Recipient Organization
KEYA FOUNDATION INC, THE .
104 O'LEARY RANCH RD
TIMBER LAKE,SD 57656
Performing Department
(N/A)
Non Technical Summary
The proposed work addresses a pressing need in American Indian (AI) communities to develop and implement a program to increase fruit and vegetable consumption and promote optimal cardio-metabolic health for families with school-aged children. The premise of the proposed project was informed by our pilot work with the Cheyenne River Sioux tribe (CRST)--the 4th largest AI community in the USA--where food insecurity and accompanying poverty rates are exceedingly high. Previous work (from Missouri Breaks Industries Research and University of Washington)highlighted: (1) the exceedingly high burden of obesity and poor diet quality among community members who reside on the reservation; (2) food cost as a major barrier to eating healthy. Unfortunately, existing interventions that target the prevention and treatment of obesity and related chronic diseases in tribal communities like the CRST have largely focused on individual-level behavior change (e.g., physical activity, diet education), and have not addressed food cost and accessibility as contributors to poor diet quality.The proposed work will leverage collaborations of the CRST Indian Health Services, CRST Adult Diabetes Program, Keya Foundation, Missouri Breaks Industries Research Inc, University of Washington, and Lakota Thrifty Mart (i.e., the large tribally owned chain of grocery stores on the CRST) to develop and implement a targeted produce prescription program, integrating a culturally adapted version of the Cooking Matters program to increase knowledge of healthy eating and active living, for families who reside on CRST reservations (n=140). In particular, the proposed work will: (a) increase the number of shoppers who purchase qualifying produce at the tribally-owned grocery stores, (b) increase fruit and vegetable consumption, (c) lower household food insecurity, (d) increase knowledge of healthy cooking and active living, and (e) lower long-term healthcare use among participating families--goals that align with the overall objectives of the GusNIP initiative.Greater efforts are needed to address the major barriers to eating healthy in rural and underserved populations. The Keya Foundation Produce Prescription Program Serving the Cheyenne River Tribe (KFPPP) will serve as an important resource to reduce the challenges associated with eating healthy foods for low-income AI families who reside on the reservation.
Animal Health Component
(N/A)
Research Effort Categories
Basic
100%
Applied
(N/A)
Developmental
(N/A)
Goals / Objectives
The overarching goal of the proposed project is to improve affordability and access to program approved produce on the CRST reservation for families participating in KFPPP.Goal 1: Increase the number of shoppers who purchase fresh fruits and vegetables at the large tribally run grocery stores on the reservation (i.e., four LTM stores).Goal 2. Increase fruit and vegetable consumption among participating families. In addition to the prescriptions, families will engage with nutrition education materials created as part of a culturally adapted Cooking Matters Program designed to improve diet quality by increasing healthy food knowledge, budgeting, purchasing, and cooking skills for AIs (12).Goal 3. Reduce individual and household food insecurity of 140 CRST participants.Goal 4. Reduction of healthcare use and the associated costs among CRST participants.
Project Methods
Methods:IHS and the CRST Adult Diabetes Program will pre-screen potential participants, most likely the head of the household, to ensure they meet program requirements. Once they determine eligibility, they will refer participants to Ms. Granados, Project Director of KFPPP. She will then verify that the family meets the criteria. Once verified, the family will be enrolled into the program.If deemed eligible, families will fill our brief questionnaires and medical release form. At that time, they will be assigned a study number and a binder with all Cooking Matters materials. The materials include links for online cooking videos for fruits and vegetables available locally, as well as a large body of simple recipes for breakfast, lunch, and snacks that can be prepared in under 30 minutes. Each month, participants will receive additional paper materials and links to videos that features a different theme, such as "eating fresh fruits and vegetables on the go" and "traditional foods with fruits and vegetables?".Each family with receive five $20 vouchers each month to spend on fresh produce for 15 months. Each voucher will include the contact name of the designated head of household and a family identification number. At the end of each month, each LTM will turn in the vouchers to Ms. Tammy Granados who will then reimburse the store. Because the name of the head of household and the family identification number will be included on each voucher, she will be able to monitor the use of the vouchers by each family member.The primary goals of the program are to (1) increase sale of qualifying produce; (2) increase fruit/vegetable consumption; (3) decrease food insecurity; (4) increase healthy food knowledge; (5) lower long-term healthcare usage. All of these outcomes are measurable--either through questionnaires or ascertained in medical records. For (1) above, we will work with LTM management to document changes in stocking and sales of key items, including fresh fruits and vegetables throughout the program. We will use pre-post testing to document change in availability and sales of fresh fruit and vegetables in year 1. For (2), we will use a fruit and vegetable screener to assess change in consumption patterns pre-post. For (3), pre-post testing using USDA Food Security Screener (10 item version); for (4), we will utilize a healthy food knowledge questionnaire that was developed for an on-going intervention in the community that is intended to assess change in knowledge and efficacy around eating healthy foods. For (5), we will track changes in key outcomes through IHS records over 3 years. As the intent of this program is to improve cardio-metabolic health, we anticipate a decrease in BMI, blood sugar, and total cholesterol. Changes in these health metrics will likely be sensitive to program adherence (as well as other changes external to the program, such as any changes in medication use, other changes in lifestyle, such as increased physical activity, etc). Clinically meaningful changes will vary across participants based on underlying health status. However, using Healthy People 2030 and the American Heart Association Life's Simple 7 as guide, across all participants, we anticipate a 2.6% decrease in the percentage of study participants with obesity (i.e., BMI>30), hyperlipidemia (i.e., SBP>=140 mmHg or DBP>=90 mmHg), hypercholesterolemia (i.e., total cholesterol>=240 mg/dL) and poorly controlled blood sugar (HbA1c>8% for participants with diabetes).