"Make Stories That Will Always Be There": Eagle Books' Appeal, Sustainability, and Contributions to Public Health, 2006-2022.

PURPOSE AND OBJECTIVES: We aimed to determine why the Eagle Books, an illustrated series for American Indian and Alaska Native (AIAN) children to address type 2 diabetes, remain viable long after their release. We sought to answer 2 questions: Why did the books maintain popularity? What factors have sustained them? INTERVENTION APPROACH: Type 2 diabetes burgeoned in the US after World War II, compounding a long legacy of injustices for AIAN peoples. By the 1980s, their rates soared above those of White people. Concerned for future generations, Tribal Leaders suggested that the Centers for Disease Control and Prevention and Indian Health Service use traditional storytelling to teach children about staying healthy. Public health interventions are most effective when culture and history are integrated into health education, particularly stories to address a relatively new disease for AIAN peoples. EVALUATION METHODS: From 2008 through 2013, we conducted a case study among 8 tribal communities to evaluate the uptake of the Eagle Books across Indian Country. To understand the Eagle Books' sustained appeal, in 2022 we reanalyzed the original case study themes and analyzed for the first time themes that emerged from evaluation results in the Eagle Books' program literature. These were programs that had independently evaluated their use of the Eagle Books and published their findings. RESULTS: Outcomes demonstrated continuous application of the Eagle Books in diverse community interventions, influencing children's healthy choices. Community implementers described sustainability components, such as the books' versatility, flexibility of use, and availability online and in print. IMPLICATIONS FOR PUBLIC HEALTH: Historical, social, economic, and environmental health determinants intersect with biological and behavioral factors to weave a complex web of causation for type 2 diabetes, beginning early in life. Compelling, colorful stories reflecting traditional wisdom and respect for Western and Indigenous science - through the eyes of a wise eagle, a clever rabbit, a tricky coyote, and kids in T-shirts and sneakers - can positively influence community health.

Obesity and Diabetes in the Winnebago Tribe of Nebraska: From Community Engagement to Action, 2014-2019.

The Winnebago Tribe of Nebraska implemented interventions to promote the health of their people, focusing on community-selected and culturally adapted policies, systems, and environmental (PSE) improvements to reduce the prevalence of obesity and type 2 diabetes. The interventions were implemented as part of the Centers for Disease Control and Prevention's (CDC's) 2014-2019 Good Health and Wellness in Indian Country program. The Winnebago Tribe used CDC's CHANGE community health assessment tool to prioritize and direct their interventions. They integrated findings from a community health assessment tool with observations from tribal working groups and implemented 6 new evidence-based PSE interventions. Their successful approaches - selected by the Winnebago community, culturally relevant, and driven by scientific assessment -demonstrate the value of flexibility in CDC grant programs.

The high incidence of cigarette smoking among American indians of the Northern Plains.

BACKGROUND: American Indians present with high rates of diabetes and smoking. METHODS: A randomized intervention was implemented on 4 Plains Indian reservations. Information on chronic diseases, nutrition, and exercise was presented interactively. In this article, we specifically discuss the high risk behavior of cigarette smoking. RESULTS: Findings indicate an extremely high smoking rate of 57.8% overall, with significantly different rates by age group. Of the participants between the ages of 18 and 24 years, 72.7% were smokers. CONCLUSION: Culturally appropriate smoking prevention, cessation, and control programs are needed to combat the high incidence of cigarette smoking for the American Indians of the Northern Plains.

Providing Culturally Appropriate Education on Type 2 Diabetes to Rural American Indians: Emotions and Racial Consciousness.

Healthy and balanced emotions are an important aspect of well-being. Today, diabetes has a high prevalence in American Indian communities. Four Talking Circle facilitators were interviewed in a phenomenological research study to describe their experience of facilitating Talking Circles during a diabetes research intervention, Diabetes Wellness: American Indian Talking Circles. The Diabetes Wellness study provided a twelve week educational curriculum in a Talking Circle format to target prevention and effective maintenance of symptoms of Type 2 diabetes among American Indians adults on two rural Northern Plains reservations. Seven essential themes emerged from the phenomenological study data. This report describes one theme: expression of the emotional aspect of diabetes and three sub-themes that depict American Indian culture: connectedness, collective living, and transformation. Type 2 diabetes is a chronic disease that affects the emotional status of American Indians in rural communities. The notion of racial consciousness is discussed as a potential context from which Talking Circle facilitators can operate and Talking Circle participants respond. This viewpoint may be a useful cultural approach for lay personnel with an (emic) inside perspective like Talking Circle facilitators when working in areas like rural American Indian reservations.