Navajo Children Research Articles

Beverage consumption patterns among Navajo children aged two to five years

Beverage consumption patterns among Navajo children aged two to five years

"But Always My Thoughts Stay with Me, My Own Way": Intellectual and Creative Claims of Sovereignty by Indian Boarding School Students in The Colored Land : A Navajo Indian Book, Written and Illustrated by Navajo Children (1937)

Abstract: In 1937, Ruth K. Brandt, Supervisor of Elementary Education, in the federal Office of Indian Affairs, edited and published The Colored Land: A Navajo Indian Book, Written and Illustrated by Navajo Children with Scribner's Sons. Diné elementary school students from the Tohatchi Boarding School in New Mexico were the featured writers of much of the text with supporting illustrations composed by students from the Santa Fe Indian School. It was presented by its editors as evidence of the government's successful approach to assimilation through education. Situating their work within frameworks offered by contemporary Diné poets, I argue that these young children resisted acculturation and assimilationist efforts in the Reorganization Era by maintaining cultural values and traditions and even, in a few cases, issuing challenges to Western epistemologies and educational regimes. This early collection of published creative work by Diné writers and artists features undercurrents of resistance alongside literary and intellectual claims of sovereignty.

Water Is K’é: Learning from the Navajo Community to Promote Early Child Health

Abstract: Background: Drinking water instead of sugary drinks is key to reducing health disparities. Since beverage habits are shaped by complex personal, community, and environmental factors, community input is critical to design any intervention promoting water. Objectives: We worked with community partners to design a program to promote healthy beverage habits among young Navajo children. Methods: The socioecological model, community-based participatory methods, and strengths-based principles shaped our process. In Phase 1, multigenerational feedback taught us about the cultural importance of water and how water quality concerns influence beverage choices. In Phase 2, our Water is K’é Community Advisory Group played a leading role to design the intervention centered around cultural connection, health literacy, and water access. Lessons Learned: Water is K’é was created through community partnership. Community listening and mini-pilots take time but allows the program to meet community’s needs and interests. Conclusions: The solutions to health disparities lie within the community itself.

Teacher and Caregiver Perspectives on Water Is K'é: An Early Child Education Program to Promote Healthy Beverages among Navajo Children.

The Water is K'é program was developed to increase water consumption and decrease consumption of sugar-sweetened beverages for young children and caregivers. The pilot program was successfully delivered by three Family and Child Education (FACE) programs on the Navajo Nation using a culturally centered curriculum between 2020 to 2022. The purpose of this research was to understand teacher and caregiver perspectives of program feasibility, acceptability, impact, and other factors influencing beverage behaviors due to the pilot program. Nine caregivers and teachers were interviewed between June 2022 and December 2022, and a study team of four, including three who self-identified as Navajo, analyzed the data using inductive thematic analysis and consensus building to agree on codes. Five themes emerged, including feasibility, acceptability, impact, suggestions for future use of the program, and external factors that influenced water consumption. The analysis showed stakeholders' strong approval for continuing the program based on impact and acceptability, and identified factors that promote the program and barriers that can be addressed to make the program sustainable. Overall, the Water is K'é program and staff overcame many challenges during the COVID-19 pandemic to support healthy behavior change that had a rippled influence among children, caregivers, teachers, and many others.

Forum Introduction: Promoting Equity in Speech-Language Services With Indigenous Children.

Forum Introduction: Promoting Equity in Speech-Language Services With Indigenous Children.

