ORIGINAL REPORTS:OBESITY ASSOCIATION OF AMERICAN INDIAN CULTURAL IDENTITY WITH PHYSICAL ACTIVITY Glen E. Duncan, PhD; Casey L. McDougall, MS; Elizabeth Dansie, PhD; Eva Garroutte, PhD; Dedra Buchwald, MD; Jeffrey A. Henderson, MD Objective: Cultural factors are associated with health behaviors among American Indians. Accordingly, the objective of our study was to investigate whether cultural identity, de- fined as the primary language spoken at home, is associated with: 1) higher total physical activity levels, and 2) levels of leisure-time physical activity recommended for health benefits in a diverse sample of American Indians. Design: Cross-sectional analysis of 5,207 American Indian adults 18 to 82 years. Partic- ipants resided on the Oglala Sioux (n52,025) and Cheyenne River Sioux (n51,528) reserva- tions in South Dakota, and the Gila River Indian Community (n51,654) in Arizona. Results: Bicultural participants in South Da- kota, but not Arizona, reported significantly higher total physical activity compared to the English-only group (P,.05). About 35% of English only speakers, 39% of American Indian/Alaska Native only speakers, and 39% of participants speaking both languages met the 150 minutes/week activity threshold. Odds of being sufficiently active were higher among bicultural respondents in both regions when compared to respondents endorsing only English, controlling for sociodemographic and health-related covariates (P,.05). Conclusion: Bicultural respondents among tribal members in South Dakota had signifi- cantly higher total physical activity, and higher levels of sufficient leisure-time activity in both South Dakota and Arizona, compared to those who spoke either language exclusively. Inter- ventions that encourage American Indians to develop their bicultural efficacy and to draw on resources for healthy living that may be available in all the cultures with which they identify are recommended. (Ethn Dis. 2014; 24[1]:1–7) Key Words: American Indian, Culture, Lan- guage, Physical Activity INTRODUCTION The health benefits associated with regular physical activity are well estab- lished. 1 However, the majority of US adults do not engage in levels of physical activity sufficient to maintain or im- prove health, 2 thus changing this be- havior is an important national health objective. 3,4 Although a recent report indicates that American Indian adults exhibit levels of physical (in)activity similar to other racial/ethnic groups in the United States, 5 overall levels are still much lower than current national health objectives. At the same time, health disparities for many conditions strongly linked to insufficient physical activity, including obesity and diabe- tes, 1,6 are extremely high in this racial/ ethnic subpopulation. For example, after adjusting for population age dif- ferences, about 16% of the total adult population served by the Indian Health Service had diagnosed diabetes in 2009, with rates varying from 5.5% among Alaska Native adults to over 33% among American Indian adults in southern Arizona, compared to 7% of age-adjusted non-Hispanic Whites in the same time period. 7 Such observations suggest efforts to increase general activity levels in Amer- ican Indians are needed. At the same time, research showing that household- type activities represent the most fre- quent type of physical activity among American Indians 5 suggests an addition- al issue. Because this category includes many physical activities performed at less than a moderate-intensity, such as mopping or sweeping, persons for whom it is a main source of energy expenditure may not experience adequate stimulus to sufficiently improve cardiorespiratory fit- ness and reduce chronic disease risk. 1,8,9 Researchers seeking to reduce the burden of chronic disease in American Indians are thus well advised to seek out variables related to individuals’ partici- pation in physical activities, specifically in moderate-to-vigorous activity, and to consider how such knowledge can inform interventions. Growing evidence argues that cul- tural factors are associated with health behaviors among American Indians. For example, identification with Native culture has been associated with in- From Department of Epidemiology, Nutritional Sciences Program, University of Washington (GED); and Center for Rural Health, University of North Dakota School of Medicine and Health Sciences (CLM); and Partnerships for Native Health, Depart- ment of Medicine, University of Washing- ton (ED, DB); and Department of Sociology, Boston College (EG); and Black Hills Center for American Indian Health (JAH). Address correspondence to Glen E. Dun- can, PhD, RCEP SM ; University of Washington, Box 353410; Seattle, WA 98195; 206. 616.2680; 206.685.1696 (fax); duncag@ u.washington.edu …we drew on data collected from two large American Indian tribes from distinct regions in the United States to investigate whether relationships with culture might extend to the domain of health relevant to physical activity. Ethnicity & Disease, Volume 24, Winter 2014 1