Zhiiwaapenewin Akino´Maagewin: Teaching to Prevent Diabetes

Funded by the American Diabetes Association

Diabetes is one of the major causes of morbidity and mortality in aboriginal Canadians. This and other chronic diseases are related to a changing lifestyle. Increasing physical activity levels and eating a diet that is low in fat and sugar and high in fiber are parts of improving lifestyle.


To work with First Nations communities to develop sustainable diabetes prevention programs that will:

  • Improve the availability of healthy foods in local stores.
  • Promote the purchase and consumption of healthy food alternatives through schools, stores, and health/social services channels.
  • Increase the levels of physical activity among all community members.
  • Evaluate how successful the programs are in increasing knowledge and improving eating patterns and physical activity.


The current ZA:TPD project is a feasibility study for an expanded trial. The feasibility study consists of:

  • 9 month intervention period:
    ◊ Round 1 – September 2005-June 2006
    ◊ Round 2 – September 2006-June 2007
  • Involves 7 First Nations and schools, stores, and health providers serving them.
  • Messages developed with approval and participation of community leaders.

The expanded trial will include a revised program based on the results of the feasibility study to be implemented in two rounds in 18-20 First Nations in Ontario and Manitoba, Canada and American Indian Tribes in Michigan and Wisconsin, USA. For more information on participating in the expanded trial, please click here.

ZA:TPD is a Network Contributor of the

ZA: TPD Manual of Procedures available in 2007!

Manual of Procedures



  • 3rd and 4th grade healthy living curriculum
  • Principals encouraged to provide healthy food choices and ban junk foods


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


  • Workshops and events
  • Band offices encouraged to make healthier options available

Mass Media in all venues:

  • Radio/TV announcements of key events and themes
  • Cartoons and notices in band and school newsletters
  • Posters, flyers and recipe cards



May 2006: Check out the ZA:TPD Spring Newsletter (pdf).

January-May 2006: Recruitment of additional Ontario First Nations and Michigan Tribes for the expanded trial. For more information on participating in the expanded trial, please click here.

Winter 2005: Check out the ZA:TPD Winter Newsletter.

December 2005: Round 1 of the intervention is underway. Preliminary description of the process evaluation and study design/baseline results are now available.

June 2004: Preliminary formative research (Development of an integrated diabetes prevention program with First Nations in Canada) engaged three Native Canadian communities in investigating their concepts, needs, and resources surrounding diabetes prevention using participatory methods, and examined how the Sandy Lake Health and Diabetes Project (SLHDP) programs could be adapted for use with other Native reserves. Data from this project were used to develop the Zhiiwaapenewin Akino´maagewin: Teaching to Prevent Diabetes (ZA: TPD) program. ZA: TPD consists of three components: a school program, a food store program (First Nations Healthy Stores), and community activities.


Ho LS*, Gittelsohn J, Harris SB, and Ford E. (2006) “Development of an integrated diabetes prevention program with First Nations in Canada,” Health Promotion International, Jun;21(2):88-97.


Rosecrans AM*, Gittelsohn J, Ho LS*, Harris S, Nagshbandi M, Sharma S, (2007) “Process Evaluation of a Multi-institutional Community-based Program for Diabetes Prevention among First Nations,” Health Education Research, Jul 26; [Epub ahead of print].


Sharma S, Cao X, Gittelsohn J, Ho LS*, Ford E, Rosecrans A*, Hanley A, Zinman B. (2007) “Dietary intake and development of a quantitative food frequency questionnaire for a lifestyle intervention to reduce risk of chronic diseases in Canadian First Nations.” Public Health Nutrition, Dec 7:1-10 [Epub ahead of print].


Ho LS, Gittelsohn J, Rimal R, Treuth M, Sharma S, Rosecrans A, Harris SB, (2008) “An integrated multi-institutional diabetes prevention program improves knowledge and healthy food acquisition in northwestern Ontario First Nations,” Health Education and Behavior, May 2. [Epub ahead of print]


Ho LS*, Gittelsohn J, Sharma S, Cao X, Treuth M, Rimal R, Harris SB (2008). “Food related behavior, physical activity, and dietary intake in First Nations – a population at high risk for diabetes,” Ethnicity and Health, Sep;13(4):335-49.


Kumar M, GittelsohnJ, HoLS*, RosecransA*, RimalR, HarrisSB, SharmaS, “Exposure to components of a diabetes risk behavior prevention program associated with improvements in psychosocial and dietary factors and body mass index,” (Manuscript submitted to Health Promotion International, March 2008).

Ho LS, Gittelsohn J, Rosecrans A, Sharma S, McGinnis M and Harris S.  “Understanding variability in participation: Context and stakeholder roles in a First Nations diabetes prevention program” (under review Social Science and Medicine).

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