Development of an Assessment Tool to Measure Healthy Eating in Navajo Children and Their Families

BackgroundTo estimate the efficacy of interventions to improve healthy eating, valid measures are essential. Although simple dietary intake tools have been developed with other populations, few have been culturally tailored and assessed for validity and reliability among Navajo. ObjectivesThis study aimed to develop a simple dietary intake tool tailored to Navajo culture, derive healthy eating indices, and assess their validity and reliability in Navajo children and adults and to describe the process used to develop this tool. MethodsA picture-sort tool using typically consumed foods was developed. Elementary school children and family members provided qualitative feedback in focus groups, used to refine the tool. Next, school–aged children and adults completed assessments at baseline and follow-up. Baseline behavior measures including child self-efficacy for fruits and vegetables (F&V) were examined for internal consistency. Healthy eating indices were derived from intake frequencies from picture sorting. The convergent validity of the indices and behavior measures for children and adults were examined. The reliability of the indices at the 2 time points was derived using Bland-Altman plots. ResultsThe picture-sort was refined from feedback provided by the focus groups. Baseline measures from 25 children and 18 adults were obtained. In children, a modified Alternative Healthy Eating Index (AHEI) and 2 other indices from the picture-sort were correlated with self-efficacy for eating F&V and had good reliability. In adults, the modified AHEI and 3 other indices from the picture-sort had significant correlations with adult abbreviated food frequency of F&V or obesogenic dietary index and had good reliability. ConclusionsThe Navajo foods picture-sort tool developed for Navajo children and adults is proven to be acceptable and feasible to implement. Indices derived from the tool has good convergent validity and repeatability, supporting use in evaluating dietary change interventions in Navajo, with the potential for broader use of the approach in other underserved populations.

Diné Bizaad at a Glance.

The American Speech-Language-Hearing Association requires speech-language pathologists (SLPs) to be aware of language disorders versus language differences. SLPs are likely to provide clinical services to Navajo and other Native American children with communication disorders. Therefore, the purpose of this article is to educate SLPs who work with Navajo children about Navajo speech and language (phonology, morphology, and syntax).

An asthma collaboration to reduce childhood asthma disparities on the Navajo Nation: Trial protocol for the Community Asthma Program

Navajo children disproportionately experience poor asthma outcomes. Following a one-year community engagement period with key stakeholders from the Navajo Nation, the Community Asthma Program (CAP) was created using evidenced based programs with the goal of reducing asthma disparities among Navajo children. CAP is being evaluated with a six-year, multi-site step-wedge design in three Navajo communities: Tuba City, Chinle and Fort Defiance, Arizona. The primary outcome is asthma exacerbations defined as use of systemic oral corticosteroids, asthma hospitalizations, asthma related ED visits, and ICU admissions. Asthma exacerbations will be measured using data from the electronic medical records of the three community health care centers. Secondary outcomes include will changes in asthma-related events and asthma control. The RE-AIM (Reach and representativeness, 2)Effectiveness, 3) Adoption, 4) Implementation, and 5) Maintenance) framework is being used to guide the implementation evaluation which includes iterative collection and analysis of process data to identify facilitators and barriers, describe relevant organizational contexts, and inform strategies for dissemination. The CAP intervention requires community engagement and participation, building community capacity, incorporating evidenced-based guidelines and practices while ensuring program strategies actively involve Navajo community members during all steps of the intervention. The outcome of this trial will allow us to determine the effectiveness of a multi-component, community-focused intervention to improve asthma in a tribal community.

Engaging School and Family in Navajo Gardening for Health: Development of the Yéego Intervention to Promote Healthy Eating among Navajo Children.

Navajo children are at increased risk for obesity, in part due to limited access to healthy foods. School garden interventions have been shown to increase access to fresh fruit and vegetables and consumption of healthy foods. Our study describes the development and pilot testing of a school garden intervention for Navajo elementary school children. We reviewed existing school garden interventions and conducted formative research with students, caregivers, and school staff to inform the intervention. The intervention consisted of a garden built at the school and a yearlong curriculum on gardening and healthy eating. We pilot tested the intervention in an elementary school on the Navajo Nation. Formative research revealed the importance of incorporating Diné culture, including traditional growing practices and the preparation of traditional foods into the curriculum. School staff also stressed the value of tying the curriculum to state and Diné educational standards. Students enjoyed opportunities for hands-on activities and snack preparation. Schools have a meaningful role to play in addressing childhood obesity disparities among Navajo children. School-based interventions that draw on cultural strengths and include healthy traditional practices can be a promising strategy for increasing fruit and vegetable consumption.

