Apache Healthy Stores

Funded by the US Department of Agriculture

INTRODUCTION

Diabetes, obesity and heart disease are severe problems among the White Mountain and San Carlos Apache. Most of these problems are related to a changing lifestyle. Eating a diet that is low in fat and sugar and high in fiber is part of improving lifestyle.

The Apache Healthy Stores Program was created to address these problems by working to improve healthy food availability and to promote healthy eating.

PROJECT GOALS

  • To improve the availability of healthy foods in local stores.
  • To promote the purchase of healthy food alternatives in local stores using health communications approaches.
  • To evaluate how successful the program is in increasing knowledge and changing food purchasing, prepartion and consumption.

FEATURES OF APACHE HEALTHY STORES INTERVENTION

  • One year intervention period: March 2003-March 2004.
  • Involves 15 small and large food stores located on the San Carlos and White Mountain Apache reservations
  • Messages developed with approval and participation of tribal leaders
  • After a positive evaluation, in mid-2005 work began to make the AHS intervention sustainable in the community setting.

COMMUNICATION METHODS AND MATERIALS

Apache Healthy Stores Manual of Procedures available in 2007! >>

In-Store:

  • Owners encouraged to stock healthy food choices
  • Shelf labels to identify healthy foods
  • Cooking demonstrations and taste tests
  • Recipe cards and flyers
  • Posters

Mass Media:

  • Radio announcements of key events and themes
  • Newspaper ads
  • Promotional video

The Bashas’ supermarket chain is partnering with Apache Healthy Stores to promote healthy foods in their grocery stores on the White Mountain and San Carlos Reservations. Apache Healthy Stores thanks Bashas’ Sign Department for their assitance with printing the intervention materials.

Intervention Materials

PROJECT REPORTS

December, 2005: To keep community members and community organizations informed about the status of the AHS program, a preliminary report on the main trial was printed and distributed.

Results of the Main Trial and Future Directions:
This report includes an explanation of the various phases of the AHS intervention, examples of materials, preliminary results of the data analysis, and a short discussion of sustainability. (PDF File)

October 26-27, 2005: Professionals from various local organizations concerned with diet gathered for a two-day workshop and built consensus about the future of the AHS program and the potential for collaboration between local organizations with shared goals.

AHS Community Workshop Report:
This report provides a detailed account of the ideas and issues discussed in the October workshop. The report includes sections on sustainability, community partnerships, and refining the AHS program. (PDF File)

June 12-13, 2003: More than 15 people from the White Mountain and San Carlos Apache reservations and the Zuni Pueblo in New Mexico attended a two-day training led by Dr. Joel Gittelsohn, Dr. Jean Anliker, and Becky Ethelbah on June 12-13 in Whiteriver in preparation for the year long project which launched June 16 in Whiteriver.

Participants helped to hone the messages, nutrition information, and recipes that will be presented to shoppers via Apache Healthy Stores and discussed ways to overcome barriers to the project’s success. Those present at this training will play an integral role in communicating the goals of the project to the community.

The first phase of the Apache Healthy Stores program emphasizes eating healthy snacks and looking for the shelf labels in community stores that will direct shoppers to healthier food choices.

New Roads to Healthful Living:
Results of Formative Research for a Food Store-Based Intervention Program to Improve Diet and Health in the White Mountain and San Carlos Apache Reservations (PDF File)

