Assessing access and use of nutrition support programs, food insecurity, and health status in urban Native American families with young children in Montana: A case study.

The purpose of this cross-sectional, mixed methods case study was to assess participation in, and use of, nutrition support programs (NSPs) and their impact on food insecurity and health status of American Indian and Alaska Native (AIAN) families with young children (ages 0-8) living in three urban areas in Montana. Convenience sampling was used to recruit urban AIANs to participate in a survey that contained closed and open-ended questions. A final sample of 177 responses were included in the analysis. Fisher exact tests, Wilcoxon rank-sum tests, and analysis of variance was used to model program participation, access, use, health scores, and food insecurity status as a function of demographic measures. Standard logistic regression was used in models with binary responses such as food insecurity. Proportional odds logistic regression was used to compare the proportion of respondents in poor, fair, good, very good, and excellent health for each of the five ordinal health measures with respect to program participation, access, use, food insecurity, and changes in the amount and variety of fruits and vegetables consumed. All logistic models used a single predictor and thus are unadjusted for additional factors. Thematic analysis was conducted on the open-ended questions. Most respondents (