The contemporary American Indian diet is high in refined carbohydrates, fat, and sodium and low in fruits and vegetables. Proliferation of fast food restaurants and convenience stores on or near reservations encourages consumption of high-fat, high-sugar foods and, coupled with poverty in Indian populations, limits access to a healthy food supply. Research shows that if community members eat fresh, healthful foods, diet-related diseases such as type-2 diabetes, heart disease, and obesity will be reduced. Access to foods is complicated by the geographic isolation of many reservations. Long distances to adequately stocked stores and lack of public transportation often mean that reservation residents have poor access to sources of high-quality food. Small, reservation-based stores frequently do not stock a full range of food, instead providing snack and convenience foods. Healthier low-calorie, nutrient-dense foods are usually among the more expensive items in small grocery stores on Indian reservations. Tribal governments can impact local food environments by undertaking initiatives that increase community access to healthy foods. One of the first steps to policy and food environment change is to conduct community assessments that can provide information on methods to best support healthy food strategies within the existing food systems and environments.
The study used quantitative and qualitative instrument tools to assess community needs and perceptions of food resources and the food environment in three small grocery stores on or near the Rocky Boy Reservation located in north central Montana. The project assessed tribal member ideas for culturally-specific and community-based strategies for increasing purchases and use of healthier foods in the local grocery stores. Qualitative interviews were conducted with tribal government and health officials to determine the likelihood of adopting a local tribal policy that increases the availability of healthy foods in the local grocery stores and supports consumer demand for these food items. The data were collected over a 10-month period, November 2006 through August 2007. All surveys, interview questions, and food-item measurement tools were approved by the University of Montana Institutional Review Board.
A convenience sample of 300 people that shopped at the reservation convenience stores completed a 69-item self-administered survey that assessed their shopping habits, ideas for strategies to improve local grocery store environments, barriers to accessing healthy foods, ideas about food assistance programs, and traditional food systems that exist in the community. Most (89 percent) of the survey respondents participated in an additional survey that was administered by the on-site project staff that asked 29 additional questions assessing customer interest in having specific, healthy foods at the local grocery stores.
Demographic data showed that 96 percent of the respondents were American Indian/Alaskan Native ethnicity (94 percent were Chippewa-Cree tribal members). Sixty-one percent of the respondents reported an annual income of less than $20,000 per year, 25 percent earned $20-$40,000 per year, and 14 percent earned more than $40,000 per year. The 69-item survey data found the main reasons for shopping at reservation stores were convenience (66.4 percent) compared with food selection (15 percent) or price (0.5 percent). The respondents rated the quality, selection, and affordability of fresh fruits and vegetables at the stores as “good” (57.9, 47.2, and 51.4 percent, respectively) compared with a rating of “poor” (33.2, 47.7, and 42.1 percent respectively). A rating of “excellent” in all three categories was less than 8 percent.
Grocery shopper survey data showed that community members are highly reliant on grocery stores, food stamps, convenience stores, and the Food Distribution Program on Indian Reservations (Commodity) for food procurement. Trading/bartering, food coop, and school garden/farm scored the lowest for degree of reliance, but this may be because these food resources are almost nonexistent in this reservation community. Hunting/gathering scored moderately high for degree of reliance (46.7 percent having a very important degree of reliance and 34.1 percent having a somewhat important degree of reliance on this community food resource). Fresh fruits, fresh produce and vegetables, lean meats, dairy products, oranges, deer meat, tripe, seasonings, traditional foods, melons, and “healthy foods” scored highest for food items most difficult to obtain on the reservation. Survey data showed tribal government and council as the main agency/individual responsible for solving food problems in the community compared with Federal or State health agencies/staff, State Cooperative Extension and/or schools and universities, or religious groups.
Survey data rating resources and strategies for improving healthy food intake on the reservation reported the need for (1) tips on getting the most for one’s money at the grocery store, (2) information on nutrition and healthful eating and cooking, (3) explanations of eligibility criteria for government food assistance programs, (4) recipes and instructions for preparing traditional foods, (5) information in native language, and (6) in-store (point-of-purchase) information about the healthy and unhealthy foods offered. Data reporting ways to get young people interested in food traditions included: (1) teach youth at an early age, (2) have more school programs in this area, (3) take youth hunting, fishing, picking berries, and (4) conduct workshops and get young people’s families and community elders more involved.
Analysis of common themes and data from Tribal Council and Health Board member interviews showed 70 percent of the interviewees (n=7) supported endorsing a local food policy for purchase and consumption of healthy foods on the reservation. Less than half of those interviewed supported eliminating (banning) the sale of all sugared soda and candy in the stores. However, all the interviewees thought the method to decrease sales of these high-sugar foods was to provide more nutrition education, perhaps posted in stores and presented to the community at health fairs, about the harmful effects of consumption of these products.
A principal benefit of the study is that reservation community members identified the strategies that might increase healthy foods in local grocery stores. This approach increases the likelihood that community members will be more interested in the healthy foods information and feel some sense of ownership as many of these strategies are being implemented in the local stores during 2008. Some of these strategies include providing information at the store on nutrition and healthful eating and cooking, tips on getting the most for one’s money at the local grocery store, or providing tribal vouchers and/or community incentives for trying new healthy foods. Tribal council has agreed to continued participation in the study to develop a local food policy supporting the sale of healthy foods in these stores. A long-term goal of the project is to implement these strategies in subsequent years and translate these findings to other American Indian reservations interested in improving local food environments, specifically reservation grocery store environments.
Direct inquiries about this study to the Project Contact listed above.