statistics were run on all variables and logistic regression models examined associations between the three food safety constructs and the children’s nutritional status. Covariates such as LGAs, caregiver’s age, household size, wealth index, child’s gender, and age were adjusted. High-level of food safety knowledge, behavior and lots of perceived control on food safety issues were reported by 77.7

Background This study protocol describes a community-based intervention that will seek to reduce added sugar intake in Yup'ik Alaska Native children by targeting reductions in sugar-sweetened fruit drinks. Methods A two-group non-randomized design will be used to evaluate the intervention in three Yup'ik communities in Alaska focusing on children age 1 to less than age 12 years with a minimum enrollment target of 192 children. Families in the intervention arm will participate in a program consisting of five sessions plus four brief check-ins, all delivered by a Yup'ik Community Health Worker. Modifications to the local store environment will be made to give families a place to purchase sugar-free water enhancers. Families in the delayed treatment control arm will receive no intervention during the main study period. There will be five data collection visits (baseline, 1-month, 3-months, 6-months, and 12-months) that will include collection of survey and dietary data, and a hair and plaque sample from each participating child. The outcomes will be change, from baseline to 6 months, in added sugar intake based on a validated hair biomarker (grams of added sugar/day). We hypothesize children in the intervention arm will have greater reductions in added sugar intake compared to children in the control arm as measured by the hair biomarker. Discussion This is one of the first known community-based sociobehavioral interventions aimed specifically at reducing added sugar intake in Alaska Native communities by targeting sugar-sweetened fruit drinks. Trial registration ClinicalTrials.gov NCT05219448 (first posted on February 2, 2022).

This study evaluated whether traditional food intake and diet quality differed by season in Yup'ik communities and examined the relationship between intake of traditional food groups and diet quality. Data were collected from 38 participants, ages 14-79 years, from two Yup'ik communities in Southwest Alaska from 2008 to 2010. Self-reported intake (24-h recalls) and dietary biomarker (nitrogen stable isotope ratio) data were collected twice in distinct seasons. Diet quality was assessed using the Healthy Eating Index. A paired sample t-test was used to test for seasonal differences in traditional food intake and diet quality, and linear regression was used to evaluate associations between traditional food intake and diet quality. Total traditional food intake and overall diet quality did not significantly differ by season, but there were differences in traditional food group intake and diet quality component scores. Diet quality was strongly associated with intake of traditional food groups including fish, tundra greens, and berries. Given the strong relationship between traditional food intake and diet quality, policies should aim to ensure continued access to traditional foods in Yup'ik communities amid environmental changes in the circumpolar North.

Background: American Indian and Alaska Native preschool-aged children experience a high prevalence of obesity, yet are under-represented in obesity prevention research. This study examined obesity prevalence and dietary risk factors among Alaska Native preschool-aged children in southwest Alaska.Methods: The study used baseline data from "Got Neqpiaq?" a culturally centered multilevel intervention focused on Yup'ik Alaska Native children, aged 3-5 years, enrolled in Head Start in 12 communities in southwest Alaska (n = 155). The primary outcomes were BMI percentile, overweight, and obesity. Dietary factors of interest were measured using biomarkers: traditional food intake (nitrogen stable isotope ratio biomarker), ultraprocessed food intake (carbon stable isotope ratio biomarker), and vegetable and fruit intake (skin carotenoid status biomarker measured by the Veggie Meter). Cardiometabolic markers (glycated hemoglobin [HbA1c] and blood cholesterol) were also measured.Results: Among the Yup'ik preschool-aged children in the study, the median BMI percentile was 91, and the prevalence of overweight or obesity was 70%. The traditional food intake biomarker was negatively associated with BMI, whereas the ultraprocessed foods and vegetable and fruit biomarkers were not associated with BMI. HbA1c and blood cholesterol were within healthy levels.Conclusions: The burden of overweight and obesity is high among Yup'ik preschool-aged children. Traditional food intake is inversely associated with BMI, which underscores the need for culturally grounded interventions that emphasize traditional values and knowledge to support the traditional food systems in Alaska Native communities in southwest Alaska. Registered with ClinicalTrials.gov #NCT03601299.

