Implementation of the Navajo fruit and vegetable prescription programme to improve access to healthy foods in a rural food desert

Sundberg, Michael A; Warren, Abigail C.; VanWassenhove-Paetzold, Joan; George, Carmen; Carroll, Danya; Becenti, Leandra Jewel; Martínez, A. López; Jones, Burrell; Bachman-Carter, Karen; Begay, Mae Gilene; Wilmot, Taylor; Sandoval-Soland, Henrietta; MacKenzie, Onagh W.; Hamilton, Lindsey R.; Tsosie, Memarie; Bradburn, Caitlyn K.; Ellis, Emilie; Malone, Jamy; Pon, Julia; Fitch, Ashley; Selig, Sara; Gall, Gail; Shin, Sonya

doi:10.1017/s1368980019005068

Cited by 14 publications

(29 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These findings suggest further opportunities for additional health promotion in the Navajo Nation food store environments. Research has already documented that the store managers are interested in providing healthier options [12], and interventions such as placing produce at the point-of-sale, providing culturally appropriate promotional materials, staff training on produce handling and reimbursement for fruit and vegetable vouchers for high-risk families merit further exploration [36][37][38].…”

Section: Discussionmentioning

confidence: 99%

Changes in food pricing and availability on the Navajo Nation following a 2% tax on unhealthy foods: The Healthy Diné Nation Act of 2014

et al. 2021

Self Cite

View full text Add to dashboard Cite

Introduction In 2014, the Navajo Nation Healthy Diné Nation Act (HDNA) was passed, combining a 2% tax on foods of ‘minimal-to-no-nutritional value’ and waiver of 5% sales tax on healthy foods, the first-ever such tax in the U.S. and globally among a sovereign tribal nation. The aim of this study was to measure changes in pricing and food availability in stores on the Navajo Nation following the implementation of the HDNA. Methods Store observations were conducted in 2013 and 2019 using the Nutrition Environment Measurement Survey-Stores (NEMS-S) adapted for the Navajo Nation. Observations included store location, type, whether healthy foods or HDNA were promoted, and availability and pricing of fresh fruits and vegetables, canned items, beverages, water, snacks and traditional foods. Differences between 2013 and 2019 and by store type and location were tested. Results The matched sample included 71 stores (51 in the Navajo Nation and 20 in border towns). In 2019, fresh produce was available in the majority of Navajo stores, with 71% selling at least 3 types of fruit and 65% selling at least 3 types of vegetables. Compared with border town convenience stores, Navajo convenience stores had greater availability of fresh vegetables and comparable availability of fresh fruit in 2019. The average cost per item of fresh fruit decreased by 13% in Navajo stores (from $0.88 to $0.76) and increased in border stores (from $0.63 to $0.73), resulting in comparable prices in Navajo and border stores in 2019. While more Navajo stores offered mutton, blue corn and wild plants in 2019 compared to 2013, these changes were not statistically significant. Discussion The findings suggest modest improvements in the Navajo store environment and high availability of fruits and vegetables. Navajo stores play an important role in the local food system and provide access to local, healthy foods for individuals living in this rural, tribal community.

show abstract

Section: Discussionmentioning

confidence: 99%

Changes in food pricing and availability on the Navajo Nation following a 2% tax on unhealthy foods: The Healthy Diné Nation Act of 2014

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…For example, in the Navajo Nation, 57% of residents in the Community Outreach and Patient Empowerment Program study stated they did not consume enough fruits and vegetables. Of these individuals, 61% cited expense as a reason, and over 51% reported needing to travel over an hour to obtain most of their food (which may have discouraged the purchase of fresh, perishable items) [ 110 ]. Similarly, a study in rural North Carolina found that rural Black older adults had a better Total Health Eating Index-2005 score compared to their White and American Indian counterparts, but the groups varied in their consumption of different types of healthy foods.…”

Section: Rural and Racial/ethnic Disparities In Cancer Across The mentioning

confidence: 99%

The Intersection of Rural Residence and Minority Race/Ethnicity in Cancer Disparities in the United States

Zahnd

Murphy

Knoll

et al. 2021

IJERPH

View full text Add to dashboard Cite

One in every twenty-five persons in America is a racial/ethnic minority who lives in a rural area. Our objective was to summarize how racism and, subsequently, the social determinants of health disproportionately affect rural racial/ethnic minority populations, provide a review of the cancer disparities experienced by rural racial/ethnic minority groups, and recommend policy, research, and intervention approaches to reduce these disparities. We found that rural Black and American Indian/Alaska Native populations experience greater poverty and lack of access to care, which expose them to greater risk of developing cancer and experiencing poorer cancer outcomes in treatment and ultimately survival. There is a critical need for additional research to understand the disparities experienced by all rural racial/ethnic minority populations. We propose that policies aim to increase access to care and healthcare resources for these communities. Further, that observational and interventional research should more effectively address the intersections of rurality and race/ethnicity through reduced structural and interpersonal biases in cancer care, increased data access, more research on newer cancer screening and treatment modalities, and continued intervention and implementation research to understand how evidence-based practices can most effectively reduce disparities among these populations.

show abstract

“…Clinic-affiliated food pharmacy programs are shown in Table 2 . These programs commonly partner with farmers’ markets [ 34 , 35 , 44 , 53 , 54 ] as the source of produce, and some programs have partnered with other food retailers, such as grocery stores [ 33 ] and small markets [ 55 ]. The social reinforcement of physicians or other healthcare providers issuing fruit and vegetable prescriptions enhances participants’ motivation to increase consumption of fruits and vegetables [ 33 ].…”

Section: Review Of the Necessity Utilization And Future Of Food Pharmacymentioning

confidence: 99%

The food pharmacy: Theory, implementation, and opportunities

Donohue¹,

Severson

Martin

2021

American Journal of Preventive Cardiology

View full text Add to dashboard Cite

The food pharmacy is an emerging program model designed to increase the access to and consumption of healthful foods, particularly fruits and vegetables. Existing research on the efficacy of the food pharmacy model shows that these programs have been effective in improving patient understanding of nutrition and removing barriers to healthy eating, and in turn may have a significant impact on diet-related health outcomes. However, efforts to date aiming to evaluate program effectiveness have been small and lack rigorous research methods. More research is needed to adequately assess the longitudinal effects of food pharmacy programs on healthful food intake and diet-related health outcomes. In this review, we outline the strengths and limitations of previous programs and explore possible options to improve the scalability and sustainability of food pharmacy programs.

show abstract

Implementation of the Navajo fruit and vegetable prescription programme to improve access to healthy foods in a rural food desert

Cited by 14 publications

References 31 publications

Changes in food pricing and availability on the Navajo Nation following a 2% tax on unhealthy foods: The Healthy Diné Nation Act of 2014

Changes in food pricing and availability on the Navajo Nation following a 2% tax on unhealthy foods: The Healthy Diné Nation Act of 2014

The Intersection of Rural Residence and Minority Race/Ethnicity in Cancer Disparities in the United States

The food pharmacy: Theory, implementation, and opportunities

Contact Info

Product

Resources

About