T.R.A.I.L. Diabetes Prevention

American Indian/Alaska Native (AI/AN) youth have the highest prevalence rate of type 2 diabetes compared with youth of all other racial and ethnic groups in the United States.

Over the last decade, rates of type 2 diabetes have been exploding among U.S. youth of color, with rates tripling among certain Native American Tribal youth, doubling among Black youth, and increasing up to 50% among Latinx and Asian/Pacific Islander youth. The expansion of the type 2 diabetes epidemic into children and adolescents in large part is a result of a food environment that increasingly promotes unhealthy dietary patterns. The unfettered advertising and marketing of what is commonly described as “junk food” (high calorie, high-sugar, high-sodium, nutrient-poor foods) and beverages to children through television, film, social media, and other internet platforms, including marketing campaigns targeting children of color, have been shown to be significant drivers of the consumption of unhealthy foods and beverages among children. Children under the age of 13 are especially vulnerable to marketing and advertising and lack the critical skills to detect if and when they are being deceived.

From 1990 to 2009 the incidence of type 2 diabetes in American Indian/Alaska Native youth increased by 110%, according to the Indian Health Service (IHS). Type 2 diabetes has been reported in American Indian youth as young as 4 years of age, and IHS also reports that mortality rates for diabetes are 1.6 times higher for American Indians compared to the U.S. general population.

In 2003, the National Congress of American Indians (NCAI), Indian Health Services (HIS), and Boys & Girls Clubs of America (BGCA), initiated a prevention program aimed at reducing the onset of type 2 diabetes among Native youth. The program – On the T.R.A.I.L. (Together Raising Awareness for Indian Life) to Diabetes Prevention – is an innovative combination of physical, educational, and nutritional activities.

The program is presented with four themes: About Me, My Health, & Being Part of a Team; Healthy Eating; Making Smart Food Choices and My Healthy Community. Woven throughout the program are self-esteem and prevention activities utilized by BGCA, including contributions from national evidence-based programs such as SMART Moves. Programs draw from Tribal traditions and history to learn about nutrition, food choices, media influences and the impact of diabetes.

The program also emphasizes the importance of teamwork and community service. Members apply decision-making and goal-setting skills when completing physical activities and engage in community education projects to improve healthy lifestyles in their communities. Club sites implement Club-wide participation in fun physical activities and games for 60 minutes every day.