A mixed method approach to understanding the food environment of seven American Indian Tribes in North Carolina

No studies, to our knowledge, have rigorously examined the food environment within American Indian settings. This project used a mixed method approach to examine the food environment in rural and urban American Indian settings in North Carolina. Zip codes (n=78) and counties (n=21) co-locating with the US Census 2010 State Designated Tribal Statistical Areas (SDTSAs) for seven North Carolina Tribes were determined and used to gather information on food outlets from five intermediate data sources. All primary, secondary, and local roads within the SDTSA were also ground-truthed, using Global Positioning Systems to determine the location and type of all observed food outlets. Only 77% of the outlets observed in the field matched existing intermediate data sources (531 out of 684 ground-truthed outlets), indicating more attention is needed to improve the validity and reliability of existing data sources in rural settings. Convenience stores with grills were the predominant food source within rural American Indian settings. Modified Talking Circles (n=7; in total, 33 participants) and key informant interviews (n=40) provided further insights on food sources, such as the home, land, and gardens, not identified through spatial data. Convenience stores with grills, Super Walmart, dollar stores, and fast food restaurants are common outlets for community members, often challenging them to purchase and prepare healthy, affordable foods on a regular basis. A combination of spatial and qualitative data provided an innovative evidence-based approach to identify policy strategies at the Tribal level to improve access to healthy, affordable foods.