Lowe, John

Over the past 30 years, obesity has increased rapidly as an epidemic and major
public health concern in the United Stated, particularly among Native American children
and adolescents. Native American adolescents have the highest prevalence rates of
obesity of all ethnic groups in the United States. Although there has been an increasing
effort to develop and evaluate obesity prevention programs for children and adolescents,
very little attention has been devoted to understanding culturally effective approaches for
ethnic populations. There is a significant gap in the research literature regarding effective
obesity intervention and prevention studies for Native American children and
adolescents.
The purpose of this study was to explore the impact of a culturally based talking
circle approach, KCTC-O, for the prevention of obesity among early adolescent Native
American (Keetoowah-Cherokee) and to examine the relationships between Cherokee self-reliance; perceived stress levels; and obesity knowledge, attitudes, and behavior. A
7-week intervention in which a 2-condition quasi-experimental design was implemented
to compare the KCTC-O experimental condition with a standard school health education
(SE) control condition on three outcome variables (Cherokee self-reliance; perceived
stress levels; and obesity knowledge, attitudes, and behavior at pre- and post-intervention.
A total sample of 100 participants were recruited for this study, 50 participants per
condition. The participants were distributed almost evenly in terms of gender: 55 females
compared to 45 males for both groups combined. Participants ranged in ages from 10 to
13, with a mean age of 11.5 years of age, and ranged in grades from 4 through 7, with
Grade 6 being the most frequently reported grade in school. The results of this study
revealed the effectiveness of the KCTC-O condition was not significantly greater than the
SE condition. However, although not statistically significant, the results of this study
provided some evidence that a culturally based intervention was slightly more effective
for the prevention of obesity than a non-culturally based intervention for Native
American early adolescents. This study helps to validate the need for more robust obesity
prevention programs from a cultural perspective among Native American early
adolescents.

In the United States, post European-colonial influence and exposure to
substances such as alcohol historically mark the beginning of substance use exposure
and involvement among all American Indian and Alaska Native (AI/AN) people.
Research findings indicate there are strong interrelationships between the origin and
prevalence of substance use and U.S.-European colonization, historical trauma, forced
assimilation, cultural losses, and relocation among urban AI/AN people (Burt, 1986;
Clinton, Chadwick, & Bahr, 1975; Yuan et al., 2010). In an historical sense, the
unsuccessful attempts of relocating AI/AN people to urban areas place the future
generations of urban AI/AN youth at risk for substance use, health conditions, and
health disparities. Nationally, incident rates of substance use among urban AI/AN
populations ages 12 and over is rising steadily, two to three folds higher than other
ethnicities in urban areas within states such as Florida. The overall objective of this study is to culturally tailor the evidence-based Lowe (2013) Cherokee Talking Circle
Intervention for substance use prevention among Cherokee adolescents to that of an
Urban Taking Circle Intervention for use among urban AI/AN adolescents in Florida.
Therefore, the feasibility of culturally tailoring this substance use intervention among a
southeastern urban AI/AN youth was examined and presented within this dissertation.