Progress 06/01/07 to 05/31/12

Outputs
OUTPUTS: The long term aims of the Helping Ourselves to Health (HOTH) program were to enhance the understanding of obesity prevention among rural Alaska Native people. Specific objectives of this project included: evaluating the impact of introducing the Food Distribution Program on Indian Reservation (FDPIR) in rural Alaska Native villages (Objective 1); implementing and evaluating a culturally-relevant nutrition education intervention that promotes use of traditional Native foods (Objective 2) and increasing intake of fruits and vegetables (Objective 3). Partnerships were forged with the Alaska based FDPIR program staff from the conception of the HOTH grant process. The programs worked together closely to track monthly community involvement in the FDPIR program and to discuss strengths and struggles experienced with maintaining the program in Alaskas remote regions. At the beginning and end of this 5 year grant data was collected in the form of: food frequency questionnaires, 24 hour dietary recalls, BMI screenings, readiness to change assessment of fruit and vegetables consumption and traditional food consumption, socio economic status, and food security. The first set of data was gathered by HOTH staff in collaboration with the University of Alberta Nutrition Research Team. The University then worked closely with HOTH program staff to compile, interpret, and present the data in the most effective and appropriate way. Two peer reviewed journal articles stemming from the first round of data collection entitled, Assessing dietary intake of Yupik people of western Alaska, and Dietary patterns and nutritional adequacy among rural Yupik women in western Alaska, were recently approved through all tribes and formal review boards for publication. It is expected that they will be submitted to Public Health Nutrition and other relevant journals within the next few weeks for publication in 2013. (Objective 1) The second set of data collected in year five of the grant is now being compiled and analyzed by the University of Alberta Nutrition Research team. Through a subcontract with ANTHC the University will provide a minimum of six peer reviewed journal articles relating to data collected for the HOTH grant. The articles will cover everything from dietary changes, nutrient adequacy of diet, and socioeconomic status changes within the last five years. Data was also used to help develop educational materials for the participating communities. Six colorful and culturally appropriate one-page front and back handouts were developed based on foods currently consumed by community members that feature healthier food substitutes also available in communities. These handouts also promote traditional foods and use basic messaging to educate about how to make healthier food choices such as, choose breads with 100% whole wheat for more fiber. Focus groups were conducted in participating villages over years two and three of the HOTH grant.. Community members identified healthy recipes, hands-on demonstrations, and videos as their preferred means of receiving nutrition education. PARTICIPANTS: Nothing significant to report during this reporting period. TARGET AUDIENCES: Nothing significant to report during this reporting period. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.

Impacts
Because of focus group data, HOTH program staff sought to meet these requests with an intervention that blended two popular ANTHC programs together, the FDPIR program and Traditional Foods Contemporary Chef (TFCC). TFCC is a, webisode, (web-based video) series highlighting Alaska Native foods available in the diverse regions of our state. To date over twenty webisodes ranging in length from 4-6 minutes have been created in six different regions of Alaska. The webisodes are being distributed at no cost throughout the Alaska Native Tribal Health System and countless venues across the state including mass distribution on YouTube, Facebook and other forms of social media. The mission of this innovative project is to promote the health benefits, awareness, and accessibility of Alaska Native foods. Alaska Native Chef Rob Kinneen and a camera crew traveled with HOTH staff to the control villages (Alakanuk and Stebbins) and let the community lead us in cultural hunting, gathering and a community event with the video camera rolling. HOTH staff brought fruits and vegetables and giveaways to the communities to be shared at each community potlatch event. (Objective 3) The product of this intervention included four, 5-6 minute long webisodes that included: the hunting and gathering of traditional foods in the Southwest Region of Alaska, live chef interactions with the community members and audience preparing recipes which highlight FDPIR foods and Native foods, cultural stories, language, and dance. The webisodes have been shared back with the communities in various ways. A movie premiere was held in each community in which fruit, vegetables, traditional foods, giveaways, and TFCC DVDs were shared and the community gave live input as they viewed the shows. (Objective 3) We have received formal as well as anecdotal feedback on how they are being received in the HOTH communities. Formal data shows us that of the twenty webisodes produced to date, the Seal Posole filmed in Alakanuk Alaska is the most popular with over 1000 hits on our You Tube channel. Commenting on the Store Outside Your Door Facebook page indicates communities trying and liking the recipes. The popularity of the intervention continues as the TFCC program has received many requests to film again in the Southwestern Alaskan area as well as the demand for hard copies DVDs continues to stay high. (Objective 2) Sustainability. Currently the HOTH program is in final stages of data analysis and a new sustainable nutrition education program within ANTHC has emerged from HOTH concepts in traditional food promotion called the Store Outside Your Door (SOYD). This program seeks to highlight foods which one can hunt, fish, gather, or grow within the unique regions of Alaska. Whereas many have embraced the concept that much of Alaska can be considered a, food desert, this program devalues that statement by highlighting those foods which can be harvested from the, store outside your door.