Navajo

Standardized norm-referenced language assessments are used to identify developmental language disorder (DLD) in bicultural Navajo children. However, these assessments do not include normative data for Navajo children, the majority of whom are exposed to both Navajo and English, and consequently the assessments may not reflect their true language abilities. The purpose of this clinical tutorial is to provide background and alternative assessment information to help practitioners accurately identify Navajo children with and without DLD. In particular, the use of dynamic assessment, a test–teach–retest method, has shown promising results in differentiating Navajo children with and without DLD.

Enhancing Language Services to Native American Children: A Look From the Inside

Enhancing Language Services to Native American Children: A Look From the Inside

Impact of a Fruit and Vegetable Prescription Program on Health Outcomes and Behaviors in Young Navajo Children.

Rates of childhood obesity are higher in American Indian and Alaska Native populations, and food insecurity plays a major role in diet-related disparities. To address this need, local healthcare providers and a local nonprofit launched the Navajo Fruit and Vegetable Prescription (FVRx) Program in 2015. Children up to 6 y of age and their caregivers are enrolled in the 6-mo program by healthcare providers. Families attend monthly health coaching sessions where they receive vouchers redeemable for fruits, vegetables, and healthy traditional foods at retailers participating in the FVRx program. We assessed the impact of a fruit and vegetable prescription program on the health outcomes and behaviors of participating children. Caregivers completed voluntary surveys to assess food security, fruit and vegetable consumption, hours of sleep, and minutes of physical activity; healthcare providers also measured children's body mass index [BMI (kg/m2)] z score at initiation and completion of the program. We calculated changes in health behaviors, BMI, and food security at the end of the program, compared with baseline values. A total of 243 Navajo children enrolled in Navajo FVRx between May 2015 and September 2018. Fruit and vegetable consumption significantly increased from 5.2 to 6.8 servings per day between initiation and program completion (P<0.001). The proportion of participant households reporting food insecurity significantly decreased from 82% to 65% (P<0.001). Among children classified as overweight or obese at baseline, 38% achieved a healthy BMI z score at program completion (P<0.001). Sixty-five percent of children were retained in the program. The Navajo FVRx program improves fruit and vegetable consumption among young children. Children who are obese or overweight may benefit most from the program.

School Nutrition Policies and Practices on an American Indian Reservation: Research and Policy Considerations.

Navajo (Diné) and other American Indian children are more affected by overweight and obesity than their U.S. counterparts. In this descriptive study, the authors combined a socioecological and Navajo cultural framework to analyze the various factors that influence food choices available to children in schools. The Healthy Hunger-Free Kids Act of 2010 updated nutrition standards for school meals and all other foods and beverages sold in schools. Some studies have shown that improved nutrition standards were not favorably received by students and school food programs. To better understand these broader trends in a Navajo context, the researcher administered in-person surveys to 6 principals and 14 food service workers from a sample of 6 schools and performed on-site observations of two schools. Data were analyzed using a combination of descriptive statistics, matrix analysis, and thematic analysis techniques. Results showed that schools were offering more healthy food options in school lunches and that some schools were still serving unhealthy foods, such as pizza, tater tots, and French fries. Classroom and fundraising events provided other sources for low-nutrient foods and beverages. Participants had mixed responses about the updated nutrition standards, and food waste of healthy foods was a major concern. This study proposes opportunities for nurses to engage in research and advance stronger policies that increase healthy food options and limit access to less healthy foods.

