Date of Defense:
April 20, 2018
Healthy eating behavior among school-age children is an important area of research. Prior work has tested how interventions regarding healthy eating behavior and nutrition affect school-age children, how American Indian children respond to surveys about knowledge, attitudes, and behavior, and on healthy eating practices from urban Native communities (Fila & Smith, 2006; Stevens et. al, 2009; Lakshman et. al, 2010). Healthy eating habits established in childhood can help prevent chronic health disorders later in life (Lakshman, 2010). This is especially important in Native communities, where diabetes was prevalent among 15.1% of American Indian/Alaska Native adults in 2015 (CDC, 2017). American Indian youth have also shown a higher prevalence of obesity than their non-native counterparts (Fila & Smith, 2006; Anderson & Whitaker, 2009). These instances of childhood obesity are well-documented, yet there is not much research into dietary habits of Native American youth or of nutrition education interventions among Native American youth (Fila & Smith, 2006). Establishing nutrition focused education for school-age children allows healthy eating skills, behaviors, and positive nutritional influences to help children form lifelong habits (Powers et. al, 2005; Lakshman, 2010).
During my field experience, I taught native cooking and nutrition education classes for the Department of Indian Work to children enrolled in the American Indian Youth Enrichment (AIYE) program. Objectives of this field experience included working with diverse populations, assisting in data collection and analysis, and understanding the role local and community organizations have in improving health.
The primary objective for DIW was to measure the difference in “Youth Healthy Eating Behavior Survey” scores before and after attending weekly cooking and nutrition classes. The intervention occurred as a series of five cooking classes. During class, the children created foods using indigenous and native foods, learned cooking skills, and participated in four nutrition education activities. These activities focused on healthy foods, proper serving sizes and healthy eating habits. The participants made foods focused on five indigenous staple foods: beans, corn, berries, squash and wild rice. Though the activities and surveys were modified for this session, the format and scope of the intervention was consistent with prior years of the program.
On the first and last day of classes, participants were given the pre-survey (N=43) and post-survey (N=41). A classroom supervisor read the questions aloud and the children circled their answers. Staff in the classroom also responded to any other questions the children had. Surveys were analyzed to determine if there were changes in “Youth Healthy Eating Behavior Survey” scores (N=34). The average pre-test, post-test, and difference in scores were calculated. A graph was generated showing the pre-test and post-test score for each student. To determine the significance of the data, various statistical analyses, including a t-test, were performed using R.
The Department of Indian Work (DIW) is a program within the non-profit organization, Interfaith Action of Greater Saint Paul. Interfaith Action provides opportunities for Saint Paul residents through various connections to community partners, like the American Indian Magnet School. DIW works to empower American Indians towards self-determination while respecting cultural and spiritual diversity. AIYE is a summer program offered by DIW. It provides indigenous cultural activities for Saint Paul youth enrolled in 1st-6th grade. Youth learn from indigenous leaders, increase awareness of their cultural heritage and history, and engage in culturally-relevant educational support.
Results and trends in the data indicate that “Youth Healthy Eating Behavior Survey” scores increased from the pre-test to the post-test. The average score on the pre-test was 32.76471 points. The average score on the post-test was 37.79412 points, an increase in score of 5.02941 points. A general trend indicated that female participants had higher pre-score and post-score tests. Female participants scored an average 34.00000 on the pre-test, and 39.23077 on the post-test while males scored an average 32.00000 on the pre-test, and 36.90476 on the post-test. Both males and females showed an increase in scores.=
Of the 34 children that participated in both the pre-test and post-test, 29 individuals showed an increase in survey scores after the intervention occurred. This indicates that 85.29% of program participants improved their “Youth Healthy Eating Behavior Survey” scores after the intervention. A paired t-test was performed at a significant level of a=0.05. The t-test was conducted to determine if pre-test scores were significantly different than post-test scores. There was a very significant difference between participants scores on the pre-test and the post-test (df=33, p-val=0.000008386).
I think the most important lesson for me from this experience was learning about and interacting with Native American culture. DIW helped me to be more aware about the challenges Native Americans currently face, as well as current and historical Native American diets and culture. As a public health professional, this will be helpful because I know I am able to interact with another culture while remaining respectful of a wide variety of people, perspectives, and experiences. Additionally, I was given the opportunity to engage with multiple facets of public health during this experience. This allowed me to understand and implement what I was learning in the classroom in a practical experience. I was able to work on lesson planning, teaching, budgeting using a grant, engaging with people of different ages and abilities, and creating, evaluating, and administering a survey. It was important for me to experience these things so that I have a better understanding of what my role in public health could be in the future. By working on so many different tasks and aspects of public health, I feel like I had the opportunity to learn so much about how I can work within a public health framework in the future.
Based on my experience, I have few recommendations for DIW and the future of this program. Implementing a school-year nutrition education program as part of AIYE may be more effective and widespread in its reach. Our program was once a week for five weeks. A more consistent and long term schedule may lead to sustainable change in healthy eating behaviors. Also, specific tailoring of class content to the age and experience of the children could improve lesson comprehension. A single survey was created for all the kids, and the same activities and foods were cooked with all classes. The same five staple food were taught each year, so prior years’ participants are not learning much new content. Having curriculum based on age could create a journey of nutrition education where the children learn more complex ideas as they age.
This field experience offered the opportunity to enter a new community and work to improve their knowledge of healthy eating behaviors though native cooking and nutrition education. Through data analysis, the intervention implemented by AIYE appeared to increase knowledge of healthy eating behaviors among American Indian youth. A wide variety of skills and tasks were utilized to help me understand my role in the larger public health context, and allowed me to use classroom lessons in a practical experience.
Anderson, S. E., & Whitaker, R. C. (2009). Prevalence of obesity among US preschool children in different racial and ethnic groups. Archives of pediatrics & adolescent medicine, 163(4), 344-348.
Centers for Disease Control and Prevention. (2017). National diabetes statistics report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services.
Fila, Stefanie A., and Chery Smith. “Applying the theory of planned behavior to healthy eating behaviors in urban Native American youth.” International Journal of Behavioral Nutrition and Physical Activity 3.1 (2006): 11.
Lakshman, Rajalakshmi R., et al. “A novel school-based intervention to improve nutrition knowledge in children: cluster randomised controlled trial.” BMC Public Health 10.1 (2010): 123.
Stevens, June, et al. “Development of a questionnaire to assess knowledge, attitudes, and behaviors in American Indian children.” The American journal of clinical nutrition 69.4 (1999): 773s-781s.
Watkins, Lara L., and Jeffrey A. Anderson. “Report on Healthy Habits – CHILD Version.” Center for Adolescent and Family Studies, (2010). http://www.diiri.org/Portals/0/Uploads/Documents/Public/FSCS/HH_Child_1.11.pdf.