Design and Methods of a Participatory Healthy Eating Intervention for Indigenous Children: The FRESH Study.

Tvli Jacob,Mary B Williams,Tara L Maudrie,Susan Sisson,Marianna S Wetherill,Tori Taniguchi,Valarie Blue Bird Jernigan,Alyson Haslam,Charlotte V Love,Cassandra J Nikolaus

doi:10.3389/fpubh.2022.790008

Abstract

ObjectiveTo increase vegetable and fruit intake, reduce body mass index (BMI), and improve parental blood pressure among American Indian families.DesignRandomized, wait-list controlled trial testing a multi-level (environmental, community, family, and individual) multi-component intervention with data collection at baseline and 6 months post-intervention.SettingTribally owned and operated Early Childhood Education (ECE) programs in the Osage Nation in Oklahoma.ParticipantsAmerican Indian families (at least one adult and one child in a ECE program). A sample size of 168 per group will provide power to detect differences in fruit and vegetable intake.InterventionThe 6-month intervention consisted of a (1) ECE-based nutrition and gardening curriculum; (2) nutrition education and food sovereignty curriculum for adults; and (3) ECE program menu modifications.Main Outcome MeasuresThe primary outcome is increase in fruit and vegetable intake, assessed with a 24-h recall for adults and plate weight assessments for children. Secondary outcomes included objective measures of BMI among adults and children and blood pressure among adults.

Highlights

In the United States, American Indians (AIs) experience significant and pervasive diet-related health disparities including obesity, diabetes, and hypertension [1,2,3,4,5,6,7], for which risk factors begin early in life
Recent publications on children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children reported that in 2016, AIs and Alaska Native children aged two to four years experienced the highest rates for obesity among all racial/ethnic groups (36.7 vs. 29.1% combined) [8]
While individual-level obesity prevention efforts have been implemented with AIs [13,14,15], few studies have addressed community-level barriers to access nutritious foods in rural tribal reservations [16,17,18,19], or the forced historical reliance on government-subsidized foods that has led to unhealthy food preferences across multiple generations [20, 21]

Summary

Introduction

In the United States, American Indians (AIs) experience significant and pervasive diet-related health disparities including obesity, diabetes, and hypertension [1,2,3,4,5,6,7], for which risk factors begin early in life. Despite persisting disparities, few interventions have been developed and implemented with AI children [10, 11], and even fewer have intervened upon the environmental, community, family, and individual levels of the social-ecological model [12]. While individual-level obesity prevention efforts have been implemented with AIs [13,14,15], few studies have addressed community-level barriers to access nutritious foods in rural tribal reservations [16,17,18,19], or the forced historical reliance on government-subsidized foods that has led to unhealthy food preferences across multiple generations [20, 21]. Since the causes of child and adult obesity disparities among AIs are multi-factorial, strategies to promote health equity within tribal communities requires simultaneous intervention across multiple levels and domains of influence [22]

Methods

Findings

Discussion

Conclusion