A First Second Thought: Bring on the Irony

Editors:A reporter once asked Bob Dylan what his songs meant. His response: “I'm the first to put it to you and the last to explain it to you.” Humor works kind of like that; you either get the punch line to “Where was Moses when the candle went out?” or you don't. You are in the dark if laughter doesn't emerge—unless, of course, you've been trained like the Navajo children that Jennifer Hughes mentions. Like Dylan (pretty funny fellow himself), writers of humor (or if you prefer “humorists,” Mr. Wuster, or “satirists,” Mr. Caron) often fail to supply a satisfactory explanation either. Still, it never stops us scholars from trying to shed light on what these writers of humor produce—that inexplicable thing called humor, all in the hopes of not producing the inevitable “dead frog” that E. B. White warned us of. (Note: to my mind, no one produced a lifeless amphibian in this issue.) Yet, as long as we have literature that produces laughter, we'll have those who want to explain how it works or what it does. And that's OK. The folks writing in the issue of StAH 4.2 titled “The Assault of Laughter” (all of whom I know and admire—well, maybe not Wuster and Caron) know their stuff. But their arguments hinge on terminology, free-floating signifiers, (a deconstructionist's dream), so I offer a “second thought” about the “terminological chaos” to which Judith Yaross Lee refers.Just as Bruce Michelson makes a bid to recover and reconsider “wit” as a neglected, and possibly stable, term, I'd like to get in a word for irony as more than a rhetorical trope or a technical device such as parody, travesty, burlesque, lampoon, caricature, epigram, fable, and mock-epic used only in service to satire. If Caron can supplement Wuster's valorizing of Twain as “mere humorist” by elevating Twain as satirist, I'd like to invoke Twain as ironist. In his book Mark Twain: The Gift of Humor (2015), Harold H. Kolb Jr. divides Twain's humor into three periods: the comic (early career), the satiric (middle), and the ironic (late), with much bleeding over from one period to another.These phases of humor (comic, satiric, and ironic) have clear corollaries with Aristotle's types of humans as they relate to the emotions and moral qualities that correspond to our various ages. The young have strong passions and gratify themselves indiscriminately, with hot tempers and hopeful dispositions. Fond of fun, they are therefore witty.So what do we do with that laughter that comes from places of discomfort and agitation, yet has no clear satiric end in sight, no ridicule to reform? First, we assent to Holger Kersten's claim that humor isn't the social corrective that we'd like to think it is. The assault of laughter doesn't change political views, religious beliefs, or social injustices. Second, once we realize that it can't make change, we recognize the irony that we thought it could. Now that's something the “mere humorist” Twain understood. Twain as satirist doesn't help us as much as Twain as ironist does in works such as “Extracts from Adam's Diary,” “Eve's Diary,” “Little Bessie,” or The Mysterious Stranger manuscripts. And please tell me I'm not the only one who finds humor (and laughter) in these pieces.As the late, great David Rakoff wrote, “Not being funny doesn't make you a bad person. Not having a sense of humor does.”3 And you don't need to know all the shades of terminology to not be a bad person. So for humor's sake, let's stick with humor as our umbrella term and keep finding all the ways that Twain is a “mere humorist.” We scholars of humor get the irony of that term and will keep writing until everyone else catches up. For it is, as Jeffery Melton argues, channeling his inner Dylan, all in the audience. Humorists are the first to put it to us but the last to explain it to us. Thus, we scholars beat on, hi-ho. To close this second thought: thank you to this group of smart folks for producing in this Mark Twain special issue if not a celebrated jumping frog of humor scholarship at least a limping and alive one.Sincerely (but also ironically),Ben ClickProfessor of English, St. Mary's College of MarylandEditor, Mark Twain Annual

Asthma in Navajo Children: Striving for Health Equity

Asthma in Navajo Children: Striving for Health Equity

Environmental Concerns for Children with Asthma on the Navajo Nation.

