Food Perceptions and Dietary Behavior of American-Indian Children, Their Caregivers, and Educators: Formative Assessment Findings from Pathways

Abstract

Dietary findings from a school-based obesity prevention project (Pathways) are reported for children from six different American-Indian nations. A formative assessment was undertaken with teachers, caregivers, and children from nine schools to design a culturally appropriate intervention, including classroom curriculum, food service, physical education, and family components. This assessment employed a combination of qualitative and quantitative methods (including direct observations, paired-child in-depth interviews, focus groups with child caregivers and teachers, and semistructured interviews with caregivers and foodservice personnel) to query local perceptions and beliefs about foods commonly eaten and risk behaviors associated with childhood obesity at home, at school, and in the community. An abundance of high-fat, high-sugar foods was detected in children's diets described by caregivers, school food-service workers, and the children themselves. Although children and caregivers identified fruits and vegetables as healthy food choices, this knowledge does not appear to influence actual food choices. Frequent high-fat/highsugar food sales in the schools, high-fat entrees in school meals, the use of food rewards in the classroom, rules about finishing all of one's food, and limited family resources are some of the competing factors that need to be addressed in the Pathways intervention.

Pre‐school staffs’ attitudes toward foods in relation to the pedagogic meal

“…Our results parallel those from recent studies in the US conducted by Gittelsohn et al 20 and Hertzler et al 21 Gittelsohn et al found that the three most commonly reported food rules practised by 24 interviewed teachers were: (i) to encourage children to finish their foods during the school meal, (ii) to wash hands, and (iii) to taste all foods. Hertzler et al found that children's food problems, according to the staff, were that they liked fast food and did not taste new foods.…”

Healthy food intentions and higher socioeconomic status are associated with healthier food choices in an Inuit population

“…The present study provides data that were not previously available with respect to the associations between psychosocial dietary factors and their potential impact on dietary behaviours amongst Inuit. Acquisition of unhealthy foods was on average more frequent than the acquisition of healthier alternatives, including traditional foods, and preparation methods that added fat were used most often, which were also found in studies of other Aboriginal North American populations (Gittelsohn et al. , 2000, 2006; Archer et al.…”

Barriers and facilitators to following the Dietary Guidelines for Americans reported by rural, Northern Plains American-Indian children

“…Rural residency alone presents a unique set of barriers to healthy eating including high cost, long commutes and poor quality of fresh foods ( 41 ) . Formative research for Pathways, a large, multi-site obesity prevention initiative in tribal communities, found that caregivers of schoolchildren reported driving considerable distances to shop at grocery or discount stores to acquire food for the family, due to reported poor availability of fresh fruits, vegetables and low-fat dairy at local reservation stores ( 31 ) . In a recent study conducted in another rural Northern Plains reservation, 40 % of households reported low food security ( 47 ) , reinforcing the need for environmental interventions to increase affordable nutrient-rich food choices on or near the reservation as well as individual-level dietary interventions.…”

“…As this method has successfully been used with children, adults and other AI tribal communities, it is considered well suited to identify and prioritize salient barriers and facilitators to DGA adherence faced by both children and adults (36)(37)(38) . Most individuals have a personal conceptualization of a 'healthy diet' (31,(39)(40)(41) . However, the low rates of DGA adherence indicate that most are unaware of the specifics of the DGA.…”

“…Regardless, the majority of Americans do not comply with the guidelines, particularly minority and low-income groups ( 26 , 27 ) . Information about the food intake of AI children is sparse and generally pertains to pre-school children ( 28 ) , but reports are largely consistent: inadequate intakes of fruit and vegetables ( 29 ) , whole grains and low-fat dairy ( 30 , 31 ) . Dietary interventions may be most effective when tailored to specific race and ethnic groups; therefore we undertook the present study to provide valuable information for designing dietary interventions in this reservation community.…”