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This study used a parallel, convergent, mixed-methods design with TribalCrit theory and intersectionality as analytical frameworks to identify how the identities of American Indian men intersect with broader structures and systems in shaping their eating and physical activity choices and behaviors, and in eliciting recommendations for a men’s lifestyle intervention. American Indian men were recruited in Minneapolis, Minnesota, and Portland, Oregon, between March and December 2017, and in Phoenix, Arizona, in December 2019 to participate in a survey and focus groups. The survey included questions on demographics and physical and cultural activities men engage in, perceived social support for lifestyle behaviors, masculine characteristics, and values important to American Indian men. The six-item Kessler Psychological Distress Scale was used to assess psychological distress. Focus groups were audio recorded and transcribed for a phenomenological analysis. Descriptive statistics and correlations were computed for survey data. We conducted 15 focus groups with 151 adult American Indian men in three urban sites. The mean age of participants ranged from 36 to 51 across the sites; 7–32% were college graduates; 13–22% were currently married, and 28–41% were working full time. The most important values reported by participants were being strong mentally and emotionally, a good parent, responsible, spiritual, and a good spouse or partner. On the K6 psychological distress scale, 63–70% scored ≥5 but <13 (moderate mental distress), and 8–15% scored ≥13, indicating severe mental distress. Younger age was significantly correlated with higher mean K6 score (P < 0.0001). Settler colonialism that took root in the United States imposed cultural and gender hegemony, which in turn enforced a patriarchal capitalist system that has had long-lasting and deleterious effects on American Indians, particularly American Indian men.
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