Navajo children living on the reservation have high rates of asthma prevalence and severity. Environmental influences may contribute to asthma on the Navajo Nation and are inadequately understood. We performed a comprehensive, integrative literature review to determine the environmental factors that may contribute to increased asthma prevalence and severity among Navajo children living on the reservation. A systematic search was conducted in four databases regarding the environmental risk factors for asthma in Navajo children living on the reservation. Relevant studies between 1990 and 2017 were examined. Nonexperimental literature was also integrated into the review to describe the environmental injustices that have historically, disproportionately, and systematically affected the Navajo people, thus contributing to respiratory disparities among Navajo children. Eight studies met inclusion criteria for systematic review; however, limited research regarding environmental risk factors specific to asthma and Navajo children living on the reservation was identified. Our integrative review indicated both indoor and outdoor environmental risk factors commonly found on the Navajo reservation appear to be important determinants of asthma. Future research should examine indoor and outdoor air pollution from wood-burning stoves and cook stoves, coal combustion, tobacco and traditional ceremonial smoke, diesel exhaust exposure from long bus rides, indoor allergens, ambient pollutants, and regional dusts. Comprehensive mitigation efforts created in partnership with the Navajo Nation are necessary to address less-recognized risk factors as well as the common risk factors known to contribute to increased childhood asthma prevalence and severity.

Chester Nez and the Unbreakable Code: A Navajo Code Talker’s Story by Joseph Bruchac

Reviewed by: Chester Nez and the Unbreakable Code: A Navajo Code Talker’s Story by Joseph Bruchac Deborah Stevenson, Editor Bruchac, Joseph Chester Nez and the Unbreakable Code: A Navajo Code Talker’s Story; illus. by Liz Amini-Holmes. Whitman, 2018 [32p] ISBN 978-0-8075-0007-1 $16.99 Reviewed from galleys R Gr. 2–4 In this picture book biography, Chester Nez was only eight when he was sent to the Fort Defiance boarding school for Navajo children, where they were punished for speaking Navajo and told to focus on living in the white man’s world. When World War II broke out, however, that deprecated language was suddenly valuable as an unbreakable code (“Chester was proud he had never given up speaking Navajo”), and Navajos were sought to join the Marines. As one of the code talkers, Nez worked on the Pacific front, where the code helped the Allies defeat the Japanese; however, the horrors of battle and the need for sustained secrecy about his role left their mark on him until his family arranged a traditional Enemy Way ceremony that “restored Chester to the trail of beauty and the Right Way.” Bruchac takes the now-familiar information about the code talkers and gives it an illuminating personal and cultural frame, emphasizing the fact that it was Nez’s committed connection to his heritage that served both his country and, throughout his life, himself. The prose is spare yet thoughtfully chosen, compacting important ideas into accessible language, and the details about the creation of the code are intriguing. Moody, somber-toned art emphasizes texture in expressionistic brushstrokes and grainy paper surfaces; while the figures are sometimes awkward, there’s an iconic flavor in the softly blurred images. This has obvious use as a war story, but it’s also a compelling account of how a national effort is made stronger by diversity and how Nez forged a satisfying self-identity in the face of racism. End matter includes an author’s note detailing Chester Nez’s post-war life, a portion of the Navajo Code complete with translation, and a timeline. Copyright © 2018 The Board of Trustees of the University of Illinois

A Cluster-Randomized, Community-Based, Tribally Delivered Oral Health Promotion Trial in Navajo Head Start Children