Publications

• No publications reported this period

Progress 06/01/08 to 05/31/09

Outputs
OUTPUTS: Developed a scientific advisory group consisting of Jean Anliker (University of Massachusetts), Joel Gittelsohn (Johns Hopkins University) and Sangita Sharma (University of North Carolina Nutrition Research Institute); and held a two day conference in Anchorage to get their input on the project, and to introduce them to our local advisory committee as well as our upper management and board members. In collaboration with Dr S Sharma at the University of North Carolina, developed a food frequency questionnaire (FFQ) specific to this region, including traditional foods particular to the region, relevant store foods, and FDPIR foods. Held training in Anchorage on use of the FFQ. Traveled to six villages over the course of six weeks and administered survey to 162 Alaska Native adults who are the main cook and food shopper in the household. Also collected information on knowledge, attitudes and beliefs related to fruits, vegetables and traditional foods; information on food security; information on household FDPIR and Food stamp usage; and BMI. Collected detailed store information on availability and price of store foods available in each village. Concurrently collected 131- 24 hour recalls to validate the FFQ. Contributed to book on Traditional Diet which has been widely distributed in the state and outside of the state, particularly to Alaska Native cancer survivors. Assisted with the development of a short recipe book called Nellie's cookbook which contains nutrient information and recipes for traditional dishes as well as dishes which are a mix of traditional and store bought foods including trapline beans, fish pie and agutuk (Eskimo ice cream). PARTICIPANTS: Jennifer Johnson MPH, RD (Project Director); Margaret Hoffman, Athabascan,(Research Associate, 10/2007-8/2008); Uyuriakaraq Ulran, Yup'ik (Research Associate, 9/2008-12/2008); Elvin Asey MS, (Programmer/Analyst); Dr Elizabeth Nobmann (consultant); Dr Sangita Sharma (collaborator); Erin Mead, MPH (collaborator) TARGET AUDIENCES: Residents of six rural villages in western Alaska, in the Yukon-Kuskokwim Delta and the Norton Sound regions of Alaska. The people are primarily Yup'ik and reside in geographically isolated villages accessible only be boat, plane or snow machine in winter. These villages have between 201 and 721 residents and one or two small stores per community. Villages in transition from a traditional subsistence based lifestyle and diet to a blended subsistence and cash economy. This transition is occurring rapidly. The Food Distribution Program for Indian Reservations has recently been introduced to Alaska, and now comprises a new source of food in some of these villages. This project particularly targets the adult in the household who is the primary food preparer and food shopper. PROJECT MODIFICATIONS: We subcontracted with Dr Sangita Sharma of the University of North Carolina for assistance with methodology, accurate data collection, analysis of data, and development of intervention. We eliminated our .5 FTE Nutrition project specialist. Anne Lanier, MD, our senior medical researcher, was not replaced by ANTHC with a similar medical researcher, and will be replaced on this project by Dr Sharma.

Impacts
Increased documented knowledge on consumption of traditional foods, store foods, and FDPIR foods in six villages in western Alaska; increased documentation on store food availability and price in rural Western Alaska villages. Project was presented at the 2008 Native Health Research Conference held by the Indian Health Service in Portland, Oregon. This meeting reaches Alaska Native and American Indian people as well as researchers from around the US. Project was chosen as the Alaska representative at the Center for Disease Control "Community Approaches to Preventing Obesity" meeting and on going group. We wrote an article describing the project for the Mukluk Telegraph, a publication of Alaska Native Tribal Health Consortium, which is distributed widely through out the state of Alaska, particularly through hospitals, clinics, and tribal councils. We targeted this issue of the Telegraph for placement of the article because it was also distributed at the Alaska Federation of Natives meeting, which brings together Alaska Native people from through out the state. During our visit to the village of Stebbins, they requested that we write an article about the project which they published in their local newspaper, the North Wind News. Poster on project was displayed at the Alaska Area Diabetes Conference, which reaches an audience of primarily village health aides as well as other rural health providers interested in preventing obesity and diabetes. The project was also presented at the Alaska Health Summit 2008, a meeting geared at public health professionals in the state.