For more than 50 years, government programmes in the USA have been in place to help those in need have consistent access to food and education. However, questions have surfaced regarding whether or not these support impact traditional ways, such as cultural activities, food preferences, and overall health, particularly for Indigenous populations. In this paper, we share insights voiced by Alaska Native Elders in the Yukon-Kuskokwim region of Alaska and their perceptions of regulations, assistance, and the impact government assistance programmes have had on their culture. Elders raised concerns so that those administering these programmes will consider how best to meet food security and education needs without interfering with Indigenous cultural practices and traditional lifestyle.

Objective: Characterize vegetable and fruit (VF) intake in a Yup'ik community using self-reported intake and skin carotenoid status (SCS) and evaluate the relationship between SCS and fish intake. Methods: Self-reported VF intake was measured using the 24-hour recall, SCS was measured by reflection spectroscopy via the Veggie Meter (Longevity Link Corporation), and fish intake was estimated by the nitrogen isotope ratio (NIR) for 80 participants in a remote community in Southwestern Alaska. Bivariate correlations were used to assess the relationship between self-reported VF intake, SCS, and NIR. Results: Intake of all VF subgroups was low. The SCS was higher for males (262.7 vs 185.3; P = 0.002) and participants consuming more than 1 VF serving (232.5 vs 183.0; P = 0.02). It was not associated with the NIR. Conclusions and Implications: Increasing VF intake is a way to improve diet in Yup'ik communities and the Veggie Meter is a simple and noninvasive tool to facilitate surveillance efforts.

Despite the essential benefits of fruits and vegetables (F&V), much of the world does not eat theminimum recommended amounts. In addition, nearly 50% of all F&V produced globally is wasted between harvest and consumption.1 These issues put unnecessary pressures on both the health of the people and the planet.1 In recognition of the critical role F&Vs play in promoting both healthy diets and sustainable food systems, the United Nations declared 2021 as the International Year of Fruits and Vegetables (IYFV 2021).

Community social networks (CSN) include individuals and groups, and those with strong partnerships and relationships are well situated for implementing community-based interventions. However, information on the nature of CSN relationships required for multilevel community-based interventions is not present in the literature. Using data from the multi-level Children’s Healthy Living (CHL) trial to reduce child obesity in nine Pacific communities, this study aimed to develop a methodology based on Social Network Analysis (SNA) to understand how CSN evolved over the course of a two-year trial, as well as the characteristics of CSN most successful in impacting indicators of childhood obesity. The two-year trial was considered in four six-month intervals. Within each interval, implemented activities, as recorded in CHL monthly reports, were coded by activity implementer(s), e.g. government agency, school, or community-based group, as well as for collective efficacy impact of the activity, e.g. to leverage resources from outside the CSN or to facilitate civic engagement. Coded data were used to create CSN maps for the four time intervals, and SNA techniques examined the CSN characteristics. CSN density increased over time, as measured by the number of ties within the network. Schools, community-based groups and large organizations were identified as the primary implementers of the CHL intervention and formed a community implementer backbone. Social leveraging, i.e. linking local groups to people with authority over outside resources, was shown to be a central component in intervention success. It took time to develop strong CSN, and stronger (denser) CSN were more successful in building social cohesion and enacting community change. Findings illustrate a methodology that can be useful for tracking the development and impact of CSN.

BACKGROUND:Given the increasing rates of childhood obesity in Alaska Native children and the understanding that the most effective interventions are informed by and reflect the cultural knowledge of the community in which they are implemented, this project sought to gather the wisdom of local Yup'ik and Cup'ik Elders in the Yukon-Kuskokwim region of Alaska around how to maintain a healthy diet and active lifestyle.METHODS:Perspectives were sought through the use of semi-structured focus groups, which were completed in person in twelve communities. All conversations were recorded, translated, transcribed, and analyzed using a qualitative approach, where key themes were identified.RESULTS:Elders provided a clear and consistent recollection of what their life looked like when they were young and expressed their perspectives related to maintaining a healthy and traditional lifestyle. The key themes the Elders discussed included an emphasis on the nutritional and cultural benefits of traditional foods; concerns around changing dietary patterns such as the consumption of processed foods and sugar sweetened beverages; and concerns on the time and use of screens. Elders also expressed a desire to help younger generations learn traditional subsistence practices.CONCLUSIONS:The risk of obesity in Alaska Native children is high and intervention efforts should be grounded in local knowledge and values. The perspectives from Yup'ik and Cup'ik Elders in the Yukon-Kuskokwim Delta area of Alaska provide a better understanding on local views of how to maintain a healthy diet, physical activities, and traditional values.