AHS PUBLICATIONS

Navajo Healthy Stores
Funded by the US Department of Agriculture

PROJECT LEADERS

  • Joel Gittelsohn, PhD, (Principal Investigator), is an Associate Professor at the Johns Hopkins Bloomberg School of Public Health, Division of Human Nutrition. Dr. Gittelsohn has extensive experience in developing community-based interventions to prevent obesity and chronic disease in low income and minority populations. He was the co-PI of the Johns Hopkins
    component of Pathways, a multi-site obesity prevention trial, and served on several Committees and Working Groups (Formative Assessment (Chair), Intervention, Process Evaluation, Knowledge, Attitudes and Behaviors, Dietary Assessment, School Climate), and is currently a co-investigator in TAAG, a multi-center intervention trial to increase physical activity in adolescent girls, where he also serves in several ways (Formative Assessment (Chair), Formative and Process Evaluation, Intervention, Promotions). He is also a co-investigator in an intervention trial using home visits to prevent obesity in African American children in Baltimore City.
  • Benjamin Caballero, MD, PhD (Co-Investigator), is Director and Professor at the Center for Human Nutrition at the Johns Hopkins School of Public Health. His areas of research include childhood obesity and amino acid and protein metabolism. He was the Principal Investigator of the Pathways project and has led other studies which seek to identify risk factors for obesity in children at different ages, including dietary patterns, physical activity, and growth patterns during early life. He is interested in the primary prevention of obesity in both the developed and developing world. His current work includes the Nutrition Transition in China Project, which is documenting the impact of socio-economic changes in China on nutrition and health by assessing dietary intake, body composition, physical activity, insulin receptor sensitivity, and lipoprotein, leptin and homocysteine levels in 6,000 children and adults from rural, suburban, and urban communities.
  • Jean Anliker, PhD, RD, LD (Consultant), is a Research Associate Professor with the Department of Nutrition at the University of Massachusetts. She has over 25 years experience on community-based interventions for culturally diverse populations. She played a major role in the development and delivery of the food service interventions for Pathways and supervised that component at all elementary schools in the White Mountain and San Carlos Apache reservations. As Co-Principal Investigator and Director of Interventions for two NCI-funded projects, she developed successful interventions to improve dietary behaviors of culturally diverse WIC participants. She has also worked with other culturally diverse populations through home and school-based interventions.
  • Sangita Sharma, PhD (Consultant), is a Research Assistant Professor at the Cancer Research Center of Hawai’i. She has significant experience developing quantitative food frequency questionnaires for African origin peoples, including those living in urban settings. Dr. Sharma is currently a consultant on the Apache Healthy Stores project, where she took the lead in developing the food frequency questionnaire and in training the data collectors in its use. She will develop the quantitative food frequency for use in the inner city population for the Baltimore Healthy Stores project, conduct training of data collectors in the use of the instrument, and will contribute to the analysis and writing up of these data.
  • Becky Ethelbah, MPA (Field Coordinator) is a member of the White Mountain Apache Tribe, with a strong record of community work in the areas of health and education. She was Project Coordinator of the Pathways study, supervising a research staff of over 15 field workers.
  • Sarah Brett Farmer, Graduate Research Assistant 
  • Amy Vastine, Graduate Research Assistant
  • Kelly Blake is the Communications/Publications Coordinator for the Johns Hopkins Center for Human Nutrition. She brings skills in writing, graphic design and website development to the Healthy Stores projects and is interested in the power of effectively-designed messages and materials to promote social and behavioral change. She designs brochures, posters, and educational displays for the Apache Healthy Stores and Baltimore Healthy Stores projects and oversees the development of the Healthy Stores website.

UPDATE

The Navajo Healthy Stores program will attempt to bring the success of the Apache Healthy Stores program to the Navajo setting. Currently the program has obtained all five of five Navajo agency area council approvals to begin work. We will now submit our application to the Navajo IRB. Once the project is approved, researchers and community members will collaborate to substantially modify the AHS program to fit the Navajo context.

Publications

Vastine, A.E.*, Gittelsohn, J., Ethelbah, B., Anliker, J., and Caballero, B. (2005) Formative research and stakeholder participation in intervention development. Am J Health Behavior, 29(1): 57-69.

http://www.ncbi.nlm.nih.gov/pubmed/15604050

Curran S*, Gittelsohn J, Anliker JA, Ethelbah B, Blake K, Sharma S and Caballero B (2005) “Process evaluation of a store-based environmental obesity intervention on two American Indian reservations,” Health Education Research, 20(6):719-29.

http://www.ncbi.nlm.nih.gov/pubmed/15872001

Gittelsohn J, Anliker JA, Sharma S, Vastine AE*, Caballero B and Ethelbah B (2006) “Psychosocial determinants of food purchasing and preparation in American Indian households,” Journal of Nutrition Education and Behavior, May-Jun;38(3):163-8.

http://www.ncbi.nlm.nih.gov/pubmed/16731451

Sharma S, Cao X, Gittelsohn J, Ethelbah B, Anliker J, Caballero B. (2007) “Dietary intake and a food frequency instrument to evaluate a nutrition intervention for the Apache in Arizona,” Public Health Nutrition, Apr 4;:1-9 [Epub ahead of print].

http://www.ncbi.nlm.nih.gov/pubmed/17408518

Sharma S, Cao X, Gittelsohn J, Ethelbah B, Anliker J, Caballero B. (2008) “Nutritional composition of traditional Apache foods in Arizona.” International Journal of Food Science and Nutrition, Feb;59(1):1-10.

http://www.ncbi.nlm.nih.gov/pubmed/18097841

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