Publications

• Development of a Food Frequency Questionnaire to measure dietary intake in an Alaska Native population in Western Alaska. Johnson JS, Asey E, Cao X, Mead E, Sharma, S. Abstract: Internat. Congress on Circumpolar Health, Yellowknife, Canada 2009.
• Helping ourselves to Health: addressing factors that contribute to obesity among Alaska Native people. Johnson JS, Nobmann EB, Asey E, Hoffman M. Abstract. 2009 Alaska Native Health Research Conference, Anchorage, AK.
• Nellie's Recipes: An Alaska Native Traditional Food Cookbook for Assisted Living Homes, Anchorage, Alaska Native Tribal Health Consortium, 2008.
• Traditional Food Guide for Alaska Native Cancer Survivors. 142 pp, Nutrition: Johnson, JS, Nobmann ED, Hoyt S. Anchorage, Alaska Native Tribal Health Consortium, 2008

Progress 06/01/07 to 05/31/08

Outputs
OUTPUTS: Achieved written resolutions with six village Tribal councils to participate in study, as well as with one Alaska Native health corporation, to participate in this study which will attempt to discern factors that contribute to obesity. Presentations of the project were made to each Tribal council. Trained Alaska Native researcher to conduct dietary surveys. Also trained village based workers in research methodology. Traveled again to the villages and began collecting baseline consumption data using diet survey in six villages, as well as collecting baseline BMI data. Targeted the household member who is the main cook and grocery shopper. Also asked about traditional foods and traditional food related activities. In these villages, people eat a blend of foods from the store and traditional foods on a regular basis. Have begun assembling food cost and availability information for each of the stores in each of the villages using the EFNEP Food Cost Survey and the Nutrition Environment Measurement Survey (NEMS). Villages have one or more very small stores. Began tracking the implementation of the pilot Food Distribution Program for Indian Reservations in Alaska. Begin assembling Scientific Advisory Team of experts to assist with project design and evaluation. PARTICIPANTS: Jennifer Johnson, MPH RD; PD of Project; Desiree Simeon, Research Asst for project (5/2007-9/2007); Margaret Hoffman, Research Asst for project (10/2007-present); Elizabeth Nobmann, PhD,MPH, RD, EDN Consulting, Alaska Nutrition expert; Melissa Toffolon-Weiss, PhD; project evaluator; Elvin Asay, MS; computer programmer TARGET AUDIENCES: Target audiences will be residents of Alaskan villages in the Yukon-Kuskokwim Delta of southwestern Alaska. The people are primarily Yup'ik and reside in remote villages accessible only by boat, plane or snow machine in the winter. These villages have between 201 and 721 residents and one to three small stores per community. Villages are in transition from a traditional subsistence-based lifestyle and diet to a blended subsistence and cash economy. This fundamental change is occurring rapidly. This project particularly targets the adult in the household who is the primary cook and food preparer. PROJECT MODIFICATIONS: We have had two personnel changes. Rather than hiring a master's level Nutrition Project Specialist for .5 FTE, we hired a Nutrition Research Program Associate for 1 FTE. Our Nutrition Research Program Associate is a young Alaska Native researcher and educator who is increasing her training and experience in working with these communities. Our Senior Medical researcher, Anne P Lanier, MD, has stepped down from the position she held as Director of the Office of Alaska Native Health Research at the Alaska Native Tribal Health Consortium. Although she still advises the project as needed, we are awaiting the filling of her position by ANTHC.

Impacts
Have increased the new fundamental knowledge of current, usual diet intake of adults in six rural Western Alaska villages, including baseline fruit and vegetable and traditional food consumption. Have increased the documented information on the food cost, availability, and food environment of people living in traditional Western Alaska villages.

Publications

• No publications reported this period