Excess added sugar intake contributes to tooth decay risk in Alaska Native communities. The goal of this exploratory study was to determine if there is seasonal variation in total added sugar intake or in the leading sources of added sugars in a Yup’ik population. Data were collected in spring and winter from 2008-2010 using self-reported intake data measured by 24-hour recall and by hair biomarker (carbon and nitrogen stable isotope). Seventy Yup’ik participants ages 14–70 years were recruited from two communities and data were collected twice from a subset of 38 participants. Self-reported added sugar intake (g/day), biomarker-predicted added sugar intake (g/day), and leading sources of added sugar were calculated. Seasonal variation was evaluated using a paired sample t-test. Total added sugar intake was 93.6 g/day and did not significantly differ by season. Sodas and other sugar-sweetened beverages (e.g. Tang, Kool-Aid) were the leading sources and added sugar from these sources did not significantly differ by season (p=.54 and p=.89, respectively). No seasonal variation in added sugar intake was detected by either self-report or biomarker. Dietary interventions that reduce intake of added sugars have the potential to reduce tooth decay in Yup’ik communities.

Low intake of fruits and vegetables and high intake of sugar-sweetened beverages persists as a public health concern in rural remote Alaska Native (AN) communities. Conducting key informant interviews with 22 storekeepers in 12 communities in the Yukon-Kuskokwim region of Alaska, we explored potential factors impeding or facilitating dietary change towards healthier food choices. We selected these sites as part of a multi-level intervention aimed at introducing more traditional AN subsistence foods, increasing fruit and vegetable intake, and decreasing SSB consumption among young children enrolled in Head Start (preschool) programmes (Clinicaltrials.gov #NCT03601299). Storekeepers in these communities agreed that seasonality and flight schedules were primary factors determining commercial foods' availability. Several storekeepers noted that federal food assistance programmes that specify which food items may be purchased with funds received from the programme and community policies that set limits on less healthy items promote customer purchases of healthier products. The fact that storekeepers are comfortable enforcing government assistance programme guidelines, company policies, and tribal resolutions suggests an important role storekeepers play in improving nutritional intake in their communities.

In an effort to characterize food costs in the United States (US)-affiliated Pacific Region, a first-time food cost survey was conducted in March 2014. A market basket survey was developed using an adaptation of the US Department of Agriculture Thrifty Food Plan. Surveys were conducted in the states of Alaska and Hawai'i; Portland, Oregon; the US-affiliated Pacific Islands of American Samoa (American Samoa); Commonwealth of the Northern Mariana Islands; the island of Pohnpei within the Federated States of Micronesia; Guam; Republic of the Marshall Islands; and Republic of Palau. Urban and rural communities were included. Multiple stores in multiple communities were surveyed in each jurisdiction. Food retailers (N = 74) ranged from convenience markets to supermarkets. Not all foods in the market basket survey were available in each of the communities. Inspection of available income data also showed that food costs represented a higher percentage of household income for American Samoa than those of Alaska, Hawai'i, and Portland. Thrifty Food Plan weighted weekly totals for the region ranged from $181.90 to $264.30. Weighting was based on the amount of the item converted to grams required for the Thrifty Food Plan menu. These food costs are significantly higher than those of Portland ($142.00) for the survey period. Protein foods, grains, vegetables, fruit, and dairy were the 5 most costly components, in descending order. Food affordability was assessed by comparing food costs across jurisdictions and examining estimated food costs to reported average jurisdiction incomes. The survey is intended to help inform public health policy and educational programs in the region. A locally adapted food survey would benefit future analyses, regional policy, and educational efforts.