Background 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 non-profit launched the Navajo Fruit and Vegetable Prescription (FVRx) Program in 2015. Children up to six years of age and their caregivers are enrolled in the six-month 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. Objective We assessed the impact of a fruit and vegetable prescription program on the health outcomes and behaviors of participating children. Methods Caregivers completed voluntary surveys to assess food security, fruit and vegetable consumption, hours of sleep, minutes of physical activity; healthcare providers also measured children's body mass index (BMI) z-score at initiation and completion of the program. We calculated changes in health behaviors, body mass index, and food security at the end of the program, compared with baseline values. Results 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 % of children were retained in the program. Conclusions 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-based health centers (SBHC) have substantial potential to improve the recognition and treatment of adolescents' mental health problems. This study was undertaken as a quality improvement project to evaluate utility of the Pediatric Symptom Checklist when completed by youth (PSC-Y) among 383 adolescents seen at a SBHC, and the extent to which identification of psychosocial dysfunction and referral to mental health services improved academic functioning. Adolescents identified by the PSC-Y were significantly more likely to be insured by Medicaid, be a teen-age parent, and to have higher rates of absenteeism and tardiness in comparison to those not identified. Adolescents identified with the PSC-Y who were referred to mental health services significantly decreased their rates of absences and tardiness. Study results provide support for the utility of psychosocial screening and referral in the SBHC environment in facilitating recognition and treatment of adolescent mental health problems and improving student academic functioning.Psychosocial dysfunction, recognized 20 years ago as the "new morbidity" in pediatric practice, now represents the leading cause of disability in childhood and adolescence. 1,2 Epidemiological research estimates that 14%-20% of American children have one or more psychiatric disorders in the moderate to severe range. 3,5 Poor and minority children face an even greater risk. [6][7][8] Numerous studies have shown that untreated mental health problems can develop into more severe psychosocial impairment as children move into adolescence, placing them at risk for school drop-out and increased use of health care service. 9,10 The federal government, the Bureau of Maternal and Child Health, the American Academy of Pediatrics, and the American Medical Association all set standards for early identification and treatment of childhood and adolescent mental disorders. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptDespite the high prevalence of emotional and behavioral problems, and mandates from heath care and the federal government, only one-sixth to one-half of children and adolescents with psychosocial dysfunction are identified. Of these, only one-fifth receive mental health services. 2 Given these discouraging figures, at least some progress has been made with the development of screening questionnaires to increase identification of psychosocial dysfunction in children. The Pediatric Symptom Checklist (PSC) is a 35-item questionnaire designed to detect psychosocial problems in school-aged children. 11,12 Studies using the PSC in a broad range of pediatric settings and populations have shown that use of a brief, parent-completed screening measure greatly improves physician recognition of children's psychosocial problems. [13][14][15]

Objective:To utilise a community-based participatory approach in the design and implementation of an intervention targeting diet-related health problems on Navajo Nation.Design:A dual strategy approach of community needs/assets assessment and engagement of cross-sectorial partners in programme design with systematic cyclical feedback for programme modifications.Setting:Navajo Nation, USA.Participants:Navajo families with individuals meeting criteria for programme enrolment. Participant enrolment increased with iterative cycles.Results:The Navajo Fruit and Vegetable Prescription (FVRx) Programme.Conclusions:A broad, community-driven and culturally relevant programme design has resulted in a programme able to maintain core programmatic principles, while also allowing for flexible adaptation to changing needs.

Background Despite increasing minority enrollment in nursing programs, student attrition remains a persistent problem. Purpose The purpose of this study was to describe the experiences of a diverse group of black alumni at a predominantly white institution in the United States. Method In this qualitative descriptive study, researchers conducted focus group interviews with 16 recent graduates of accelerated baccalaureate and direct-entry nurse practitioner programs. Results Four themes emerged as barriers to success: burden of exclusion and isolation, lack of diversity among students and faculty, struggling to find mentors, and cultural assumptions. Five themes captured the strategies alumni adopted to succeed: strength in numbers, helpful mentors, resilience, faith, and self-silencing. Conclusion Participants experienced challenges but successfully navigated the program until they graduated. The study findings lay the groundwork for the development of programs that foster success for all students.

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