The authors tested the effectiveness of a community-based, tribally delivered oral health promotion (OHP) intervention (INT) at reducing caries increment in Navajo children attending Head Start. In a 3-y cluster-randomized trial, we developed an OHP INT with Navajo input that was delivered by trained Navajo lay health workers to children attending 52 Navajo Head Start classrooms (26 INT, 26 usual care [UC]). The INT was designed as a highly personalized set of oral health–focused interactions (5 for children and 4 for parents), along with 4 fluoride varnish applications delivered in Head Start during academic years of 2011 to 2012 and 2012 to 2013. The authors evaluated INT impact on decayed, missing, and filled tooth surfaces (dmfs) increment compared with UC. Other outcomes included caries prevalence and caregiver oral health–related knowledge and behaviors. Modified intention-to-treat and per-protocol analyses were conducted. The authors enrolled 1,016 caregiver-child dyads. Baseline mean dmfs/caries prevalence equaled 19.9/86.5% for the INT group and 22.8/90.1% for the UC group, respectively. INT adherence was 53% (i.e., ≥3 child OHP events, ≥1 caregiver OHP events, and ≥3 fluoride varnish). After 3 y, dmfs increased in both groups (+12.9 INT vs. +10.8 UC; P = 0.216), as did caries prevalence (86.5% to 96.6% INT vs. 90.1% to 98.2% UC; P = 0.808) in a modified intention-to-treat analysis of 897 caregiver-child dyads receiving 1 y of INT. Caregiver oral health knowledge scores improved in both groups (75.1% to 81.2% INT vs. 73.6% to 79.5% UC; P = 0.369). Caregiver oral health behavior scores improved more rapidly in the INT group versus the UC group (P = 0.006). The dmfs increment was smaller among adherent INT children (+8.9) than among UC children (+10.8; P = 0.028) in a per-protocol analysis. In conclusion, the severity of dental disease in Navajo Head Start children is extreme and difficult to improve. The authors argue that successful approaches to prevention may require even more highly personalized approaches shaped by cultural perspectives and attentive to the social determinants of oral health (ClinicalTrials.gov NCT01116739).

Validation of the Sense of Coherence Scale in an American Indian population.

This study examined the psychometric properties of the Sense of Coherence (SOC) scale in the context of an oral health-related clinical trial conducted in an American Indian population-specifically, people of the Navajo Nation. Data were derived from baseline evaluations of parents (or caregivers) of Navajo children aged 3-5 from 52 Head Start classes enrolled in a trial of an intervention to prevent early childhood caries (ECC). A 190-item Basic Research Factors Questionnaire, which included the SOC, was administered to 1,016 parents/caregivers. Assessment of internal reliability and convergent validity, and confirmatory factor analyses were conducted. Multiple linear regression analysis was used to examine associations between parents' SOC and other potentially convergent measures. Confirmatory factor analysis was used to examine 1- and 3-factor solutions of the SOC scale. Higher SOC was significantly related to higher parental education and income, employment status, and higher scores for social support, internal Oral Health Locus of Control (OHLOC), self-efficacy, importance of oral health, oral health knowledge and behavior, and children's oral health quality of life. Higher SOC also was related to lower reported distress and lower external OHLOC. Cronbach's α was 0.84 for all SOC items, but lower for each of the 3 SOC subscales. Confirmatory factor analyses suggested a 3-factor solution was superior to a 1-factor solution. The SOC scale had good internal reliability and convergent validity in this American Indian population.

Spirometric reference values for Hopi Native American children ages 4-13 years.

Spirometry is the most important tool in diagnosing pulmonary disease and is the most frequently performed pulmonary function test. Respiratory disease is also one of the greatest causes for morbidity and mortality on the Hopi Nation, but no specific reference equations exist for this unique population. The purpose of this study was to determine if population reference equations were necessary for these children and, if needed, to create new age and race-specific pulmonary nomograms for Hopi children. Two hundred and ninety-two healthy children, ages 4-13 years, attending Hopi Nation elementary schools in Arizona, were asked to perform spirometry for a full battery of pulmonary volumes and capacities of which the following were analyzed: forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1 ), FEV1 % (FEV1 /FVC), FEF25-75% and peak expiratory flow rate (PEFR). Spirometric data from Navajo children living in the same geographical region as the Hopi children were compared as well as spirometric data from common reference values used for other ethnic groups in the USA. Spirometry tests from 165 girls and 127 boys met American Thoracic Society quality control standards. We found that the natural log of height, body mass and age were significant predictors of FEV1 , FVC, and FEF25-75% in the gender-specific models and that lung function values all increased with height and age as expected. The predictions using the equations derived for Navajo, Caucasian, Mexican-American, African-American youth were significantly different (P ≤ 0.05) from the predictions derived from the Hopi equations for all of the variables across both genders, with the exceptions of Hopi versus Navajo FEV1 /FVC in the males and Hopi versus Caucasians FEF25-75% in the females. Thus it would appear for this population important to have specific formulae to provide more accurate reference values.