Date of Award


Degree Type


Degree Name

Doctor of Philosophy



Major Professor

Mary Ann Bass

Committee Members

Jane R. Savage, William M. Bass, Robert H. Orr, Michael H. Logan


The goal of this study was to gather, analyze, and interpret assessment data related to the problem of diabetes within the Eastern Cherokee township of Snowbird. Information was obtained from 105 Snowbird women, ages 18 to 87, during the spring of 1982. The three specific aims of the study along with related findings are summarized below.

The first specific aim was to assess selected aspects of household and individual food behavior. The 71 women in charge of obtaining and preparing food in each home were interviewed concerning household food behavior, and each subject’s previous day’s intake of food and nutritional supplements was elicited. Greater than 95 percent of the households augmented their food supply by producing food, obtaining food from the natural environment, or preserving seasonal foods. The types of food eaten in the homes and by individual subjects were not unlike those eaten by the general United States population. Nonetheless, the use of native Cherokee foods illustrated the unique food selection of this group. In addition, the Snowbird women ate fewer dairy products and fruits, and more eggs and legumes than their counterparts in the general United States population. Purchased foods provided the major source of kilocalories in the diet.

When compared with the R.D.A. standards, the nutrients which most frequently fell below recommended levels were vitamin A, iron, calcium, and vitamin C. There was no meaningful association between caloric intake and obesity indices, illustrating the necessity of a multidimensional approach to this problem.

The second specific aim was to examine height, weight, and triceps skinfold measurements in terms of degree of body fatness. These measurements were compared with various anthropometric standards, percentiles, and data from the Health and Nutrition Examination Survey, the Ten State Nutrition Survey, Seltzer and Mayer, and five groups of American Indian women. Regardless of the standard used, a high prevalence of obesity was demonstrated among the study participants. The obesity prevalence figures may be inflated to some extent due to genetic dissimilarities between the groups compared. However, the obesity rate was consistently too high to discount that a large number of the research population had more body fat than is currently considered physiologically health.

The third specific aim was to evaluate diabetes-related attitudes and knowledge. First, an individual and family profile of diabetes was elicited from each subject. In this study, diagnosed diabetes was more prevalent among older women, and women in the upper Indian inheritance quartile. In addition, a larger number of diabetic family members was reported by subjects who were greater than 75 percent Indian inheritance. Among the Snowbird women, a meaningful relationship between diagnosed diabetes and obesity indices was not demonstrated. This finding perhaps was due to the high incidence of obesity among all subgroups, and the probability that undiagnosed cases of the disease existed among these women.

Next, general knowledge of diabetes was assessed. Each subject was asked to list causes, prevention measures, and treatments for diabetes. Both the total number of responses per subject and the number of accurate responses were low. In addition, approximately one-third of the subjects professed no knowledge of the causes of diabetes, or how to prevent the disease. Subjects who had been diagnosed as having diabetes, or who had diabetic family members were as likely to plead incognizance as those with no experience with the disease. These findings indicate that many Snowbird women lacked an appropriate knowledge base on which to build preventive diabetes behaviors.

Last, information was obtained regarding attitudes toward body size. Using a series of body profile drawings ranging from thin to heavy, it was found that the specific body size associated with attractiveness or health differed between subjects, and that the physique chosen as most attractive was not always the one chosen as healthiest. In addition, approximately 75 percent of the women desired a body size smaller than their present physique. The body profile representing a balance between the endomorphic, ectomorphic, and mesomorphic components was chosen most often as most attractive, healthiest, and most desirable for self.

Although a desire to change weight was expressed at all weight levels, heavier subjects were more likely to be dissatisfied with their weight. At the time of the study, 40.0 percent of the women were engaged in weight change activities, and 75.2 percent had attempted weight change in the past.

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